#20-45-NS 7th Amendment (Pharmacy Benefit Management Services Agreement) SEVENTH AMENDMENT TO AGREEMENT#20-045-NS
FOR
Pharmacy Benefit Management Services Agreement
THIS SEVENTH AMENDMENT made and entered into on this (Effective
Date), by and between Navitus Health Solutions, LLC (the "Navitus" or "Contractor") and Collier
County, a political subdivision of the State of Florida,(the"County"),(collectively,the"Parties"):
WHEREAS,on June 23, 2020, (Agenda Item 11.C),the County entered into an Agreement with
Navitus to provide prescription medications to Members of the Collier County Group Health Plan through
a Pharmacy Benefit Management Program with an effective date of January 1, 2021;and
WHEREAS,on January 18,2022,the Parties entered into a First Amendment to the Agreement to
include Group Purchasing Organization Rebate program and to provide modifications to Articles IV, IX,
and Exhibit 1 of the Agreement to reflect that revision;and
WHEREAS,on March 24,2022,the Parties entered into a Second Amendment to the Agreement
to modify Exhibit 1 and add Exhibit 4 Copay Max Addendum;and
WHEREAS,on January 09, 2023, the Parties entered into a Third Amendment to the Agreement
to incorporate Exhibit 5, Consolidated Appropriations Act ("CAA") 2021 Rx Data Collection Reporting
Opt-Out/Opt-In Notice and to include additional CAA reporting services offered by the Contractor pursuant
to Exhibit 5, including additional fees of$5,000 per calendar year;and
WHEREAS, on December 20, 2023, the Parties entered into a Fourth Amendment to the
Agreement to add Navitus'access guidance services and associated fees with an effective date of January
1, 2024, by including a Third-Party Payor Processing Attestation section to Article XI, update Exhibit 1
Administrative Fees Schedule to add a new Access Guidance Service fee,attached as the Exhibit 4-1 Access
Guidance Services Addendum;and
WHEREAS, on July 24, 2024, the Parties entered into a Fifth Amendment to the Agreement to
modify the renewal term under Article XII, Exhibit 1 and Exhibit 2,to update the prescription pricing and
the administrative fee menu,which was anticipated to result in substantial cost savings to the County;and
WHEREAS,on December 26,2024,the Parties entered into a Sixth Amendment to the Agreement
to modify the renewal term under Article XII, Exhibit 1 and Exhibit 2, to update the prescription pricing
and the administrative fee menu,which was anticipated to result in substantial cost savings to the County;
and
WHEREAS,the Parties desire to further amend the Agreement to extend the renewal term under
Article XII,Exhibit 1,Exhibit 2,and add Exhibit 4 to accept participation in the Biosimilar Value Program,
which is anticipated to result in substantial cost savings to the County.
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NOW,THEREFORE,in consideration of the mutual promises and covenants herein contained, it
is agreed by the Parties as follows:
Words below struck through are deleted;Words underscored are added.
1. Article XII is amended as follows:
Section 12.01. Term of Agreement. This Agreement is effective as of the Effective Date above and will
continue in full force and effect through December 31, 2023, (the "Initial Term"). This Agreement will
continue again from January 1,2024,through December 31,2024(the"Second Renewal Term"),and again
from January 1, 2025,through December 31, 2025 (the"Third Renewal Term"),and again from January 1,
2026, through December 31, 2026 (the "Fourth Renewal Term"). Any additional Renewal Terms shall be
subject to termination rights as otherwise provided in this Agreement.
* * * * *
2. Exhibit 1,Administrative Services Fee Schedule, is amended as follows:
* * * * *
Client agrees to pay Navitus an administrative charge of$2,8-7$2.96 per Eligible Person per month during
the Third Fourth Renewal Term; provided that the monthly administrative fee will not be less than $9,372
(the "Minimum Monthly Administrative Fee"). In the event that Client's membership falls below 3,900
Members, or the scope of services provided hereunder materially change due to a Client request or
regulatory requirement,the administrative fee may be adjusted upon notice to the Client.The administrative
fee does not include fees for certain additional charges, described below.
To preserve the integrity of our transparent pricing model,the administrative fee includes the following
credits and fees as outlined below. If Client chooses not to receive such credits,the administrative fees
(a) Pharmacy Management Credit. An on going pharmacy management credit of$3.00 per Member
per year,based upon eligibility on the first month of each contract will be offered to Client. Funds
can be used to maximize the value of the Client's pharmacy program and is limited to the
Navitus any amounts used for that contract year, and such a refund is not considered termination
penalties.
In the event of termination of thi. ^greement, er decline in Client's member ,
or consulting fees that have not been recouped shall be the responsibility of the Client and billed back by
Navitus for reimbursement.Additionally, if Client membership decreases by 20% or the scope of services
is materially changed due to Client request or regulatory requirements, the administrative fee may be
adjusted.
* * * * *
3. Exhibit 2, Prescription Pricing Schedule, is hereby deleted in its entirety and replaced with
Exhibit 2 attached hereto this Seventh Amendment.
4. The attached Affidavit Regarding Labor and Services and Contracting is incorporated into and
made a part of the Agreement.
5. All other terms and conditions of this Agreement, which have not been expressly modified by
this Seventh Amendment,will remain in full force and effect.
IN WITNESS WHEREOF,the Parties have executed this Seventh Amendment by an authorized person
or agent on the date and year first written above.
ATTEST:
Crystal K. Kinzel, Clerk of the Circuit BOARD OF COUNTY COMMISSIONERS
Court and Comptroller COLLIER COUNTY, FLORIDA
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By: ,L 1Y, ByAeole/...,.,404014f4'-
-- , • �' Burt L. Saunders,Chairman
5Attest as to Chairman's
Dated: Cb" ',,.4-vi- signature only
(SEAL) v a
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CONTRACTOR:
Navitus Health Solutions,LLC
By: Cg.?-----0.1/.
Signature
Paul Page, Secretary
TType/print signature and titleT
Date
A r ed as o Fo n Legality:
L._-
cott R ach
Deputy County Attorney
1
Exhibit 2
PRESCRIPTION PRICING SCHEDULE
Section E2.01. General. Client acknowledges that the discount rates and dispensing fees set forth below are
guaranteed average discounts during the Fourth Renewal Term established for the pricing distribution channels
necessary to meet access requirements. Client acknowledges that 100% of the pricing will be passed through
to Client from the Participating Pharmacies.Navitus agrees to negotiate to achieve or exceed these guaranteed
average rates. Any discounts obtained by Navitus that exceed the guaranteed averages stated below will be
passed through to Client. It is acknowledged by both parties that individual contracts may vary from the
guaranteed average rate based upon negotiation.
Retail 30 Day pricing applies to a supply of Covered Products between 1 and 83 days. Retail 90 day pricing
applies to a supply of Covered Products for 84 or more days.
Section E2.02.Guarantees Rates and Rebates.Navitus will deliver the entire value of the proposed network
reimbursement terms and manufacturer Rebates, including all upside performance. In accordance with a full
Pass-Through model,the fmancial performance of AWP discounts and dispensing fees in one channel can be
used to offset a shortfall within that channel but such offsetting may not be used to offset performance between
channels;channels include:retail network,mail order,and specialty.Manufacturer Rebate guarantees stand on
their own and will be reconciled in aggregate across all channels. Should a shortfall occur after applying this
methodology, Navitus will cover dollar-for-dollar any shortfall to compensate Client for a missed fmancial
guarantee. All financial conditions outlined for each channel and Rebates under this Agreement must be met
for guarantees to apply.
(a) Network Rates. Navitus passes through all pharmacy discounts to Client. Navitus does not assess
network fees or any other forms of revenue from the pharmacies that participate in its network.Navitus
will pass through the amount paid to the Participating Pharmacy,which will be the same about that it
invoices Client. The network guarantees are representative reimbursement amounts(including AWP
discount and MAC) and dispensing fees. Under the Navitus transparent, full Pass-Through model,
Client pays the actual reimbursement rate (discounts and dispense fees) paid to the Participating
Pharmacy from which the Claim originates, less the Member Co-payment or Coinsurance. The
contracted discount for each Participating Pharmacy will vary,causing the actual reimbursement paid
to each Participating Pharmacy to be greater or less than the guarantees identified.Guarantees represent
the average performance of all Participating Pharmacies.
AWP and WAC pricing is reflective of the 11-digit National Drug Code(NDC)as of the date of service,
and as reported and verifiable by Medi-Span, a national pricing source. Unless it is otherwise
unavailable, in which case a mutually agreed upon nationally recognized alternative would be used,
Medi-Span is Navitus' only source of drug pricing data used for all Claims adjudication.
Navitus will manage the pharmacy credentialing and contracting process. Navitus will determine
which pharmacies are eligible to participate in the network and will negotiate all pharmacy pricing and
terms. Network participation will vary, and Navitus does not guarantee the number of Participating
Pharmacies.
For applicable guarantees to be in effect the following conditions apply:
(a) A minimum of 1,000 Claims per pricing component (retail generic discount, retail generic
dispensing fee,etc.)each annual reporting period.
(b) Use of the Navitus Formulary.Guarantees are subject to change in response to material formulary
and/or Plan design changes.
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(c) Mail guarantees are contingent upon the use of Costco Mail Order as the sole Mail Order provider.
Network discounts and dispensing fee guarantees exclude the following Claim types:
(a) Compound Claims
(b) Paper/member submitted/direct member reimbursement Claims
(c) Secondary payer(Coordination of Benefit)Claims
(d) Subrogation Claims
(e) Vaccine Claims
(f) Long-term care/assisted living facility Claims
(g) Home infusion Claims
(h) Non-specialty drugs filled through a Specialty Pharmacy
(i) Claims paid at state or federal government required amounts.
(j) Claims originated in Oklahoma and required to be reimbursed at WAC due to placement on
the FDA Drug Shortages Database,per Oklahoma Statue §59-360.
Network discounts and dispensing fee guarantees exclude the following provider types:
(a) Military/government pharmacies,
(b) Pharmacies deemed by Client as necessary to include in the network,but which do not meet
Navitus discount or credential standards,
(c) Pharmacies that hold a direct agreement with the Client.
Navitus reserves the right to equitable adjust guarantees in response to any of the following scenarios:
(a) More than 2.00% of Claims originate from Alabama, Arkansas, Colorado, Iowa, Indiana,
Kentucky, Louisiana, Montana, Tennessee designated Low Volume Pharmacies,
Massachusetts,West Virgina,Kentucky,Hawaii,Alaska,Puerto Rico,any U.S.Territory,or
rural pharmacies.
(b) Any future government rules or regulation that require pharmacy reimbursement minimums
or change in methodology.(previous examples include,T.C.A. § 56-7-3206,Ark.Code§23-
92-506,W.Va.Code §33-51-9)
Navicare National Broad Network: Network discounts and dispensing fee guarantees are based on
the continued use of Navicare National Broad Network. If Client chooses an alternative benefit,
Navitus reserves the right to update guarantees.
The specialty discount and dispensing fee guarantees are based on drug type(i.e.specialty versus non-
specialty). Specialty Drug Claims are included in the applicable specialty guarantees regardless of
dispensing pharmacy type. Guarantees are reconciled based on Navitus' specialty drug list. The
specialty guarantees are applicable if Lumicera Health Services,LLC("Lumicera"), is the exclusive,
mandatory Specialty Pharmacy provider.
For the specialty guarantees to be in effect,a 5%Generic dispensing rate(GDR)minimum is required
through Lumicera in the reporting period.The specialty guarantees are based on the historical Claims
data. If actual Claim volume and/or drug mix varies significantly from the historical data, Navitus
reserves the right to update the specialty guarantees accordingly._If drug mix changes and/or market
conditions, such as manufacturer drug pricing changes, prevent Navitus from meeting the specialty
guarantees, Navitus reserves the right to equitably adjust the guarantees to reflect the changes.
Offsetting cross the specialty guarantees is permitted.
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CivicaScript product Claims are reconciled to the guarantees based upon the AAWP(Average Average
Wholesale Price)as published by Medi-Span,rather than AWP.
The specialty guarantees exclude the following: (i) in-house/Client-owned/Client-affiliated
pharmacy Claims; (ii) direct contract pharmacy Claims; (iii) medical Specialty Drug Claims; (iv)
new to market Specialty Drug Claims;and(v)non-Specialty Drug Claims.
If the plan implements any alternative funding or other specialty Co-payment program that reduces
and/or changes the expected or actual utilization of specialty drug Claims filled through Lumicera,the
specialty guarantees will no longer be in effect. This does not apply to Navitus' Access Guidance
Services.
Lumicera's pricing model is a first-in first-out(FIFO)net acquisition cost,plus a patient management
fee, plus a shipping fee model [Lumicera's Total Cost = Lumicera's Acquisition Cost + Patient
Management Fee + Shipping Cost]. Lumicera does not use a tradition discount off AWP price
methodology for pricing of Specialty Pharmaceuticals but will report to Client the performance based
on discount off AWP [AWP Discount= 1—(Lumicera's Total Cost/Total AWP Cost)].
Reimbursement for each branded Covered Product, not requiring compounding, dispensed by a
Participating Pharmacy will be based upon the lower of: (1)AWP, less an average of the applicable
percentage in the below table, plus an average dispensing fee of the applicable dispensing fee in the
below table; (2) such pharmacy's Usual and Customary Price; or (3) the amount submitted by the
Participating Pharmacy.
Reimbursement for each Generic Covered Product dispensed by a Participating Pharmacy will be the
lower of:(1)the Navitus MAC plus a dispensing fee, if applicable;(2)each Participating Pharmacy's
respective contracted price for such Covered Product, including a discount plus a dispensing fee; (3)
such Participating Pharmacy's Usual and Customary Price;or(4)the amount submitted. The average
effective discount performance for Generic Covered Product is AWP minus the applicable percentage
in the below table,plus an average dispensing fee of the applicable dispensing fee in the below table.
Navicare National Plus Network Discount off of AWP Dispensing Fees
Guarantees Guarantees
Pharmacy Type Brand/ 2026 2026
Generic
Retail 30 Day Brands 18.85% $3.22
Retail 30 Day Generics 84.15% $1.52
Retail 90 Day Brands 21.00% $4.32
Retail 90 Day Generics 89.80% $1.28
Mail Service Brands 24.00% $0.00
Mail Service Generics 85.30% $0.00
Specialty-on average,for 19.20% $0.00
specialty products dispensed Brands
through Lumicera
Specialty- on average,for 52.00% $0.00
specialty products dispensed Generics
through Lumicera
(b) Rebates.Navitus guarantees during the Fourth Renewal Term Rebates per Brand Covered Product
will meet or exceed the following:
Per Brand Claim 2026
Retail $484
Retail 90 $929
Mail $728
Specialty $2,154
30-Day
Includes LDD
Formulary
Rebate guarantees are contingent upon Client's primary Claims and use of the Navitus Signature Select
Formulary inclusive of all Prior Authorization and utilization management criteria, with either a 2-tier
closed design or a 3-tier closed design. Rebate guarantees assume removal of Brand Stelara and 98%
conversion to the Ustekinumab biosimilar. If the Client does not adopt all Navitus standard utilization
management criteria and Prior Authorization criteria, Rebate guarantees may be adjusted upon notice to
Client. If applicable, any custom in-house specialty optimization programs may result in additional fees
and adjustments to Rebate guarantees.
Clinical Transitions/Grandfathering
Rebate guarantees apply after an implementation-grandfathering period, prior to Client's full use of the
Navitus Formulary. If additional clinical transitions affect rebate performance, Rebate calculation may
account for the impact on the guarantees.
Rebate-Per-Brand Claim Calculation
Navitus agrees to pass 100%of Rebates to the Plan.Rebate guarantees are calculated by multiplying total
eligible Brand Claims by the applicable guarantee for that dispensing channel.Total eligible Brand Claims
will exclude the following:
(a) Vaccines(including COVID-19 vaccines)
(b) Acute COVID-19 treatments(e.g., PaxlovidTM)and COVID-19 self-tests/kits
(c) Diabetic syringes and lancets
(d) Health care provider-administered products(medical benefit)
(e) Generically named Brand products
(f) Compounded medications or medication components used to compound
(g) Non-legend drugs designated as OTC,with the exception of diabetic test strips
(h) 340B
(i) Originator Brands with Generics available(Medi-Span "0"drugs)
(j) COB Claims
(k) Subrogation Claims
(1) Claims for Novolog®,Novolin®,insulin aspart,Levemir®,Humalog®,Humulin®,insulin lispro,
and Lantus®
(m)Long-Term Care pharmacies
(n) Non-standard pharmacies (e.g., hospital inpatient pharmacies, pharmacies with upfront Pharma
direct purchase contracts, Federal Supply Schedule FSS pharmacies)
Reconciliation
On an annual basis, Navitus will pay the greater of 100% of Rebates received or the minimum Rebate
guarantee measured in aggregate across all dispensing channels.
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Assumptions and Conditions
The retail channel assumes a 1- to 83-day supply; and for retail 90, an 84+ day supply. Specialty Rebate
guarantees are based on the day supply consistent with Client data. Rebate guarantees are contingent upon
Client utilization, maintaining 150 qualifying Brand Claims in any respective, stated channel (e.g., mail,
retail-90, specialty)or greater, per quarter.Rebate guarantees assume weight loss is excluded.
Market Event Assumptions
In the event of any of the following,Rebate metrics may be changed by Navitus upon notice to Client:
(a) A Plan design change or Formulary customization directed by Client that materially impacts the
economics of the Rebate arrangement
(b) A change in government legislation that materially impacts the economics of the rebating process
between pharmaceutical manufacturers and Navitus
(c) A product that is unexpectedly introduced to the market and has a material, adverse impact on the
Rebate arrangement
(d) Material changes to Rebate discount assumptions with manufacturers for Rebates of branded drugs
(e) A change in the Brand/Generic or product mix that materially impacts the number of available
branded and rebated products
(f) The average day supply of Claims or the number of Claims varies by at least 5 percent from the
data provided.
(g) Navitus reserves the right to revise Rebates metrics if lower-net-cost products become available or
if manufacturers materially modify their methodologies to pricing products.
(h) Shift in utilization as a result of a manufacturer shortage of a Formulary branded product.
(i) In the event of product discontinuations/list price changes due to market dynamics (ex-legislative
changes),and/or a biosimilar or Generic launch,Navitus reserves the right to utilize Rebate credits
to reconcile Rebate guarantees.
Specialty
Specialty Rebates are defined by the Specialty Pharmaceutical,regardless of channel used and are inclusive
of limited distribution drugs(LDD).All specialty will be reconciled combined.
If the services provided under Navitus' Specialty Drug Manufacturer Co-payment Assistance and access
guidance services adversely impact the amount of Rebates Client receives, Navitus will not be deemed to
have failed to meet applicable Rebate guarantees and will not be liable to Client for missed Rebate
guarantees to the extent such a shortfall is caused by the implementation of the programs. If, as a result of
Client's participation in these programs, Navitus is required to repay Rebates that Client has been paid
under the agreement,for any reason(including,without limitation,any conflicts between applicable Rebate
agreements and Client's participating in the program), Client shall promptly pay Navitus such amount to
fund the repayment of such Rebates as so required.
AFFIDAVIT REGARDING LABOR AND SERVICES
AND CONTRACTING WITH ENTITIES OF FOREIGN COUNTRIES OF CONCERN PROHIBITED
Effective July 1, 2024, pursuant to § 787.06(13), Florida Statutes, when a contract is executed, renewed,or extended between a
nongovernmental entity and a governmental entity, the nongovernmental entity must provide the governmental entity with an
affidavit signed by an officer or a representative of the nongovernmental entity under penalty of perjury attesting that the
nongovernmental entity does not use coercion for labor or services.
Effective January 1,2024,a governmental entity may not accept a bid on,a proposal for,or a reply to,or enter into,a contract with
an entity which would grant the entity access to an individual's personal identifying information unless the entity provides the
government with an affidavit signed by an officer or representative under penalty of per jury attesting that the entity does not meet
any of the following criteria: (a)the entity is owned by the government of a foreign country of concern; (b)the government of a
foreign country of concern has a controlling interest in the entity;or(c)the entity is organized under the laws of or has its principal
place of business in a foreign country of concern.
Effective July 1,2025,when an entity extends or renews a contract with a governmental entity which would grant the entity access
to an individual's personal identifying information,the entity must provide the governmental entity with an affidavit signed by an
officer or representative of the entity under penalty of perjury attesting that the entity does not meet any of the criteria in paragraphs
(2)(a)-(c),§ 287.138,Florida Statutes.
Nongovernmental Entity's Name: Navitus Health Solutions, LLC
Address: 361 Integrity Drive, Madison WI 53717
Phone Number: 877-571-7500
Authorized Representative's Name: Paul Page
Authorized Representative's Title: Secretary
Email Address: legal@navitus.com
I, Paul Page (Name of Authorized Representative), as authorized representative attest under
penalty of perjury that Navitus Health Solutions, LLC (Name of Nongovernmental Entity) does not: (1) use
coercion for labor or services as defined in § 787.06,Florida Statutes,and(2)the nongovernmental entity is not(a)owned by
a government of a foreign country of concern,(b)that a foreign country of concern does not have a controlling interest in the
entity, and (c) that the entity is not organized under the laws of or has its principal place of business in a foreign country of
concern,all as prohibited under§287.138,Florida Statutes.
Under penalty of perjury,I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
0ign-.)„,,est/L-1 - 09/22/2025
ature of authorize rep et'sentative) Date
STATE OF Wisconsin
COUNTY OF Dane
Sworn to(or affirmed)and subscribed before me by means ofill physical presence or❑online notarization this
22 day of September,20 25,byf)a l,{L pent, (Name of Affiant),
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Personally Known El OR Produced Identification DI 'IrE OF
Type of Identification Produced: