rxinsights - clovis unified school district€¦ · rxinsights ® this analysis is an ... 11 9 8...
Post on 17-Sep-2018
219 Views
Preview:
TRANSCRIPT
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
Prescription Benefit Review
CLOVIS UNIFIED SCHOOL DISTRICT
Jul 2014 - Jun 2015
RxInsights®
This analysis is an estimate for information purposes only. These estimates do not represent an existing or future contractual guarantee provided by CVS/caremark. This information may be subject to change and does not represent any specific offer by CVS/caremark of return on investment in the future. All data sharing complies with applicable privacy laws and is in accordance with our PBM agreements. The Maintenance Choice program is available to self-funded employer clients that are subject to ERISA. Non-ERISA plans such as insured health plans, plans for city, state or government employees, and church plans need CVS/caremark Legal's approval prior to offering the Maintenance Choice program. Prices may vary between mail service and CVS/pharmacy due to dispensing factors, such as applicable local or use taxes.
1
3
5
10
15
20
>20
CVS Health: A Purpose-Driven Company Helping People on Their Path to Better Health
• Expertise in serving more than 2,000+
clients, 63M+ members
• Innovative formulary and network solutions, including health-focused network
• “Mail at Retail” flexibility
• Digital innovation lab
• Face-to-face counseling at
7,700+ stores
• Home delivery*
• 90-day pricing for payor and lower copays for members
• Extensive consumer knowledge
• Expanding services and reach,
including telemedicine
• 970+ locations
• Affiliated with 50+
major health systems
• Health and wellness support
CVS/PHARMACY®
73.3%
5
of your members are within
mile(s) of
CVS/pharmacy
CVS/MINUTECLINICTM
CVS/CAREMARKTM PBM
• Range of cost management solutions
• High-touch clinical support and broad therapy offering for the treatment of complex chronic or genetic conditions
• Nurse part of core team
• Improved drug access through CVS/pharmacy locations**
CVS/SPECIALTYTM
MEMBER PROVIDER
PAYOR
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
5
of your members
are within
mile(s) of
MinuteClinic
0.3%
* Where allowed by law **In-store pick up is not available in Arkansas, Oklahoma and West Virginia. Some states require first fill prescriptions to be transmitted directly to the dispensing
specialty pharmacy. Other restrictions may apply.
ClovisUSD, Jul 2014 to Jun 2015
Page 2 of 16
ELIGIBILITY JUL-JUN 14 % CHANGE JUL-JUN 15 PEER*
Average Eligible Members Per Month 11,251 3.5% 11,641
Avg. Monthly Utilizers as % of Members 30.7% 1.7% 31.2% 32.8% 34.8%
Average Member Age 37 1.1% 38 37 38
COST
Total Gross Cost $15,040,843 11.6% $16,790,971
Total Net Cost $13,525,241 12.7% $15,244,202
Gross Cost PMPY $1,337 7.9% $1,442 $1,219 $1,387
Net Cost PMPY $1,202 8.9% $1,310 $1,060 $1,261
Member Cost Share 10.1% -8.6% 9.2% 13.0% 9.1%
DRUG MIX
% Single Source Brands 19.7% -10.3% 17.7% 16.2% 17.8%
% Multi Source Brands 1.5% -0.7% 1.5% 1.6% 1.5%
Generic Dispensing Rate 78.8% 2.6% 80.9% 82.3% 80.7%
Generic Substitution Rate 98.2% 0.1% 98.2% 98.1% 98.1%
UTILIZATION
Total Prescriptions 87,888 5.9% 93,095
% Retail Prescriptions 54.2% 1.8% 55.2% 78.1% 72.3%
% Mail Prescriptions 6.9% -10.9% 6.1% 21.9%** 27.7%**
Days' Supply PMPY 405.92 1.1% 410.30 389.74 421.12
SPECIALTY
Specialty Total Net Cost $2,802,652 34.8% $3,777,864
Specialty Utilizers as % of Members 1.2% 9.1% 1.4%
Specialty Net Cost PMPY $249 30.3% $325 $355 $397
Specialty % of Total Net Cost 20.7% 19.6% 24.8% 33.5% 31.5%
Specialty % of Total Prescriptions 0.8% 15.0% 0.9% 0.9% 0.9%
% Specialty Member Cost Share 0.9% -12.7% 0.7% 2.8% 1.0%
EMPLOYER
BOB
8.9%
12.8% 12.1%
TOTAL NET TREND
PEER* NET TREND
EMPLOYER NET TREND
Key Metrics at a Glance
** Includes Maintenance Choice® Claims
30.3%
3.4%
SPECIALTY TREND NON-SPECIALTY TREND
YOUR SPECIALTY VS. NON-SPECIALTY TREND
BOB Trend information is based on trend data ending YTD Mar 31, 2015
SNAPSHOT
* Peer: School Systems
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
YOUR NET TREND
ClovisUSD, Jul 2014 to Jun 2015
Page 3 of 16
0% 1% 2%
19%
55%
21%
2%
< 66% 66% - 70% 71% - 75% 76% - 80% 81% - 85% 86% - 90% > 90%
PERCENT OF CLIENTS
GDR RANGE
GENERIC AND BRAND PERFORMANCE
Reduce Unnecessary Pharmacy Cost: GDR Distribution
* Peer: School Systems
CVS/CAREMARK BOB GDR DISTRIBUTION
MULTI SOURCE BRAND
DISPENSING RATE
SINGLE SOURCE BRAND
DISPENSING RATE
80.9% 80.7%
82.3%
GENERIC DISPENSING RATE
CLOVISUSD PEER* EMPLOYER BOB
PERCENT OF CLAIMS
17.7% 17.8%
16.2%
CLOVISUSD PEER* EMPLOYER BOB
PERCENT OF CLAIMS
1.5%
1.5%
1.6%
CLOVISUSD PEER* EMPLOYER BOB
PERCENT OF CLAIMS
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
PROJECTED SAVINGS FROM JUL 2015 - JUN 2016 GENERIC LAUNCHES
RANK DRUG NAME UTILIZERSTOTAL
RXSJUL-JUN 16 JUL-JUN 17 JUL-JUN 18 TOTAL
1 CRESTOR 22 65 $9,152 $140,787 $204,645 $354,584
2 GLEEVEC 1 3 $18,619 $120,870 $140,681 $280,170
3 NASONEX 76 139 $26,757 $50,770 $58,568 $136,096
4 WELCHOL 21 52 $25,354 $47,921 $55,282 $128,556
5 GLUMETZA 2 6 $5,967 $43,878 $53,372 $103,217
All Other 121 297 $86,659 $210,576 $249,410 $546,645
243 562 $172,509 $614,803 $761,957 $1,549,269
PROJECTED SAVINGS FROM JUL 2016 - JUN 2017 GENERIC LAUNCHES
RANK DRUG NAME UTILIZERSTOTAL
RXSJUL-JUN 17 JUL-JUN 18 TOTAL
1 ZETIA 54 151 $32,588 $142,471 $175,059
2 AXIRON 14 38 $9,530 $82,829 $92,360
3 BENICAR 22 74 $15,013 $49,534 $64,547
4 AZILECT 4 13 $5,652 $41,770 $47,423
5 NUVIGIL 8 41 $16,850 $28,096 $44,946
All Other 231 320 $56,381 $191,753 $248,133
333 637 $136,014 $536,453 $672,468
TOTAL
TOTAL
Projected Savings from New Generics
GENERIC OUTLOOK
CVS/caremark can help you maximize generic utilization with formulary and clinical management strategies including step therapy and DAW** designs.
INSIGHTS
*Impact of future generic launches has been calculated by drug strength and rolled up by drug name. GDR impact and savings are reported under brand name and launch date of the first available generic within each drug name.
** DAW may not apply to all client types.
This page contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS/caremark.
Significant Pending Patent Expirations:
Compiled using Generic Prospective Pipeline Analysis Summary, December 5, 2014. Information related to prospective drug launches is subject to change without notice due to market events and other factors.
BRAND (GENERIC)
Abilify (aripiprazole)
Copaxone (glatiramer)
Crestor (rosuvastatin)
Gleevec (imatinib)
Namenda (memantine)
Nexium (esomeprazole)
Seroquel XR (quetiapine)
Zetia (ezetimibe)
PRIMARY USE
schizophrenia
multiple sclerosis
high cholesterol
cancer
Alzheimer’s disease
gastric reflux
schizophrenia
high cholesterol
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 5 of 16
Trend Analysis by Net CostCOST
UTILIZATION
DRUG MIX/
INFLATION
THERAPEUTIC CLASS GDR
TOTAL
RX NET COST UTILIZERS
NET
COST
(PMPM)
NET
PMPM
DAYS'
SUPPLY
PMPM
NET COST
PER DAY UTILIZERS
DAYS' SUPPLY/
UTILIZER
5 5 1 Dermatologicals 70.2% 4,442 $1,247,288 1,975 $8.93 45.9% 6.3% 37.3% -5.0% 11.8%
1 3 2 Antidiabetics 59.2% 2,892 $1,223,226 578 $8.76 24.2% 6.8% 16.2% -0.4% 7.3%
6 1 3 Antihyperlipidemics 86.5% 6,168 $1,165,223 1,643 $8.34 1.2% 0.4% 0.8% -2.2% 2.7%
2 4 4Analgesics - Anti-
Inflammatory86.2% 2,528 $1,002,037 1,230 $7.17 7.3% 3.7% 3.5% 4.8% -1.1%
7 6 5Antiasthmatic And
Bronchodilator Agents22.4% 3,741 $864,137 1,499 $6.19 3.6% 2.9% 0.7% 2.5% 0.4%
4 7 6Psychotherapeutic And
Neurological Agents - 30.0% 317 $861,094 83 $6.16 23.0% -1.9% 25.4% -14.7% 14.9%
8 8 7 Antineoplastics 90.1% 517 $639,073 122 $4.57 12.4% 10.6% 1.6% 7.2% 3.1%
11 9 8 Ulcer Drugs 88.8% 3,390 $507,271 1,137 $3.63 -5.7% -0.4% -5.3% 1.6% -1.9%
9 12 9Adhd/Anti-
Narcolepsy/Anti-65.9% 2,317 $491,899 476 $3.52 11.7% 10.2% 1.4% -6.7% 18.1%
3 20 10 Antivirals 79.9% 1,122 $484,172 686 $3.47 129.6% 0.5% 128.4% 13.3% -11.3%
69.9% 27,434 $8,485,418 $60.74 17.6% 2.8% 22.5%
85.4% 65,661 $6,758,784 $48.38 0.0% 0.3% -0.3%
TOTAL 80.9% 93,095 $15,244,202 8,470 $109.13 9.1% 1.1% 7.9% -1.6% 6.3%
55.7%
COST COMPONENTS
BO
B R
AN
K*
PR
IOR
RA
NK
CU
RR
EN
T R
AN
K
TOP 10 THERAPEUTIC CLASSES AS A PERCENT OF NET COST
UTILIZATION COMPONENTS
DENSITY OF USE
ALL OTHER CATEGORIES
SUBTOTAL OF TOP 10
Your Top 10 Therapeutic Class Review
* Employer BOB information is based on the most recent year ending Jun 30, 2015.
PERCENTAGE CHANGE OVER TIME
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 6 of 16
BO
B R
AN
K*
PR
IOR
RA
NK
CU
RR
EN
T
RA
NK
DRUG NAME
DISPENSE
TYPE THERAPEUTIC CLASS
GENERIC
LAUNCH
DATE**
NET
COST
TOTAL
RX UTILIZERS
NET COST
PER RX
NET COST
PER DAYS'
SUPPLY
AWP
INFLATION
18 9 1 Revlimid Specialty Assorted Classes NA $293,016 36 6 $8,139.33 $316.77 9.4%
26 4 2 Atorvastatin CalciumGeneric Antihyperlipidemics NA $277,730 2,791 896 $99.51 $1.15 0.8%
2 NA 3 Harvoni Specialty Antivirals NA $259,854 8 2 $32,481.80 $1,160.06 NA
11 3 4 Advair Diskus Brand Antiasthmatic And Bronchodilator AgentsNA $254,954 434 217 $587.45 $8.51 6.9%
9 10 5 Tecfidera Specialty Psychotherapeutic And Neurological Agents - Misc.NA $244,905 38 4 $6,444.88 $177.47 8.8%
6 5 6 Abilify Brand Antipsychotics/Antimanic Agents NA $241,664 123 44 $1,964.75 $27.50 15.2%
3 2 7 Enbrel Sureclick Specialty Analgesics - Anti-Inflammatory NA $237,214 48 10 $4,941.97 $105.90 17.8%
NA 1 8 Multi-Ingredient CompoundsBrand Multi-Ingredient Compounds NA $203,501 310 127 $656.45 $25.77 NA
139 74 9 Absorica Brand Dermatologicals NA $181,419 154 38 $1,178.04 $39.27 3.3%
4 8 10 Crestor Brand Antihyperlipidemics Q2-2016 $172,415 386 130 $446.67 $5.16 12.0%
13 13 11 Januvia Brand Antidiabetics NA $169,113 210 61 $805.30 $8.98 16.8%
232 24 12 Doryx Brand Tetracyclines NA $167,815 198 76 $847.55 $27.91 21.2%
1 23 13 Humira Pen Specialty Analgesics - Anti-Inflammatory NA $157,826 42 8 $3,757.77 $106.93 21.8%
684 52 14 Apokyn Specialty Antiparkinson Agents NA $153,890 2 1 $76,945.00 $854.94 NA
63 17 15 Solodyn Brand Tetracyclines NA $148,640 144 42 $1,032.22 $32.17 10.7%
14 22 16 Victoza Brand Antidiabetics NA $147,427 110 40 $1,340.25 $15.90 17.4%
17 11 17 Enbrel Specialty Analgesics - Anti-Inflammatory NA $146,962 25 6 $5,878.50 $128.02 17.7%
130 15 18 Omeprazole Generic Ulcer Drugs NA $144,349 1,399 531 $103.18 $1.30 2.1%
20 21 19 Novolog Brand Antidiabetics NA $128,243 98 39 $1,308.60 $15.01 22.0%
16 19 20 Novolog Flexpen Brand Antidiabetics NA $128,017 115 47 $1,113.19 $13.74 20.6%
134 6 21 Betaseron Specialty Psychotherapeutic And Neurological Agents - Misc.NA $126,790 8 2 $15,848.72 $182.17 13.8%
22 16 22 Gleevec Specialty Antineoplastics And Adjunctive TherapiesQ1-2016 $124,184 6 2 $20,697.30 $240.67 20.0%
28 31 23 Norditropin FlexproSpecialty Endocrine And Metabolic Agents - Misc.NA $123,475 17 2 $7,263.22 $248.44 35.7%
30 27 24 Zetia Brand Antihyperlipidemics Q4-2016 $120,760 249 89 $484.98 $5.47 19.5%
114 20 25 Niacin Er Generic Antihyperlipidemics NA $120,745 213 73 $566.88 $6.29 6.3%
$4,474,909 7,164 1,920 $624.64 $8.20
$10,769,294 85,931 8,391 $125.32 $2.55
$15,244,202 93,095 8,470 $163.75 $3.19
SUBTOTAL OF TOP 25 DRUGS
ALL OTHERS
TOTAL
BY NET COST
Your Top 25 Drugs
This page contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS/caremark.
* Employer BOB information is based on the most recent year ending Jun 30, 2015.
Specialty drugs are those drugs filled through specialty pharmacy. ** Generic launch date is based on numerous market factors and is an estimation. "NA" means that no estimate launch date is available at the time of this report.
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 7 of 16
BO
B
RA
NK
*
PR
IOR
RA
NK
CU
RR
EN
T
RA
NK
DRUG NAME
DISPENSE
TYPE THERAPEUTIC CLASS
TOTAL NET
COST
% TOTAL
DAYS'
SUPPLY
TOTAL
RXS
TOTAL
UTILIZERS
NET
COST
PER RX
NET COST
PER DAYS'
SUPPLY
AWP
INFLATION
1 1 1 Atorvastatin Calcium Generic Antihyperlipidemics $277,730 5.1% 2,791 896 $99.51 $1.15 0.8%
6 2 2 Levothyroxine SodiumGeneric Thyroid Agents $1,033 3.1% 1,751 521 $0.59 $0.01 11.0%
5 4 3 Omeprazole Generic Ulcer Drugs $144,349 2.3% 1,399 531 $103.18 $1.30 2.1%
2 3 4 Lisinopril Generic Antihypertensives $10,758 2.3% 1,323 430 $8.13 $0.10 1.3%
10 5 5 Metoprolol Succinate ErGeneric Beta Blockers $16,898 2.0% 1,132 345 $14.93 $0.17 0.9%
3 6 6 Simvastatin Generic Antihyperlipidemics $76,721 1.7% 912 294 $84.12 $0.95 0.5%
8 7 7 Synthroid Brand Thyroid Agents $18,346 1.6% 885 245 $20.73 $0.24 16.8%
4 8 8 Amlodipine Besylate Generic Calcium Channel Blockers $23,138 1.5% 836 263 $27.68 $0.32 0.6%
12 11 9 Losartan Potassium Generic Antihypertensives $36,367 1.5% 836 267 $43.50 $0.51 0.9%
14 13 10 Fluticasone PropionateGeneric Nasal Agents - Systemic And Topical$40,345 1.4% 1,547 847 $26.08 $0.59 -0.6%
7 12 11 Metformin Hcl Generic Antidiabetics $21,234 1.4% 787 252 $26.98 $0.32 -0.1%
15 9 12 Escitalopram OxalateGeneric Antidepressants $70,679 1.4% 884 288 $79.95 $1.08 0.6%
11 10 13 Sertraline Hcl Generic Antidepressants $40,790 1.4% 854 275 $47.76 $0.63 -0.1%
24 14 14 Zolpidem Tartrate Generic Hypnotics/Sedatives/Sleep Disorder Agents$56,750 1.0% 982 246 $57.79 $1.24 -1.4%
9 16 15 Hydrochlorothiazide Generic Diuretics $110 0.9% 545 185 $0.20 $0.00 3.8%
26 15 16 Hydrocodone/AcetaminophenGeneric Analgesics - Opioid $44,654 0.9% 2,801 1,207 $15.94 $1.01 30.9%
33 17 17 Amos Levothyroxine SodiumGeneric Thyroid Agents $369 0.9% 490 170 $0.75 $0.01 10.9%
31 26 18 Proair Hfa Brand Antiasthmatic And Bronchodilator Agents$52,937 0.9% 1,403 1,055 $37.73 $1.29 5.6%
13 42 19 Montelukast Sodium Generic Antiasthmatic And Bronchodilator Agents$49,135 0.9% 536 231 $91.67 $1.21 -0.1%
17 18 20 Pantoprazole SodiumGeneric Ulcer Drugs $39,210 0.8% 517 197 $75.84 $0.97 1.7%
32 21 21 Bupropion Hcl Xl Generic Antidepressants $48,276 0.8% 489 155 $98.72 $1.27 -3.6%
34 30 22 Losartan Potassium/HydrocGeneric Antihypertensives $25,610 0.8% 429 129 $59.70 $0.67 -0.6%
35 24 23 Tamsulosin Hcl Generic Genitourinary Agents - Miscellaneous$38,009 0.8% 443 155 $85.80 $1.06 0.0%
22 19 24 Atenolol Generic Beta Blockers $2,498 0.7% 408 114 $6.12 $0.07 -3.1%
16 25 25 Pravastatin Sodium Generic Antihyperlipidemics $29,550 0.7% 409 134 $72.25 $0.85 -3.2%
$1,165,497 36.83% 25,389 4,842 $45.91 $0.66
$14,078,705 63.17% 67,706 8,127 $207.94 $4.67
$15,244,202 93,095 8,470 $163.75 $0.01
SUBTOTAL OF TOP 25 DRUGS
ALL OTHERS
TOTAL
©2008 Caremark. All rights reserved.
Your Top 25 Drugs
* Employer BOB information is based on the most recent year ending Jun 30, 2015.
Specialty drugs are those drugs filled through specialty pharmacy.
This page contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with
BY DAYS' SUPPLY
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 8 of 16
JUL-JUN 14 % CHANGE JUL-JUN 15 JUL-JUN 15 JUL-JUN 15
Specialty Prescriptions 670 21.8% 816 EMPLOYER BOB PEER*
% of Specialty Total Prescriptions 0.8% 15.0% 0.9% 0.9% 0.9%
% CVS Caremark Specialty Pharmacy
Prescriptions60.9% -9.4% 55.1%
Specialty Utilizers 140 12.9% 158
Specialty Utilizers as % of Utilizers 1.6% 14.7% 1.9%
Average Age Per Specialty Utilizer 52.4 0.8% 52.8
JUL-JUN 14 % CHANGE JUL-JUN 15 JUL-JUN 15 JUL-JUN 15
Specialty Gross Cost $2,826,866 34.6% $3,806,343 EMPLOYER BOB PEER*
Specialty % of Total Gross Cost 18.8% 20.6% 22.7% 30.0% 28.9%
Specialty Net Cost $2,802,652 34.8% $3,777,864
Specialty % of Total Net Cost 20.7% 19.6% 24.8% 33.5% 31.5%
Specialty Member Cost $24,214 17.6% $28,479
% Specialty Member Cost Share 0.9% -12.7% 0.7% 2.8% 1.0%
Gross Cost Per Specialty Utilizer $20,192 19.3% $24,091
Specialty Utilizers as % of Members 1.2% 9.1% 1.4%
Specialty Pharmacy Trend, Cost and Utilization Metrics
Use Multiple Strategies to Manage Specialty Spend in the Pharmacy Benefit:
•Help control PRICE with Exclusive Pharmacy Network**
•Help manage UTILIZATION with Specialty Guideline Management
•Help control MIX with Preferred Drug Formulary Strategy
UTILIZATION
SPECIALTY NET TREND
PRICE INFLATION
DRUG MIX
3.8%
11.6%
12.4%
30.1%
YOUR SPECIALTY UTILIZATION METRICS
YOUR SPECIALTY COST METRICS
* Peer: School Systems
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
30.3%
** Subject to state law restrictions.
ClovisUSD, Jul 2014 to Jun 2015
Page 10 of 16
BO
B R
AN
K
PR
IOR
RA
NK
CU
RR
EN
T
RA
NK
SPECIALTY CLASS NET COST*
% OF
SPECIALTY
NET COST
NET COST
PMPM UTILIZERS
% CHANGE
IN
UTILIZERS
NET COST
PER
UTILIZER TOTAL RXS
PRIOR YEAR %
RXS CVS/
SPECIALTY
% RXS CVS/
SPECIALTY
1 1 1 Rheumatoid Arthritis $870,192 23.0% $6.23 32 -13.5% $27,193 196 71.9% 77.0%
4 2 2 Oncology $850,639 22.5% $6.09 22 4.8% $38,665 123 57.0% 45.5%
2 3 3 Multiple Sclerosis $673,389 17.8% $4.82 13 -7.1% $51,799 73 93.8% 83.6%
3 NA 4 Hepatitis C $259,854 6.9% $1.86 2 NA $129,927 8 0.0% 75.0%
26 10 5 Movement Disorders $153,890 4.1% $1.10 1 0.0% $153,890 2 100.0% 100.0%
7 6 6 Psoriasis $147,718 3.9% $1.06 7 250.0% $21,103 15 100.0% 60.0%
6 4 7 Growth Hormone And Related Disorders $123,475 3.3% $0.88 2 -60.0% $61,737 17 100.0% 100.0%
5 5 8 Human Immunodeficiency Virus $97,541 2.6% $0.70 5 0.0% $19,508 23 0.0% 0.0%
11 7 9 Transplant $85,620 2.3% $0.61 18 20.0% $4,757 146 0.0% 0.0%
15 9 10 Asthma $75,436 2.0% $0.54 4 0.0% $18,859 25 100.0% 100.0%
14 NA 11 Seizure Disorders $65,242 1.7% $0.47 1 NA $65,242 1 0.0% 100.0%
39 14 12 Urea Cycle Disorders $54,873 1.5% $0.39 1 0.0% $54,873 4 100.0% 100.0%
21 13 13 Hormonal Therapies $54,215 1.4% $0.39 8 33.3% $6,777 13 77.8% 100.0%
10 8 14 Inflammatory Bowel Disease $52,540 1.4% $0.38 3 0.0% $17,513 18 46.7% 33.3%
33 11 15 Immune (Idiopathic) Thrombocytopenic Purpura$49,709 1.3% $0.36 2 100.0% $24,855 13 100.0% 92.3%
18 16 16 Osteoporosis $47,896 1.3% $0.34 10 100.0% $4,790 25 80.0% 56.0%
12 15 17 Infertility $34,526 0.9% $0.25 17 54.5% $2,031 51 79.4% 74.5%
37 NA 18 Pulmonary Disorders - Other $16,031 0.4% $0.11 1 NA $16,031 2 0.0% 100.0%
20 NA 19 Neutropenia $14,176 0.4% $0.10 2 NA $7,088 9 0.0% 11.1%
45 26 20 Alcohol Dependency $8,345 0.2% $0.06 3 200.0% $2,782 7 100.0% 100.0%
24 19 21 Renal Disease $8,163 0.2% $0.06 2 -33.3% $4,082 5 20.0% 40.0%
9 25 22 Pulmonary Arterial Hypertension $7,161 0.2% $0.05 4 100.0% $1,790 16 0.0% 0.0%
34 24 23 Anemia $6,786 0.2% $0.05 2 100.0% $3,393 14 100.0% 100.0%
46 NA 24 Retinal Disorders $6,187 0.2% $0.04 1 NA $6,187 3 0.0% 100.0%
35 NA 25 Pre-Term Birth $3,492 0.1% $0.03 1 NA $3,492 1 0.0% 100.0%
99.72%
24.97%
BY NET COST
PERCENTAGE OF TOP 25 SPECIALTY THERAPEUTIC CLASSES NET SPEND/TOTAL SPECIALTY NET SPEND
PERCENTAGE TOTAL SPECIALTY NET SPEND/TOTAL NET SPEND
Your Top 25 Specialty Class Review
*Represents pharmacy claims only. NA = No prior data available Source: CVS/caremark Data Warehouse and Internal Sources
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 11 of 16
BO
B R
AN
K*
PR
IOR
RA
NK
CU
RR
EN
T
RA
NK
DRUG NAME SPECIALTY CLASS
TOTAL NET
COST
% OF
SPECIALTY
NET COST
TOTAL
UTILIZERS
TOTAL
RXS
NET COST
PER RX
NET COST
PER DAYS'
SUPPLY
8 3 1 Revlimid Oncology $293,016 7.76% 6 36 $8,139.33 $316.77
2 0 2 Harvoni Hepatitis C $259,854 6.88% 2 8 $32,481.80 $1,160.06
6 4 3 Tecfidera Multiple Sclerosis $244,905 6.48% 4 38 $6,444.88 $177.47
3 1 4 Enbrel Sureclick Rheumatoid Arthritis $237,214 6.28% 10 48 $4,941.97 $105.90
1 9 5 Humira Pen Rheumatoid Arthritis $157,826 4.18% 8 42 $3,757.77 $106.93
178 17 6 Apokyn Movement Disorders $153,890 4.07% 1 2 $76,945.00 $854.94
7 5 7 Enbrel Rheumatoid Arthritis $146,962 3.89% 6 25 $5,878.50 $128.02
43 2 8 Betaseron Multiple Sclerosis $126,790 3.36% 2 8 $15,848.72 $182.17
10 8 9 Gleevec Oncology $124,184 3.29% 2 6 $20,697.30 $240.67
14 11 10 Norditropin Flexpro Growth Hormone And Related Disorders $123,475 3.27% 2 17 $7,263.22 $248.44
9 10 11 Stelara Psoriasis $116,765 3.09% 4 11 $10,615.01 $150.47
12 6 12 Humira Rheumatoid Arthritis $110,377 2.92% 4 21 $5,256.04 $106.34
4 12 13 Copaxone Multiple Sclerosis $104,791 2.77% 2 7 $14,970.13 $178.22
13 14 14 Gilenya Multiple Sclerosis $98,351 2.60% 3 6 $16,391.91 $190.60
80 0 15 Nexavar Oncology $89,906 2.38% 2 8 $11,238.31 $374.61
56 7 16 Sutent Oncology $87,856 2.33% 1 7 $12,550.92 $313.77
26 13 17 Simponi Rheumatoid Arthritis $87,412 2.31% 4 19 $4,600.63 $116.86
57 28 18 Pomalyst Oncology $78,292 2.07% 2 7 $11,184.64 $466.03
17 15 19 Xolair Asthma $75,436 2.00% 4 25 $3,017.42 $81.64
28 35 20 Orencia Rheumatoid Arthritis $72,760 1.93% 2 25 $2,910.38 $103.94
31 30 21 Aubagio Multiple Sclerosis $71,249 1.89% 2 6 $11,874.86 $181.76
11 19 22 Atripla Human Immunodeficiency Virus $68,279 1.81% 3 12 $5,689.95 $63.22
87 0 23 Inlyta Oncology $65,542 1.73% 2 6 $10,923.67 $364.12
18 0 24 Acthar H P Seizure Disorders $65,242 1.73% 1 1 $65,242.06 $4,660.15
292 27 25 Buphenyl Urea Cycle Disorders $54,873 1.45% 1 4 $13,718.23 $152.42
$3,115,250
82.46%
BY NET COST
TOTAL TOP NET SPECIALTY DRUGS
TOTAL TOP NET SPECIALTY DRUGS/OVERALL BIOTECH SPECIALTY DRUGS
This page contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS/caremark.
Your Top 25 Specialty Drugs
Source: CVS/caremark Data Warehouse and Internal Sources
* Employer BOB information is based on the most recent year ending Jun 30, 2015.
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 12 of 16
Diabetes Hypertension HyperlipidemiaHeart
Failure
Coronary
Artery
Disease
DepressionAsthma/
COPDOsteoporosis
Breast
Cancer
Other
Behavioral
Health
Parkinson's
Disease
Benign
Prostatic
Hyperplasia
NEW TO
THERAPY8 38 32 7 0 17 5 1 0 1 0 0
FIRST FILL
DROP OFF4 25 16 4 2 22 8 1 0 0 0 0
OFF
THERAPY17 98 80 3 2 25 28 5 2 0 0 0
REFILL
REMINDER58 284 238 12 17 69 34 13 8 2 0 9
Managing Chronic Conditions: Your Adherence Measures
PRESCRIPTION ADHERENCE CAN
HELP LOWER HEALTH CARE
COSTS
2. Pharmacy Care Economic Model 3.0 Enterprise Analytics 2014
1. Optimal: ≥ 80% MPR
INTERVENTION SUMMARY - PHARMACY ADVISOR SUPPORT
* Peer: School Systems
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
Conditions are ordered by importance. "Total intervention counts include successful interventions only."
72.0
%
76.2
%
70.4
%
60.7
%
77.1
%
65.5
%
65.9
%
72.4
%
68.0
%
52.7
%
70.3
%
60.2
%
64.8
%
71.6
%
67.4
%
52.9
%
70.0
%
57.2
%
63.0
%
69.6
%
66.3
%
49.5
%
66.6
%
52.7
%
DIABETES HYPERTENSION HYPERLIPIDEMIA HEART FAILURE CORONARY ARTERY DISEASE
DEPRESSION
PERCENT OPTIMAL1 ADHERENCE BY CHRONIC CONDITION
CLOVISUSD AGE ADJUSTED PEER* AGE-ADJUSTED EMPLOYER** MANDATORY MAINTENANCE CHOICE® CLIENTS
Research shows
that adherent
members spend
less on total care
than those who are
non-adherent,
offsetting increased
pharmacy costs.2
**Age-adjusted BOB benchmark provides Book of Business projected spend and utilization if the peer had the same age demographics as the client.
28.1
%
65.1
%
70.7
%
60.2
%
87.5
%
75.9
%
30.8
%
61.3
%
64.5
%
56.8
%
73.5
%
62.1
%
30.9
%
59.6
%
60.6
%
52.6
%
67.3
%
61.7
%
30.3
%
56.9
%
58.0
%
47.8
%
66.2
%
59.4
%
ASTHMA/COPD OSTEOPOROSIS BREAST CANCER OTHER BEHAVIORAL HEALTH
PARKINSON'S DISEASE
BENIGN PROSTATIC HYPERPLASIA
ClovisUSD, Jul 2014 to Jun 2015
Page 14 of 16
CONTRACEPTIVE DRUG CLASS
SUMMARYGDR UTILIZERS GROSS COST NET COST GROSS PMPM NET PMPM
DAYS' SUPPLY
PMPMUTILIZERS
Barrier Contraceptives - Cervical Cap 0.0% 0 $0 $0 0.0% 0.0% 0.0% 0.0%
Barrier Contraceptives - Diaphragm 0.0% 0 $0 $0 0.0% 0.0% 0.0% 0.0%
Combination Contraceptives - Transdermal100.0% 8 $4,410 $4,104 75.7% 93.2% 80.9% 100.0%
Combination Contraceptives - Vaginal 0.0% 39 $28,402 $23,386 17.2% 21.2% -1.3% -11.4%
Contraceptives - OTC 0.0% 0 $0 $0 0.0% 0.0% 0.0% 0.0%
Emergency Contraceptives 100.0% 3 $88 $61 140.6% 4707.9% 189.9% 200.0%
Progestin Contraceptives - Implants 0.0% 0 $0 $0 0.0% 0.0% 0.0% 0.0%
Progestin Contraceptives - Injectable 0.0% 0 $0 $0 0.0% 0.0% 0.0% 0.0%
Progestin Contraceptives - IUD 0.0% 0 $0 $0 0.0% 0.0% 0.0% 0.0%
Progestin Contraceptives - Oral 73.6% 647 $228,689 $178,260 9.9% 12.4% 3.7% -6.9%
TOTAL CONTRACEPTIVE 70.1% 690 $261,589 $205,811
Cost of Coverage: Contraceptive Drugs
* Peer: School Systems
PERCENTAGE CHANGE OVER TIME
$1.87
$1.47
$2.33 $2.24
$1.82 $1.73
GROSS NET
CONTRACEPTIVE PMPM COMPARISON
CLOVISUSD PEER* EMPLOYER BOB
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 15 of 16
PREVENTIVE DRUG CLASS
SUMMARYUTILIZERS GROSS COST NET COST GROSS PMPM NET PMPM
DAYS' SUPPLY
PMPMUTILIZERS
0 $0 $0 0.0% 0.0% 0.0% 0.0%
39 $34,164 $32,391 -18.3% -14.8% -11.2% 8.3%
146 $12,071 $8,349 -13.7% -9.6% 22.4% -18.9%
10 $109 $27 -27.4% -21.1% -58.5% -50.0%
0 $0 $0 0.0% 0.0% 0.0% 0.0%
0 $0 $0 0.0% 0.0% 0.0% 0.0%
0 $0 $0 0.0% 0.0% 0.0% 0.0%
15 $5,864 $5,039 -29.9% -28.7% -43.5% -34.8%
1 $205 $205 0.0% 0.0% 0.0% 0.0%
0 $0 $0 0.0% 0.0% 0.0% 0.0%
211 $52,413 $46,011
TOTAL COST OF COVERAGE SUMMARY 901 $314,003 $251,822
Vitamin D (Fall Prevention)
TOTAL
Aspirin
Breast Cancer Prevention
Colonoscopy Prep
Fluorides
Tobacco Cessation RX
Vaccines
Folic Acid
Iron
Tobacco Cessation OTC
Cost of Coverage: Preventive Drugs
* Peer: School Systems
PERCENTAGE CHANGE OVER TIME
$0.38 $0.33
$0.51 $0.48 $0.49 $0.45
GROSS NET
PREVENTIVE PMPM COMPARISON
CLOVISUSD PEER* EMPLOYER BOB
©2015 CVS Health and/or one of its affiliates: Confidential & Proprietary
ClovisUSD, Jul 2014 to Jun 2015
Page 16 of 16
top related