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Attachment 10Blue InsightMonthly Financial ReportCITY OF MESQUITE: ALL01/01/2017 to 12/31/2017A Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association.Ξ ŽƉLJƌŝŐŚƚ 2018 Health Care Service Corporation. All rights reserved.
Table of ContentsPLAN PERFORMANCEData Parameters3Enrollment Overview4PharmacyFinancial OverviewFinancial Summary6Network Overview7Blue Card Savings Analysis8Medical Claim Expense Distribution9High Cost Claimants10Medical Out of Pocket11Lag Report12Overall Medical Paid PMPM Leading Diagnostic Category13Financial Summary14Key Indicators15Generic vs. Formulary Experience16Top Non-Specialty Therapeutic Drug Classes17Top Non-Specialty Prescription Drugs18Specialty Drug Analysis19Appendix20Glossary232CITY OF MESQUITE: ALL
Data ParametersCurrent Period: The current reporting period represents claims paidfrom January 1, 2017 through December 31, 2017.Prior Period: The prior reporting period represents claims paidfrom January 1, 2016 through December 31, 2016.The report includes medical claims and pharmacy claims.Reporting Segments: ALLCharacteristics: ALLGroup/Sections: ALLReporting Support Contact InformationFor reporting support, please contact Client Reporting Service CenterEmail: client reporting@bcbsil.comPhone: 1-877-837-1866Hours of Operation: Monday - Friday: 8:00am - 5:00pm CTReport prepared on 01/10/20183CITY OF MESQUITE: ALL
Enrollment OverviewZĞƉŽƌƚ ĞƐĐƌŝƉƚŝŽŶ͗ Provides the current enrollment based on the current scribersPharmacyMembersJan 20171,1072,5631,1072,563Feb 20171,1062,5611,1062,561Mar 20171,1072,5591,1072,559Apr 20171,1042,5461,1042,546May 20171,1032,5341,1032,534Jun 20171,1042,5371,1042,537Jul 20171,1092,5381,1092,538Aug 20171,1102,5471,1102,547Sep 20171,1232,5451,1232,545Oct 20171,1242,5511,1242,551Nov 20171,1232,5611,1232,561Dec 20171,1212,5661,1212,566Month4CITY OF MESQUITE: ALL
Enrollment OverviewZĞƉŽƌƚ ĞƐĐƌŝƉƚŝŽŶ͗ Provided medical demographics for the current period compared to the prior period and percent change.Medical DemographicsJan 2016 - Dec 2016 Jan 2017 - Dec 2017% ChangeAverage 4417-15.6%1,0511,022-2.8%Average Contract Size2.42.3-4.2%Average 80.9%Dependent12.612.70.9%% Under 3047.4%48.3%% 30 to 4929.2%28.0%% 50 to 6422.1%22.4%% 65 1.3%1.3%Proportion of Males54.4%55.4%Proportion of Females45.7%44.6%Females Ages 20-4416.4%15.2%SpouseDependent Overall, membership decreased by 4.3% between reporting periods The average age was 31.8 ĂŶĚ decreased by 0.6% between reportingƉĞƌŝŽĚƐ͘ Contract size decreased by 4.2% between reporting periods. Females between the ages of 20 and 44 decreased from 16.4% to 15.2%between reporting periods.Gender5CITY OF MESQUITE: ALL
Financial Overview: Financial SummaryReport Description: Provides a breakdown of the medical order of reduction from billed to paid for the current month, current period, prior period and a percent change. Thisreport may highlight key measures and their potential impact on paid expenses.Medical Order of ReductionPaid MonthBilledNot CoveredDec 2017Jan 2016 - Dec 2016Jan 2017 - Dec 2017% Change 4,008,797 30,100,640 33,007,7859.7% 808,383 3,421,903 5,262,36553.8%Covered 3,200,414 26,678,737 27,745,4204.0%Discount 2,037,411 16,394,591 16,654,3371.6%Allowed 1,163,003 10,284,146 11,091,0827.9%Out of Pocket 202,352 2,824,178 2,915,5203.2%COB 5,417 19,083 69,165262.4%COB Medicare 48,155 16,756 73,838340.7% 0 4,561 304-93.3%Other ReductionsOther Adjustments( 1,483)( 10,342)( 17,615)-70.3%Paid - Provider 908,561 7,429,909 8,049,8708.3% 2,319 4,202 5,84839.2% 910,880 7,434,111 8,055,7188.4%Other PaymentsMedical PaidGroup Liability BreakdownFees and Credits BreakdownPaid MonthDec 2017Jan 2016 - Dec 2016Jan 2017 - Dec 2017% ChangePaid MonthDec 2017Jan 2016 - Dec 2016Jan 2017 - Dec 2017% ChangeMedical Paid 910,880 7,434,111 8,055,7188.4%Access Fee 0 0 00.0%Pharmacy Paid 265,931 2,723,782 2,311,153-15.2%Admin Fee 57,989 731,629 689,716-5.7%VBC Payments 1,115 8,112 8,033-1.0%ASO Adjustments 0( 50,713)( 62,924)-24.1% 1,177,926 10,166,006 10,374,9042.1%Rx Credit Fees 0( 13)( 1,613)-12,670.0% 1,177,926 10,165,994 10,373,2912.0% 37,161 487,428 379,065-22.2%HCA Draft Amount 0 0 00.0%Capitation Paid 0 0 00.0%Group Liability 1,215,087 10,653,422 10,752,3560.9%Total Paid ClaimsRecoveriesTotal Paid Claims RecoveriesFees & Credits( 20,828)( 193,488)( 247,727)-28.0%Aggregate Stop Loss 0 0 00.0%Specific Stop Loss 0 0 00.0%Extra Fees 0 0 00.0%ASO Other Services 0 0 00.0%ASO All Other 0 0 00.0% 37,161 487,428 379,065-22.2%SummaryOther reductions includes penalties, workers compensation savings, and subrogation savings.Other payments includes Blue Card access fees and surcharges. Also displayed are other adjustments.6CITY OF MESQUITE: ALL
Financial Overview: Network OverviewZĞƉŽƌƚ ĞƐĐƌŝƉƚŝŽŶ͗ This report displays the discount amount, discount percent, paid amount and paid percent for medical claims split by Medicare/Non-Medicare, in/out ofnetwork and service category for the current period.Medicare Primary IndicatorNetwork IndicatorService CategoryCoveredDiscountDiscount %Paid% Of PaidFacility Inpatient 4,653,582 2,251,72948.4% 2,178,82527.0%Facility Outpatient 8,787,537 4,697,74653.5% 2,966,30236.8%Professional 11,348,319 7,090,36962.5% 2,840,30335.3%Summary 24,789,439 14,039,84356.6% 7,985,42999.1%Facility Inpatient 301,862 292,06996.8% 1,975Facility Outpatient 1,519,870 1,399,93892.1% 48,7270.6%Professional 1,035,161 913,36788.2% 13,7610.2%Summary 2,856,893 2,605,37391.2% 64,4620.8% 27,646,332 16,645,21760.2% 8,049,89199.9%In NetworkNoOut of NetworkSummaryFacility Inpatient 49,323 1,316Facility Outpatient 25,038( 18)-0.1% 773Professional 20,616 8,80942.7% 3,737Summary 94,978 8,7919.3% 5,8270.1%Facility Outpatient 3,409 220.6%Professional 701 30944.0%Summary 4,110 3308.0% 99,088 9,1219.2% 5,8270.1% 27,745,420 16,654,33760.0% 8,055,718100.0%In NetworkYesFacility InpatientOut of NetworkSummarySummaryKey Findings: The overall network savings discount (excluding Medicare) was 56.6% ĨŽƌ ƚŚĞ ĐƵƌƌĞŶƚ ƉĞƌŝŽĚ͘ dŚĞ ŝŶͲŶĞƚǁŽƌŬ ƉĂŝĚ ƉĞƌĐĞŶƚ ǁĂƐ 99.2% for the current period.7CITY OF MESQUITE: ALL
Financial Overview: Blue Card Savings AnalysisReport Description: dŚĞ ůƵĞ ĂƌĚ ĂǀŝŶŐƐ ƌĞƉŽƌƚ ŝůůƵƐƚƌĂƚĞƐ ƚŚĞ ǀĂůƵĞ ŽĨ ŚĂǀŝŶŐ ĂĐĐĞƐƐ ƚŽ ŽƚŚĞƌ ĐŽŶƚƌĂĐƚƐ ǁŝƚŚŝŶ ƚŚĞ hŶŝƚĞĚ ƚĂƚĞƐ ƚŚƌŽƵŐŚ ƚŚĞ ůƵĞ ĂƌĚ ƉƌŽŐƌĂŵ͘ ĂǀŝŶŐƐ from BCBS network discounts are passed to the client, providing savings on potentially costly out of state claims that would otherwise be paid at full provider billed amount.Jan 2017 - Dec 2017BilledAllowedEffectiveAllowed RateDiscountPaidEffectivePaid RateBlue CardAccess FeeAZ 598,425 192,85632.2% 403,212 182,94930.6% 4,089OK 61,123 18,82030.8% 35,434 11,78119.3% 0TN 35,233 11,89233.8% 22,080 6,68219.0% 556AR 21,017 7,14734.0% 12,932 3,34915.9% 326FL 9,834 3,01130.6% 6,823 2252.3% 66HI 9,851 2,88529.3% 6,776 1711.7% 171OH 14,796 9,10561.5% 5,631 1,91412.9% 142BC CA 6,240 76412.2% 5,476 20.0% 2Highmark Shield PA 5,630 4888.7% 5,142 2885.1% 130IL 6,421 1,52123.7% 4,900 520.8% 0All Other Blue Card 32,939 16,65950.6% 10,388 9,91630.1% 255All Other Non-Blue Card 32,206,277 10,825,93433.6% 16,135,547 7,838,39024.3% 112Summary 33,007,785 11,091,08233.6% 16,654,337 8,055,71824.4% 5,848Par Plan StateKey Findings: AZ had the greatest Blue Card savings amount, with a Discount amount of 403,212͘ dŚĞ ŽǀĞƌĂůů ĨĨĞĐƚŝǀĞ ůůŽǁĞĚ ZĂƚĞ ĨŽƌ ƚŚĞ ĐƵƌƌĞŶƚ ƉĞƌŝŽĚ ǁĂƐ 33.6%.8CITY OF MESQUITE: ALL
Financial Overview: Medical Claim Expense DistributionReport Description: dŚĞ ĚŝƐƚƌŝďƵƚŝŽŶ ŽĨ ŵĞĚŝĐĂů ƉĂŝĚ ĞdžƉĞŶƐĞ ďLJ ĐůĂŝŵĂŶƚ ĂŶĚ ƚŚĞ ĂǀĞƌĂŐĞ ŵĞĚŝĐĂů ƉĂŝĚ ƉĞƌ ĐůĂŝŵĂŶƚ ĂŵŽƵŶƚ ĂƌĞ ƐŚŽǁŶ ĨŽƌ ƚŚĞ ĐƵƌƌĞŶƚ ƉĞƌŝŽĚ͘Paid BandClaimantsClaimants %PaidPaid %Paid/ClaimantLess than 2001,34652.1% 75,4790.9% 56 200 - 1,00072528.1% 321,7764.0% 444 1,001 - 5,00027510.6% 598,6667.4% 2,177 5,001 - 10,000913.5% 661,8588.2% 7,273 10,001 - 30,000813.1% 1,467,40718.2% 18,116 30,001 - 50,000351.4% 1,305,68616.2% 37,3052,55398.8% 4,430,87355.0% 1,736ClaimantsClaimants %PaidPaid %Paid/Claimant 50,001 - 75,000120.5% 725,5789.0% 60,465 75,001 - 100,00040.2% 329,4884.1% 82,372 100,001 - 150,00050.2% 604,6417.5% 120,928 150,001 - 200,00060.2% 1,130,13714.0% 188,356 200,001 - 250,00010.0% 210,1462.6% 210,146 250,001 - 500,00020.1% 624,8567.8% 312,428301.2% 3,624,84545.0% 120,8282,583100.0% 8,055,718100.0% 3,119Summary 50,000Paid Band 500,001 Summary 50,001 or GreaterCombined SummaryKey Findings: The proportion of claimants who received less than 200 in services for the current period was 52.1%͘ dŚĞƐĞ ĐůĂŝŵĂŶƚƐ ƐƉĞŶƚ 0.9% of the total paid expenses andthe average paid expense per claimant was 56͘ 1.2% ŽĨ ĐůĂŝŵĂŶƚƐ ŚĂĚ ĞdžƉĞŶƐĞƐ ŽǀĞƌ ΨϱϬ͕ϬϬϭ ĨŽƌ ƚŚĞ ĐƵƌƌĞŶƚ ƉĞƌŝŽĚ͘ These claimants spent 45.0% of the total paidexpenses and the average paid expense per claimant was 120,828.9CITY OF MESQUITE: ALL
Financial Overview: High Cost ClaimantsReport Description: This report provides a detailed listing of the top 20 high cost claimants with paid expenses of 50,000 or more for the current period.Jan 2017 - Dec 2017Encrypted Member IDRelationshipAge/GenderBandLeading Diagnostic dPharmacyPaidPaid3770869525034342979SubscriberMale 50-59Neoplasms 33,408 307,151 21,264 70,684 432,5075844933138401739206DependentMale 1-19Perinatal 233,529 6,370 23,133 10 263,0424343046825469608752SubscriberFemale 60-64 Skin Diseases 0 89,370 120,776 29,346 239,4925856914816751520846SpouseFemale 60-64 0 662 1,807 205,753 208,2228553575386552930956SubscriberFemale 50-59 Musculoskeletal 143,205 13,913 40,813 4,422 202,3531386158967760324494SubscriberMale 60-64Neoplasms 58,032 115,606 16,420 5,209 195,2672313023046971847897DependentFemale 20-29 Circulatory 98,636 57,050 29,677 5,061 190,424250184190614240110DependentMale 1-19Perinatal 172,073 0 16,318 8 188,3991850552376060217232DependentMale 1-19Perinatal 147,091 0 40,729 6 187,8261088629785894076201DependentMale 1-19Circulatory 150,236 3,373 26,965 216 180,790550691306026492070SubscriberFemale 60-64 37,263 11,979 17,736 84,518 151,4968090586869447685344SpouseMale 60-64Injury/Poisoning 49,231 53,336 27,489 13,849 143,9054122875611259814010SubscriberFemale 50-59 Nervous System 31,169 83,574 14,511 7,360 136,6148013523681648500858DependentMale 1-19 0 6,006 117,469 3,117 126,5922047490870083433237SpouseFemale 40-49 Musculoskeletal 90,196( 1,085) 22,060 920 112,0915906455289794885492SubscriberMale 50-59 16,639 80,581 13,464 919 111,603348590163472326409DependentMale 1-19 0 19,491 4,223 85,536 109,2506975293104046430427SubscriberMale 60-64 0 69,672 5,724 26,404 101,8002007133047150814886SpouseFemale 40-49 13,814 23,969 17,490 43,422 98,6953837752254023667352SubscriberFemale 60-64 Nervous System 17,902 7,532 66,096 4,146 95,676 1,292,424 948,550 644,164 590,906 3,476,044Mental HealthCirculatoryGenitourinaryHigh Cost Claimant Total110CITY OF MESQUITE: ALL
Financial Overview: Medical Out of PocketReport Description: Provides a distribution of claimants by their total medical out of pocket expenses for the current period compared to the prior period and percent change.This report helps determine the impact of any changes in plan design on out of pocket.Claimant Distribution by Out of Pocket Expense BandsJan 2016 - Dec 2016Out of Pocket BandJan 2017 - Dec 2017% ChangeClaimantsClaimants %Out of PocketOut of Pocket %ClaimantsClaimants %Out of PocketOut of Pocket %Claimants ChangeOut of Pocket ChangeLess than 10081032.2% 17,6670.6%87934.0% 9,1470.3%8.5%-48.2% 101 - 20026310.5% 38,3841.4%28711.1% 42,0021.4%9.1%9.4% 201 - 3001646.5% 41,2511.5%1937.5% 47,8471.6%17.7%16.0% 301 - 4001475.8% 51,1031.8%1335.1% 46,3521.6%-9.5%-9.3% 401 - 5001054.2% 46,4641.6%993.8% 44,8731.5%-5.7%-3.4% 501 - 7501777.0% 110,9813.9%1796.9% 109,2323.7%1.1%-1.6% 751 - 1,0001134.5% 97,6423.5%1064.1% 91,6283.1%-6.2%-6.2% 1,001 - 1,5001566.2% 190,8136.8%1375.3% 169,2915.8%-12.2%-11.3% 1,501 - 2,0001034.1% 179,3356.4%953.7% 163,6655.6%-7.8%-8.7% 2,001 - 2,500783.1% 175,9716.2%682.6% 152,3765.2%-12.8%-13.4% 2,501 - 3,000592.3% 161,4145.7%411.6% 112,4033.9%-30.5%-30.4% 3,001 - 4,000873.5% 306,23110.8%983.8% 353,35212.1%12.6%15.4% 4,001 - 5,0001636.5% 765,53427.1%552.1% 245,8308.4%-66.3%-67.9% Greater than 5,001883.5% 641,38922.7%2138.2% 1,327,52445.5%142.0%107.0%2,513100% 2,824,178100%2,583100% 2,915,520100%2.8%3.2%SummaryOut of Pocket Expense by Coverage TierJan 2017 - Dec 2017Coverage TierAllowedDeductibleDeductible % of AllowedCopaymentCopay % of AllowedCoinsuranceEmployee Only 2,942,614 609,98420.7% 2200.0% 49,9771.7% 660,18122.4% 2,217,749Employee One 1,508,267 370,15824.5% 3600.0% 38,9042.6% 409,42227.1% 1,094,508Employee Dependent(s) 2,071,082 526,64025.4% 5120.0% 36,8551.8% 564,00727.2% 1,502,291Coins % of Allowed Out of Pocket OPX % of AllowedPaidFamily 4,569,119 1,195,16626.2% 3,7980.1% 82,9451.8% 1,281,91028.1% 3,241,170Summary 11,091,082 2,701,94824.4% 4,8900.0% 208,6821.9% 2,915,52026.3% 8,055,718dŚŝƐ ŝƐ Ă ĐůĂŝŵĂŶƚ ĂŶĂůLJƐŝƐ͕ ǁŚĞƌĞ ŽŶůLJ ŵĞŵďĞƌƐ ǁŚŽ ŚĂĚ Ă ĐůĂŝŵ ĂƌĞ ŝŶĐůƵĚĞĚ͘ dŚĞ ƚĂďůĞƐ ĞdžĐůƵĚĞ Ăůů ŵĞĚŝĐĂů ĞŶƌŽůůĞĚ ŵĞŵďĞƌƐ ƚŚĂƚ ĚŝĚ ŶŽƚ ƐƵďŵŝƚ Ă ĐůĂŝŵ͘dŚŝƐ ƌĞƉŽƌƚ ŝƐ ďĂƐĞĚ ŽŶ ĐůĂŝŵ ĚĂƚĂ ĂŶĚ ŵĂLJ ŶŽƚ ƌĞĨůĞĐƚ ĐůŝĞŶƚ ƐƉĞĐŝĨŝĐ ďĞŶĞĨŝƚƐ ďĞŝŶŐ ĂƉƉůŝĞĚ ƚŽ ŵĞŵďĞƌ ŽƵƚ ŽĨ ƉŽĐŬĞƚ͘ WůĞĂƐĞ ĐŽŶƚĂĐƚ LJŽƵƌ ĐĐŽƵŶƚ džĞĐƵƚŝǀĞ ĨŽƌ hD reporting.11CITY OF MESQUITE: ALL
Financial Overview: Lag ReportReport Description: ŝƐƉůĂLJƐ͕ ďLJ ƉĂŝĚ ŵŽŶƚŚ͕ ƚŚĞ ŵĞĚŝĐĂů ĚŽůůĂƌƐ ƉĂŝĚ ĂŶĚ ƚŚĞ ĐŽƌƌĞƐƉŽŶĚŝŶŐ ŵŽŶƚŚ ŝŶĐƵƌƌĞĚ ĨŽƌ Ă ϭϮ ŵŽŶƚŚ ƌŽůůŝŶŐ ƉĂŝĚ ƉĞƌŝŽĚ ;ŝĨ ĂǀĂŝůĂďůĞ ĨŽƌ LJŽƵƌ ĂĐĐŽƵŶƚͿ͘ This report provides insight into the monthly claim lag and can help identify IBNR.IncurredMonthPaid MonthJan 2017Feb 2017Mar 2017Apr 2017 219 644May 2017Jun 2017Jul 2017 37 91Aug 2017Sep 2017Oct 2017Nov 2017Dec 2017SummaryAll PriorJan 2016 53Feb 2016( 119) 924 89 20 148 14 112 33( 22)May 2016 603 826 561( 47)Jun 2016 67 1,432 277 689Jul 2016( 5,335) 3,002 35Aug 2016 13,496 4,288 365( 3,714) 5,795( 212) 93 726Sep 2016 9,694 6,514 890 348( 293) 1,661( 898) 1,264 593Oct 2016 13,479 3,602 14,814 1,060 785 1,313 221 172 285 715 36,447Nov 2016 199,909 11,623 9,653 5,092 343 10 256( 101) 267 714 227,766Dec 2016 242,261 134,538 9,332 7,496 805 101 205 154Jan 2017 186,451 101,278 26,214 12,287 2,464 180 861 727 6,191 165,383 121,306 98,479 3,553 1,800 83 65,660( 1,486) 219,175 164,684 24,854 335,474 65,370 28,235 289,517 119,459 97,627 4,747 21,616 370,276 260,785 48,026 169,384 286,304 120,429 36,020 320,979Mar 2016Apr 2016Feb 2017Mar 2017Apr 2017( 2,097) 275( 1,801) 4,582 2,792( 40) 1,743 194 4,593May 2017Jun 2017 566 24 3,241Aug 2017 890 5,315 2,349 446 19,775 6 1,439Summary 989,817 560,542 336,396 64 459,390 990 5,937 1,229 8,899 7,667 556,698 11,779 344 1,089 189 861,872 2,331 4,139 332( 183) 449,373 200,888 73,509 1,729 46,822 1,072 645,000 302,713 262,773 15,909 80,072 19,275 680,742 227,292 363,459 94,460 17,927 703,137 382,193 223,445 198,893 804,531 333,449 257,733 591,183Dec 2017 532,576 396,975 1,035Nov 2017 576,512 638( 256) 724Oct 2017 403,006 21,282 3,822Sep 2017 432,589 5,710 54Jul 2017 660,826( 1,988) 828,349 590,038 775,293 795,289 839,817 409,957 409,957 910,880 8,055,71812CITY OF MESQUITE: ALL
Financial Overview: Overall Medical Paid PMPM by Leading Diagnostic CategoryReport Description: Lists the top 15 overall paid expense across inpatient facility, outpatient facility, and professional settings by leading diagnostic categories for the currentmonth, current period, prior period and percent change.Paid PeriodLeading Diagnostic CategoryDec 2017Jan 2016 Dec 2016Jan 2017 Dec 2017% ChangePaid PMPM Paid PMPM Paid PMPM Paid PMPMMusculoskeletal 78 48 42-12.5%Circulatory 70 35 24-31.4%Nervous System 41 11 1863.6%Symptoms/Ill-Defined 34 21 2938.1%Respiratory 23 13 1623.1%Mental Health 22 15 10-33.3%Injury/Poisoning 18 14 157.1%Genitourinary 15 11 1536.4%Neoplasms 15 21 224.8%Pregnancy 9 13 8-38.5%Endocrine 8 6 950.0%Digestive 6 12 138.3%Blood Diseases 5 1 2100.0%Infectious/Parasitic 5 3 433.3%Residual/Unclassified 4 2 20.0%All Other Values 2 6 33450.0% 355 232 26313.4%SummaryKey Findings: The top three Leading Diagnostic Categories in the current reporting month based on Paid PMPM were Musculoskeletal, Circulatory, and Nervous System.13CITY OF MESQUITE: ALL
Pharmacy: Financial SummaryReport Description:This report provides an overview of pharmacy order of reduction from billed to paid for the current month, current period, prior period, and percent change.Pharmacy Order of ReductionDec 2017Jan 2016 - Dec 2016Jan 2017 - Dec 2017% ChangeBilled 628,991 6,785,382 6,276,261-7.5%Covered 628,991 6,785,382 6,276,261-7.5%Discount 325,264 3,433,467 3,360,425-2.1%Allowed 303,727 3,351,915 2,915,837-13.0%Out of Pocket 37,757 626,151 601,621-3.9% 38 1,981 3,06254.6%Paid - Provider 265,931 2,723,782 2,311,153-15.2%Paid 265,931 2,723,782 2,311,153-15.2%Other AdjustmentsTotal PaidSpecialty PaidPrior 2,723,782 837,229Current 2,311,153 847,58114CITY OF MESQUITE: ALL
Pharmacy: Key IndicatorsReport Description: This report provides an overview of the prescription expenses as well as providing percent change in these expenses between the current month, currentperiod, prior period and percent change.Key Indicators SummaryKey Indicators SummaryDec 2017Jan 2016 - Dec 2016Jan 2017 - Dec 2017% ChangeUnique Pharmacy MembersAverage Age (Years)Proportion of MalesProportion of FemalesMember MonthsClaimantsServicesPrescriptions PMPMPaidPaid PMPMAllowedAllowed PMPMAvg. Ingredient Cost/PrescriptionGeneric Dispensing RateFormulary Compliance RateGeneric Substitution RateOut of Pocket Percent of AllowedRetail as a Percent of PrescriptionsMail Order as a Percent of PrescriptionsSpecialty Percent of Total PrescriptionsSpecialty Percent of Total PaidSpecialty Average 69372,3430.91 265,931 103.64 303,727 118.37 2.054.4%45.7%31,9812,18724,3780.76 2,723,782 85.17 3,351,915 104.81 1.855.4%44.6%30,6082,10022,4660.73 2,311,153 75.51 2,915,837 95.26 %-9.1%-5.6%1.3%-5.2%0.2%10.4%0.0%-1.1%28.1%19.3% 5,463.49 6,515.38 5,657.11-13.2%Cost Sharing DistributionDec 2017Cost Sharing DistributionMember Out of PocketPlan PaidRetail12.4%87.6%Mail11.7%88.3%Jan 2016 - Dec 2016RetailMail18.6%25.0%81.4%75.0%Jan 2017 - Dec 2017RetailMail20.5%31.9%79.5%68.1%% ChangeRetail10.1%-2.3%Mail27.5%-9.2%Savings SummarySavings SummaryDiscount% DiscountRetail 319,99151.6%Dec 2017Mail 5,27459.9%Summary 325,26451.7%Jan 2016 - Dec 2016RetailMailSummary 3,367,329 66,138 3,433,46750.4%62.6%50.6%Jan 2017 - Dec 2017RetailMailSummary 3,295,191 65,233 3,360,42553.4%61.7%53.5%Retail-2.1%5.9%% ChangeMail-1.4%-1.4%Summary-2.1%5.8%15CITY OF MESQUITE: ALL
Pharmacy: Generic vs. Formulary ExperienceReport Description: For the current period, the prescription drug expenses are displayed below for retail and mail order providers and broken out by drug type and formularyindicator.Total ExpenseAllowed /AllowedPrescription 489,418 26.42 2,385,986 638.99Member ExpenseOut of Pocket /Out of PocketPrescription 251,678 13.58 337,048 90.26Prescriptions18,5283,734% of TotalPrescriptions83%17%Summary22,261100% 2,875,404 129.17 588,726Brand Type BreakdownSingle-Source Brand3,34415% 2,300,261 687.883901472%1% 85,726 23,961 219.81 163.00Brand Formulary1,8208% 1,373,889Brand Non-Formulary1,9149% 1,012,097Prescriptions164% of TotalPrescriptions80%BrandSummary4120520%100% 31,902 40,432 778.09 197.23 9,587 12,895Single-Source BrandMulti-Source BrandMulti-Source Brand w/ DAW1347717%3%3% 31,230 672 672 918.52 95.97 95.97Brand FormularyBrand Non-Formulary15267%13% 12,189 19,713 812.59 758.18Prescriptions18,6923,77522,466% of TotalPrescriptions83%17%100%Brand Type BreakdownSingle-Source BrandMulti-Source BrandMulti-Source Brand w/ DAW13,37839715415%2%1% 2,331,490 86,397 24,632 690.20 217.63 159.95 317,246 29,389 13,239Brand FormularyBrand Non-Formulary1,8351,9408%9% 1,386,078 1,031,810 755.36 531.86 159,439 187,196Retail PrescriptionsGenericBrandMulti-Source BrandMulti-Source Brand w/ DAW1Mail PrescriptionsGenericTotal PrescriptionsGenericBrandSummaryPlan ExpensePaid 237,740 2,045,876Paid/Prescription 12.83 547.90 26.45 2,283,616 102.58 308,330 92.20 1,993,205 596.05 28,717 12,567 73.63 85.49 52,671 11,394 135.05 77.51 754.88 156,570 86.03 1,216,888 668.62 528.79 180,477 94.29 828,988 433.12Total ExpenseAllowed /AllowedPrescription 8,531 52.02Total ExpenseAllowed /AllowedPrescription 497,949 26.64 2,417,888 640.50 2,915,837 129.79Member ExpenseOut of Pocket /Out of PocketPrescription 3,308 20.17Plan ExpensePaid 5,222Paid/Prescription 31.84 233.83 62.90 22,314 27,537 544.25 134.33 8,915 672 672 262.22 95.97 95.97 22,314 0 0 656.31 0.00 0.00 2,869 6,719 191.24 258.41 9,320 12,994 621.36 499.77Member ExpenseOut of Pocket /Out of PocketPrescription 254,986 13.64 346,635 91.82 601,621 26.78Plan ExpensePaid 242,962 2,068,191 2,311,153Paid/Prescription 13.00 547.87 102.87 93.92 74.03 85.97 2,015,520 52,671 11,394 596.66 132.67 73.98 86.89 96.49 1,226,209 841,982 668.23 434.0116CITY OF MESQUITE: ALL
Pharmacy: Top Non-Specialty Therapeutic Drug ClassesReport Description: dŚĞ ƚŽƉ Ϯϱ ƚŚĞƌĂƉĞƵƚŝĐ ĚƌƵŐ ĐůĂƐƐĞƐ ĨŽƌ ƚŚĞ ĐƵƌƌĞŶƚ ƉĞƌŝŽĚ ĂƌĞ ĚŝƐƉůĂLJĞĚ ďĞůŽǁ ƌĂŶŬĞĚ ďLJ ŝŶŐƌĞĚŝĞŶƚ ĐŽƐƚ͘Current/PriorRankPlan Therapeutic ClassPrescriptionsUtilizingMembersIngredient CostAvg. IngredientCost/Prescription(Current)Avg. icRank byVolume11Insulin20044 254,040 1,270.20 973.6071.5%0.0%3122Antidiabetic Combinations15037 124,183 827.89 776.7336.0%9.3%4134Sympathomimetics577262 103,183 178.83 175.4190.6%21.0%543Incretin Mimetic Agents (GLP-1 Receptor Agonists)7123 99,492 1,401.30 1,190.0745.1%0.0%7255Dipeptidyl Peptidase-4 (DPP-4) Inhibitors8529 83,313 980.16 944.2877.7%0.0%6169Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors12322 81,705 664.27 625.6471.5%0.0%4778Amphetamines36176 64,448 178.53 219.6186.2%47.7%21810Diagnostic Tests15676 48,158 308.71 307.7830.1%0.0%40911Acne Products11971 45,784 384.74 400.1643.7%52.1%481025Beta Blockers Cardio-Selective400100 34,181 85.45 63.0572.3%73.3%181116Antihypertensive Combinations553149 27,628 49.96 59.5592.0%98.0%61212Stimulants - Misc.10830 25,429 235.45 236.5544.4%73.2%511320Thyroid Hormones732165 24,381 33.31 35.1460.9%61.6%4147HMG CoA Reductase Inhibitors1,121355 24,083 21.48 68.1993.4%98.7%11514Anticonvulsants - Misc.41197 24,010 58.42 78.9088.8%92.5%171618Steroid Inhalants8243 22,920 279.51 262.4474.4%34.2%651721Combination Contraceptives - Oral483126 22,621 46.83 49.3184.3%94.0%1318Anti-Obesity Agents3216 21,189 662.17 00.0%0.0%11119Biguanides28196 19,255 68.52 34.4398.9%100.0%272022Proton Pump Inhibitors506164 18,262 36.09 49.9491.1%95.5%112123Corticosteroids - Topical220176 18,014 81.88 133.5284.1%95.5%2922Influenza Agents146148 17,842 122.21 145.4567.8%84.9%4223Phosphate Binder Agents122 17,624 1,468.63 1,673.368.3%8.3%15324Anti-infective Agents - Misc.6052 17,259 287.64 71.01100.0%91.7%8025Combination Contraceptives - Vaginal6516 16,138 248.27 201.56100.0%0.0%77All Other15,2441,954 683,071 44.81 62.5188.4%90.7%Summary22,2982,099 1,938,214 86.92 98.8185.7%83.8%17CITY OF MESQUITE: ALL
Pharmacy: Top Non-Specialty Prescription DrugsReport Description: dŚĞ ƚŽƉ Ϯϱ ƉƌĞƐĐƌŝƉƚŝŽŶ ĚƌƵŐƐ ĨŽƌ ƚŚĞ ĐƵƌƌĞŶƚ ƉĞƌŝŽĚ ĂƌĞ ĚŝƐƉůĂLJĞĚ ďĞůŽǁ ƌĂŶŬĞĚ ďLJ ŝŶŐƌĞĚŝĞŶƚ embersIngredientCostInsulin7021 68,043 972.04 839.64YESNO34Brand NamePlan Therapeutic Class12LANTUS26HUMALOG KWIK INJ 100/MLInsulin3110 60,121 1,939.37 1,217.57NONO12733JANUVIADipeptidyl Peptidase-4 (DPP-4) Inhibitors4917 48,477 989.33 924.47YESNO67413HUMALOGINJ 100/MLInsulin246 41,635 1,734.79 1,393.57NONO17357LEVEMIRINJ FLEXTOUCInsulin238 37,233 1,618.81 1,028.97YESNO19068GLYXAMBIAntidiabetic Combinations268 36,091 1,388.10 1,066.17NONO15575VICTOZAIncretin Mimetic Agents (GLP-1 Receptor2411 33,329 1,388.69 1,131.01YESNO175829TRULICITY INJ 0.75/0.5Incretin Mimetic Agents (GLP-1 Receptor237 31,558 1,372.07 1,298.95NONO18894TRULICITY INJ 1.5/0.5Incretin Mimetic Agents (GLP-1 Receptor165 29,552 1,847.00 1,304.38NONO2961010ONETOUCHTES ULTRA BLDiagnostic Tests6034 23,258 387.63 361.02NONO441121INVOKANATAB 100MGSodium-Glucose Co-Transporter 2 (SGLT2315 20,189 651.27 838.01YESNO1301220TRADJENTA TAB 5MGDipeptidyl Peptidase-4 (DPP-4) Inhibitors186 19,244 1,069.11 1,044.05NONO2611317INVOKANASodium-Glucose Co-Transporter 2 (SGLT2315 19,086 615.67 506.53YESNO131Not Available44 18,050 4,512.38NONO1256Insulin145 16,835 1,202.48 844.85YESNO34314INJ SOLOSTARAvg. Ingredient Avg. IngredientCost/Cost/PrescriptionPrescription Formulary Generic Rank by(Current)(Prior)Indicator Indicator VolumeTAB 100MGTAB 25-5 MGINJ 18MG/3MLTAB 300MG!1514NOVOLOG1618RENVELATAB 800MGPhosphate Binder Agents112 16,458 1,496.21 1,822.78NONO4811715VYVANSECAP 60MGAmphetamines5411 16,298 301.81 403.18YESNO521811JARDIANCE TAB 25MGSodium-Glucose Co-Transporter 2 (SGLT2157 16,139 1,075.93 811.96YESNO3241931NUVARINGCombination Contraceptives - Vaginal6516 16,138 248.27 219.77YESNO392027BYSTOLICBeta Blockers Cardio-Selective6419 15,998 249.97 241.21NONO402124SYMBICORT AER 160-4.5Sympathomimetics3617 15,566 432.39 514.02YESNO1042219ADVAIR DISKU AER 250/50Sympathomimetics1811 15,332 851.76 602.82YESNO253SAXENDAAnti-Obesity Agents52 15,240 3,047.92NONO952XIGDUO XR TAB 10-1000Antidiabetic Combinations204 15,176 758.78 1,052.05NONO230XIFAXANAnti-infective Agents - Misc.31 14,064 4,687.96 1,520.98YESNO1538All Other21,5632,095 1,279,108 59.32 75.79Summary22,2982,099 1,938,214 86.92 98.8123242526INJ FLEXPENMISTAB 10MGINJ 6MG/MLTAB 550MG18CITY OF MESQUITE: ALL
Pharmacy: Specialty Drug AnalysisReport Description: ƉĞĐŝĂůƚLJ ĚƌƵŐƐ ŐĞŶĞƌĂůůLJ ŚĂǀĞ ƵŶŝƋƵĞ ƵƐĞƐ͕ ƌĞƋƵŝƌĞ ƐƉĞĐŝĂů ĚŽƐŝŶŐ Žƌ ĂĚŵŝŶŝƐƚƌĂƚŝŽŶ͕ ĂƌĞ ƚLJƉŝĐĂůůLJ ƉƌĞƐĐƌŝďĞĚ ďLJ Ă ƐƉĞĐŝĂůŝƐƚ ƉƌŽǀŝĚĞƌ ĂŶĚ ĂƌĞ ƐŝŐŶŝĨŝĐĂŶƚůLJ more expensive than alternative drugs or therapies. This report provides specialty drug analysis for the current month, current period, prior period and percent change.Specialty Drug Key IndicatorsDec 2017Jan 2016 - Dec 2016Jan 2017 - Dec 2017% ChangeUnique Pharmacy Members2,5662,9152,858-2.0%Member Months2,56631,98130,608-4.3%ClaimantsPercent of Utilizing MembersServicesSpecialty Percent of Total PaidPercent of Total Prescriptions 30.7%36.7%19.3%0.6%0.6%0.7%28.2%Paid 75,590 837,229 847,5811.2%Paid PMPM 29.46 26.18 27.695.8%Average Ingredient Cost/Prescription 5,463 6,515 5,657-13.2%Out of Pocket 900 61,912 74,54220.4%Out of Pocket PMPM 0.35 1.94 2.4425.8%Out of Pocket Percent of Allowed1.2%6.9%8.1%17.4%Top 15 Specialty Drugs by Ingredient Cost for the Current PeriodBrand NameSpecialty ClassHUMIRA PEN INJ 40MG/0.8LETAIRIS TAB 5MGADEMPAS TAB 2.5MGOMNITROPE INJ 10/1.5MLENBREL SRCLK INJ 50MG/MLREVATIO SUS 10MG/MLHUMIRAKIT 40MG/0.8POMALYST CAP 4MGORENCIA CLCK INJ 125MG/MLSTELARA INJ 45MG/0.5ENBRELINJ 25/0.5MLTRACLEER TAB 62.5MGOTEZLATAB 30MGAUBAGIO TAB 14MGPOMALYST CAP 2MGAll Y.HYPERTENSIGROWTH YPERTENSIAUTOIMMUNEMULTIPLE SCLEROSISCANCER-ORALIngredientCost 224,731 107,186 104,445 52,209 52,004 50,246 43,542 40,955 37,765 36,947 34,671 32,741 29,963 29,134 29,002 16,568 922,109PrescriptionsAvg. 110126103104167105310163 6,609.72 8,932.20 9,495.02 5,220.94 4,333.70 8,374.40 4,354.19 13,651.55 3,776.50 9,236.66 2,166.92 4,677.34 2,996.33 5,826.78 9,667.18 1,656.78 5,657.1141112111112131182519CITY OF MESQUITE: ALL
Appendix: ICD Category DefinitionsComplications of Pregnancy, Childbirth and the Puerperium: Includes vaginal and cesarean deliveries and complications of pregnancy, such as ectopic and molar pregnancies.Puerperium refers to 42 days following childbirth and expulsion of the placenta. Refers to the mother only.Conditions Influencing Health Status: This includes post-surgical states, organ / tissue transplants, artificial limbs and replacements. Examples include knee replacements andkidney transplant status.Conditions in the Perinatal Period: Perinatal refers to the period beginning after the 28th week of gestation and ending 28 days after birth. Problems can include hemorrhage,digestive disorders, respiratory distress syndrome and disorders relating to short gestation and unspecified low birth weight.Congenital Anomalies: Includes the treatment of any condition present at birth. This includes Spina Bifida, cleft palate, Down's Syndrome, heart disease, kidney displacement& polycystic kidney disease.Diseases of the Blood and Blood Forming Organs: Includes any problems associated with white or red blood cells, platelets or plasma. An example includes Anemia, adeficiency in red blood cells.Diseases of the Circulatory System: Includes problems with the heart, blood vessels and circulation. Some common diagnoses include Coronary Artery Disease, cardiovasculardisease, and stroke.Diseases of the Digestive System: Includes the treatment of any organ or area of the body pertaining to digestion. These areas include the mouth/teeth, esophagus, stomach,intestines, gall bladder, liver and pancreas. Diagnoses include: Esophageal Reflux, Gastroenteritis, Appendicitis and hernias.Diseases of the Genitourinary System: Includes problems related to the kidneys, bladder and male and female genitalia. Common diagnoses include Hematuria, Urinary TractInfection, Acute or Chronic Renal Failure and Calculus of Kidney (stones).Diseas
Email: client_reporting@bcbsil.com Phone: 1-877-837-1866 Hours of Operation: Monday - Friday: 8:00am - 5:00pm CT. Report prepared on 01/10/2018. The report includes medical claims and pharmacy claims. Reporting Segments: ALL Characteristics: ALL Group/Sections: ALL. CITY OF MESQUITE: ALL .
