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On agenda:
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9/2/2025
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Final action:
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9/2/2025
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Title:
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Approve an Amendment to the Contract with Navitus Health Solution, LLC, for RFP No. 604027-16, for Prescription Benefits Manager Services for Clark County's Self-Funded Prescription Drug Plan; and authorize the Chief Financial Officer or her designee to sign the Amendment; or take other action as appropriate. (Previous Amendments and original Contract are available for public viewing at the County Clerk's Office, Commission Division) (For possible action)
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CLARK COUNTY BOARD OF COMMISSIONERS
AGENDA ITEM
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Petitioner: |
Jessica Colvin, Chief Financial Officer Jessica Lyons, Director of Risk Management |
Recommendation:
title
Approve an Amendment to the Contract with Navitus Health Solution, LLC, for RFP No. 604027-16, for Prescription Benefits Manager Services for Clark County's Self-Funded Prescription Drug Plan; and authorize the Chief Financial Officer or her designee to sign the Amendment; or take other action as appropriate. (Previous Amendments and original Contract are available for public viewing at the County Clerk's Office, Commission Division) (For possible action)
body
FISCAL IMPACT:
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Fund #: |
6520 |
Fund Name: |
Self-Funded Group Insurance |
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Fund Center: |
1020520000 |
Funded PGM/Grant: |
N/A |
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Amount: |
$2,685,496 |
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Description: |
Prescription Benefits Manager Services for Clark County’s Self-Funded Prescription Drug Plan |
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Additional Comments: |
Amendment No. 7 will increase the Contract amount by $2,685,496, for a new total Contract amount of $16,330,113.97 should all renewal options be exercised. The total Contract amount is subject to change as it is based on a per member per month cost of all eligible employees and retirees enrolled in the Clark County Self-Funded Health Benefit Plan and the Clark County Self-Funded Exclusive Provider Organization (EPO) Plan. |
BACKGROUND:
On August 2, 2016, the Board of County Commissioners (Board) approved the award of RFP No. 604027-16 for Prescription Benefit Manager Services to Navitus Health Solutions, LLC in the amount of $4,939,310.77.
The following are the pertinent provisions of the Contract:
• The term of the Contract was from date of award through December 31, 2017, and included the option to renew for 6, one-year periods. There are no renewal options remaining.
• Included the County’s option to terminate for cause, convenience or default and suspend the Contract with advanced written notice.
Amendment No. 1 allowed for the addition of an appeals process for members.
Amendment No. 2 provided for the inclusion of Electronic Real Time Benefit Tools (RTBT) in compliance with the electronic real time tool standards put in place by the Centers for Medicare and Medicaid Services for 2021. This included a passthrough vendor transaction cost.
Amendment No. 3 added the Clark County Exclusive Provider Organization (EPO) Plan to the Contract as well as a $.40 per person per month Rebate administration fee.
Amendment No. 4 provided for the addition of the Copay Max Program for both plans and added 2 one-year renewal terms to the Contract for a total of 8 renewal terms through December 31, 2025.
Amendment No. 5 provided for additional reporting of the Consolidated Appropriations Act (CAA) RxDC report.
Amendment No. 6 provided for changes to current services and the implementation of the Medicare Prescription Payment Plan (M3P) Program.
Approval of Amendment No. 7 will add 3 one-year renewal terms to the Contract for a total of 11 renewal terms through December 31, 2028, revise the prescription pricing schedule and administrative fees and add the Access Guidance Services Addendum. The attached Amendment No. 7 document details the modifications and costs involved.
Navitus Health Solutions, LLC currently holds a Clark County Business License.
Contract Summary:
BCC Agenda Date / Agenda Item No. (# from
P.A. Checksheet meeting agenda if applicable) Description Amount(*)
Approval Date
8/2/2016 No. 6 Award $4,939,310.77
12/6/2016 No. 9 Amendment 1 No fiscal impact
3/2/2021 No. 7 Amendment 2 No fiscal impact
12/21/2021 No. 11 Amendment 3 $354,757.20
11/1/2022 No. 9 Amendment 4 $2,265,550
6/6/2023 No. 9 Amendment 5 No fiscal impact
10/3/2023 No. 12 Funding Increase $6,000,000
1/21/2025 No. 13 Amendment 6 $85,000
(*) Amounts reported reflect the maximum allowable and are inclusive of annual escalators.
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