Top Drug Utilization Ranked by Net Paid-2018 - OptionManaged Pharmacy Cost and Utilization by Month-2018Managed Pharmacy Cost and Utilization by Month-2018Managed Pharmacy Cost and Utilization by Month-2018 - OptionSummaryRecent ReportsSummary
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Top Drug Utilization Ranked by Net Paid-2018
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Top Drug Utilization Ranked by Net Paid

Top Drugs
NDC NumberGeneric/Brand CategoryPrescription TierSubmission Method CategoryDrug NameFDB Standard Therapeutic ClassMetricsNumber of ClaimantsNumber of PrescriptionsPlan Net PaidHRA Net PaidTotal Net Paid% of Total Prescriptions% of Plan Net Paid% of HRA Net Paid% of Total Net PaidPlan Net Paid per PrescriptionHRA Net Paid per PrescriptionTotal Net Paid per PrescriptionAverage Days SupplyIngredient Cost Paid per Day Of Therapy
00002143380Brand DrugTier 3RetailTRULICITYDIABETIC THERAPY514$7,098$0$7,0980.1%0.4%0.0%0.4%$507.03$0.00$507.0328.07$24.97
Subtotal--14$7,098$0$7,0980.1%0.4%0.0%0.4%$507.03$0.00$507.0328.07$24.97
Subtotal --14$7,098$0$7,0980.1%0.4%0.0%0.4%$507.03$0.00$507.0328.07$24.97
00002143480Brand DrugTier 3RetailTRULICITYDIABETIC THERAPY920$7,884$0$7,8840.1%0.5%0.0%0.5%$394.21$0.00$394.2128.10$25.19
Subtotal--20$7,884$0$7,8840.1%0.5%0.0%0.5%$394.21$0.00$394.2128.10$25.19
Subtotal --20$7,884$0$7,8840.1%0.5%0.0%0.5%$394.21$0.00$394.2128.10$25.19
Home DeliveryTRULICITYDIABETIC THERAPY11$1,915$0$1,9150.0%0.1%0.0%0.1%$1,915.24$0.00$1,915.2484.00$22.80
Subtotal--1$1,915$0$1,9150.0%0.1%0.0%0.1%$1,915.24$0.00$1,915.2484.00$22.80
Subtotal --1$1,915$0$1,9150.0%0.1%0.0%0.1%$1,915.24$0.00$1,915.2484.00$22.80
00002446230Brand DrugTier 3RetailCIALISMISCELLANEOUS33$265$0$2650.0%0.0%0.0%0.0%$88.24$0.00$88.2413.33$11.45
Subtotal--3$265$0$2650.0%0.0%0.0%0.0%$88.24$0.00$88.2413.33$11.45
Subtotal --3$265$0$2650.0%0.0%0.0%0.0%$88.24$0.00$88.2413.33$11.45
00002446234Brand DrugTier 3Home DeliveryCIALISMISCELLANEOUS11$769$0$7690.0%0.0%0.0%0.0%$768.95$0.00$768.9590.00$10.77
Subtotal--1$769$0$7690.0%0.0%0.0%0.0%$768.95$0.00$768.9590.00$10.77
Subtotal --1$769$0$7690.0%0.0%0.0%0.0%$768.95$0.00$768.9590.00$10.77
RetailCIALISMISCELLANEOUS24$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.25$1.93
Subtotal--4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.25$1.93
Subtotal --4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.25$1.93
00002446330Brand DrugTier 3RetailCIALISMISCELLANEOUS11$256$0$2560.0%0.0%0.0%0.0%$255.97$0.00$255.9730.00$11.17
Subtotal--1$256$0$2560.0%0.0%0.0%0.0%$255.97$0.00$255.9730.00$11.17
Subtotal --1$256$0$2560.0%0.0%0.0%0.0%$255.97$0.00$255.9730.00$11.17
00002446430Brand DrugTier 3RetailCIALISMISCELLANEOUS1426$6,086$0$6,0860.1%0.4%0.0%0.4%$234.08$0.00$234.0821.88$14.74
Subtotal--26$6,086$0$6,0860.1%0.4%0.0%0.4%$234.08$0.00$234.0821.88$14.74
Subtotal --26$6,086$0$6,0860.1%0.4%0.0%0.4%$234.08$0.00$234.0821.88$14.74
00002512330Brand DrugTier 3RetailEFFIENTANTICOAGULANTS11$452$0$4520.0%0.0%0.0%0.0%$452.30$0.00$452.3030.00$15.38
Subtotal--1$452$0$4520.0%0.0%0.0%0.0%$452.30$0.00$452.3030.00$15.38
Subtotal --1$452$0$4520.0%0.0%0.0%0.0%$452.30$0.00$452.3030.00$15.38
00002751001Brand DrugTier 1RetailHUMALOGDIABETIC THERAPY39$6,070$0$6,0700.0%0.4%0.0%0.4%$674.40$0.00$674.4029.67$26.83
Subtotal--9$6,070$0$6,0700.0%0.4%0.0%0.4%$674.40$0.00$674.4029.67$26.83
Subtotal --9$6,070$0$6,0700.0%0.4%0.0%0.4%$674.40$0.00$674.4029.67$26.83
00002751659Brand DrugTier 2RetailHUMALOGDIABETIC THERAPY13$1,003$0$1,0030.0%0.1%0.0%0.1%$334.39$0.00$334.3930.00$17.10
Subtotal--3$1,003$0$1,0030.0%0.1%0.0%0.1%$334.39$0.00$334.3930.00$17.10
Subtotal --3$1,003$0$1,0030.0%0.1%0.0%0.1%$334.39$0.00$334.3930.00$17.10
00002771227Brand DrugTier 2RetailHUMALOG KWIKPEN U-200DIABETIC THERAPY12$2,553$0$2,5530.0%0.2%0.0%0.2%$1,276.25$0.00$1,276.2524.00$53.15
Subtotal--2$2,553$0$2,5530.0%0.2%0.0%0.2%$1,276.25$0.00$1,276.2524.00$53.15
Subtotal --2$2,553$0$2,5530.0%0.2%0.0%0.2%$1,276.25$0.00$1,276.2524.00$53.15
00002771559Brand DrugTier 1RetailBASAGLAR KWIKPEN U-100DIABETIC THERAPY3583$37,505$0$37,5050.4%2.2%0.0%2.2%$451.87$0.00$451.8728.41$17.38
Subtotal--83$37,505$0$37,5050.4%2.2%0.0%2.2%$451.87$0.00$451.8728.41$17.38
Subtotal --83$37,505$0$37,5050.4%2.2%0.0%2.2%$451.87$0.00$451.8728.41$17.38
Home DeliveryBASAGLAR KWIKPEN U-100DIABETIC THERAPY78$7,089$0$7,0890.0%0.4%0.0%0.4%$886.11$0.00$886.1190.00$11.13
Subtotal--8$7,089$0$7,0890.0%0.4%0.0%0.4%$886.11$0.00$886.1190.00$11.13
Subtotal --8$7,089$0$7,0890.0%0.4%0.0%0.4%$886.11$0.00$886.1190.00$11.13
00002803101Brand DrugTier 2RetailGLUCAGON EMERGENCY KITDIABETIC THERAPY23$848$0$8480.0%0.1%0.0%0.1%$282.80$0.00$282.801.00$281.87
Subtotal--3$848$0$8480.0%0.1%0.0%0.1%$282.80$0.00$282.801.00$281.87
Subtotal --3$848$0$8480.0%0.1%0.0%0.1%$282.80$0.00$282.801.00$281.87
00002821501Brand DrugTier 1RetailHUMULIN RDIABETIC THERAPY11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$4.98
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$4.98
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$4.98
00002879959Brand DrugTier 2RetailHUMALOGDIABETIC THERAPY1125$14,224$0$14,2240.1%0.9%0.0%0.9%$568.96$0.00$568.9626.80$21.19
Subtotal--25$14,224$0$14,2240.1%0.9%0.0%0.9%$568.96$0.00$568.9626.80$21.19
Subtotal --25$14,224$0$14,2240.1%0.9%0.0%0.9%$568.96$0.00$568.9626.80$21.19
Home DeliveryHUMALOGDIABETIC THERAPY22$3,997$0$3,9970.0%0.2%0.0%0.2%$1,998.51$0.00$1,998.5190.00$22.26
Subtotal--2$3,997$0$3,9970.0%0.2%0.0%0.2%$1,998.51$0.00$1,998.5190.00$22.26
Subtotal --2$3,997$0$3,9970.0%0.2%0.0%0.2%$1,998.51$0.00$1,998.5190.00$22.26
00002882427Brand DrugTier 2RetailHUMULIN R U-500 KWIKPENDIABETIC THERAPY15$5,757$0$5,7570.0%0.3%0.0%0.3%$1,151.45$0.00$1,151.4515.00$76.71
Subtotal--5$5,757$0$5,7570.0%0.3%0.0%0.3%$1,151.45$0.00$1,151.4515.00$76.71
Subtotal --5$5,757$0$5,7570.0%0.3%0.0%0.3%$1,151.45$0.00$1,151.4515.00$76.71
00003085222Brand DrugTier 3RetailSPRYCELANTINEOPLASTICS14$46,505$0$46,5050.0%2.8%0.0%2.8%$11,626.36$0.00$11,626.3630.00$429.27
Subtotal--4$46,505$0$46,5050.0%2.8%0.0%2.8%$11,626.36$0.00$11,626.3630.00$429.27
Subtotal --4$46,505$0$46,5050.0%2.8%0.0%2.8%$11,626.36$0.00$11,626.3630.00$429.27
00003089321Brand DrugTier 3RetailELIQUISANTICOAGULANTS14$456$0$4560.0%0.0%0.0%0.0%$113.89$0.00$113.8930.00$14.01
Subtotal--4$456$0$4560.0%0.0%0.0%0.0%$113.89$0.00$113.8930.00$14.01
Subtotal --4$456$0$4560.0%0.0%0.0%0.0%$113.89$0.00$113.8930.00$14.01
00003089421Brand DrugTier 3RetailELIQUISANTICOAGULANTS1023$5,093$0$5,0930.1%0.3%0.0%0.3%$221.42$0.00$221.4232.61$13.98
Subtotal--23$5,093$0$5,0930.1%0.3%0.0%0.3%$221.42$0.00$221.4232.61$13.98
Subtotal --23$5,093$0$5,0930.1%0.3%0.0%0.3%$221.42$0.00$221.4232.61$13.98
Home DeliveryELIQUISANTICOAGULANTS11$987$0$9870.0%0.1%0.0%0.1%$987.21$0.00$987.2190.00$13.19
Subtotal--1$987$0$9870.0%0.1%0.0%0.1%$987.21$0.00$987.2190.00$13.19
Subtotal --1$987$0$9870.0%0.1%0.0%0.1%$987.21$0.00$987.2190.00$13.19
00004080085Brand DrugTier 2RetailTAMIFLUANTIVIRALS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.005.00$30.47
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.005.00$30.47
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.005.00$30.47
00004082205Brand DrugTier 2RetailTAMIFLUANTIVIRALS33$798$0$7980.0%0.0%0.0%0.0%$265.90$0.00$265.905.00$61.00
Subtotal--3$798$0$7980.0%0.0%0.0%0.0%$265.90$0.00$265.905.00$61.00
Subtotal --3$798$0$7980.0%0.0%0.0%0.0%$265.90$0.00$265.905.00$61.00
Tier 3RetailTAMIFLUANTIVIRALS10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal--0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal --0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
00006003330Brand DrugTier 3RetailBELSOMRASEDATIVE NON-BARBITURATE56$765$0$7650.0%0.0%0.0%0.0%$127.49$0.00$127.4926.67$12.70
Subtotal--6$765$0$7650.0%0.0%0.0%0.0%$127.49$0.00$127.4926.67$12.70
Subtotal --6$765$0$7650.0%0.0%0.0%0.0%$127.49$0.00$127.4926.67$12.70
00006007861Brand DrugTier 3RetailJANUMET XRDIABETIC THERAPY13$9$0$90.0%0.0%0.0%0.0%$3.01$0.00$3.0130.00$7.17
Subtotal--3$9$0$90.0%0.0%0.0%0.0%$3.01$0.00$3.0130.00$7.17
Subtotal --3$9$0$90.0%0.0%0.0%0.0%$3.01$0.00$3.0130.00$7.17
00006008061Brand DrugTier 3RetailJANUMET XRDIABETIC THERAPY24$1,298$0$1,2980.0%0.1%0.0%0.1%$324.56$0.00$324.5630.00$14.39
Subtotal--4$1,298$0$1,2980.0%0.1%0.0%0.1%$324.56$0.00$324.5630.00$14.39
Subtotal --4$1,298$0$1,2980.0%0.1%0.0%0.1%$324.56$0.00$324.5630.00$14.39
00006008062Brand DrugTier 3RetailJANUMET XRDIABETIC THERAPY12$884$0$8840.0%0.1%0.0%0.1%$441.75$0.00$441.7530.00$14.68
Subtotal--2$884$0$8840.0%0.1%0.0%0.1%$441.75$0.00$441.7530.00$14.68
Subtotal --2$884$0$8840.0%0.1%0.0%0.1%$441.75$0.00$441.7530.00$14.68
00006008131Brand DrugTier 3RetailJANUMET XRDIABETIC THERAPY38$2,561$0$2,5610.0%0.2%0.0%0.2%$320.14$0.00$320.1430.00$14.25
Subtotal--8$2,561$0$2,5610.0%0.2%0.0%0.2%$320.14$0.00$320.1430.00$14.25
Subtotal --8$2,561$0$2,5610.0%0.2%0.0%0.2%$320.14$0.00$320.1430.00$14.25
00006008154Brand DrugTier 3RetailJANUMET XRDIABETIC THERAPY13$1,325$0$1,3250.0%0.1%0.0%0.1%$441.75$0.00$441.7530.00$14.68
Subtotal--3$1,325$0$1,3250.0%0.1%0.0%0.1%$441.75$0.00$441.7530.00$14.68
Subtotal --3$1,325$0$1,3250.0%0.1%0.0%0.1%$441.75$0.00$441.7530.00$14.68
00006011231Brand DrugTier 3RetailJANUVIADIABETIC THERAPY49$3,083$0$3,0830.0%0.2%0.0%0.2%$342.58$0.00$342.5830.00$13.01
Subtotal--9$3,083$0$3,0830.0%0.2%0.0%0.2%$342.58$0.00$342.5830.00$13.01
Subtotal --9$3,083$0$3,0830.0%0.2%0.0%0.2%$342.58$0.00$342.5830.00$13.01
00006011254Brand DrugTier 3RetailJANUVIADIABETIC THERAPY25$2,169$0$2,1690.0%0.1%0.0%0.1%$433.85$0.00$433.8530.00$14.43
Subtotal--5$2,169$0$2,1690.0%0.1%0.0%0.1%$433.85$0.00$433.8530.00$14.43
Subtotal --5$2,169$0$2,1690.0%0.1%0.0%0.1%$433.85$0.00$433.8530.00$14.43
00006022131Brand DrugTier 3RetailJANUVIADIABETIC THERAPY11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$14.35
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$14.35
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$14.35
00006027731Brand DrugTier 3RetailJANUVIADIABETIC THERAPY1540$15,572$0$15,5720.2%0.9%0.0%0.9%$389.30$0.00$389.3030.00$14.35
Subtotal--40$15,572$0$15,5720.2%0.9%0.0%0.9%$389.30$0.00$389.3030.00$14.35
Subtotal --40$15,572$0$15,5720.2%0.9%0.0%0.9%$389.30$0.00$389.3030.00$14.35
00006027754Brand DrugTier 3RetailJANUVIADIABETIC THERAPY11$442$0$4420.0%0.0%0.0%0.0%$441.75$0.00$441.7530.00$14.68
Subtotal--1$442$0$4420.0%0.0%0.0%0.0%$441.75$0.00$441.7530.00$14.68
Subtotal --1$442$0$4420.0%0.0%0.0%0.0%$441.75$0.00$441.7530.00$14.68
00006027782Brand DrugTier 3RetailJANUVIADIABETIC THERAPY12$631$0$6310.0%0.0%0.0%0.0%$315.63$0.00$315.6322.50$13.99
Subtotal--2$631$0$6310.0%0.0%0.0%0.0%$315.63$0.00$315.6322.50$13.99
Subtotal --2$631$0$6310.0%0.0%0.0%0.0%$315.63$0.00$315.6322.50$13.99
00006033530Brand DrugTier 3RetailBELSOMRASEDATIVE NON-BARBITURATE23$507$0$5070.0%0.0%0.0%0.0%$168.97$0.00$168.9730.00$11.08
Subtotal--3$507$0$5070.0%0.0%0.0%0.0%$168.97$0.00$168.9730.00$11.08
Subtotal --3$507$0$5070.0%0.0%0.0%0.0%$168.97$0.00$168.9730.00$11.08
00006057561Brand DrugTier 3RetailJANUMETDIABETIC THERAPY411$3,890$0$3,8900.1%0.2%0.0%0.2%$353.61$0.00$353.6130.00$14.37
Subtotal--11$3,890$0$3,8900.1%0.2%0.0%0.2%$353.61$0.00$353.6130.00$14.37
Subtotal --11$3,890$0$3,8900.1%0.2%0.0%0.2%$353.61$0.00$353.6130.00$14.37
Home DeliveryJANUMETDIABETIC THERAPY11$1,127$0$1,1270.0%0.1%0.0%0.1%$1,127.05$0.00$1,127.0590.00$12.52
Subtotal--1$1,127$0$1,1270.0%0.1%0.0%0.1%$1,127.05$0.00$1,127.0590.00$12.52
Subtotal --1$1,127$0$1,1270.0%0.1%0.0%0.1%$1,127.05$0.00$1,127.0590.00$12.52
00006057761Brand DrugTier 3RetailJANUMETDIABETIC THERAPY718$5,153$0$5,1530.1%0.3%0.0%0.3%$286.28$0.00$286.2828.33$13.90
Subtotal--18$5,153$0$5,1530.1%0.3%0.0%0.3%$286.28$0.00$286.2828.33$13.90
Subtotal --18$5,153$0$5,1530.1%0.3%0.0%0.3%$286.28$0.00$286.2828.33$13.90
00006057762Brand DrugTier 3RetailJANUMETDIABETIC THERAPY11$431$0$4310.0%0.0%0.0%0.0%$431.21$0.00$431.2130.00$14.35
Subtotal--1$431$0$4310.0%0.0%0.0%0.0%$431.21$0.00$431.2130.00$14.35
Subtotal --1$431$0$4310.0%0.0%0.0%0.0%$431.21$0.00$431.2130.00$14.35
00006496341Brand DrugTier 3RetailZOSTAVAXBIOLOGICALS11$214$0$2140.0%0.0%0.0%0.0%$213.84$0.00$213.841.00$213.09
Subtotal--1$214$0$2140.0%0.0%0.0%0.0%$213.84$0.00$213.841.00$213.09
Subtotal --1$214$0$2140.0%0.0%0.0%0.0%$213.84$0.00$213.841.00$213.09
00008112312Brand DrugTier 3RetailDUAVEEESTROGENS13$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$5.75
Subtotal--3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$5.75
Subtotal --3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$5.75
00009041701Brand DrugTier 3RetailDEPO-TESTOSTERONEANDROGENS13$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0028.00$0.35
Subtotal--3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0028.00$0.35
Subtotal --3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0028.00$0.35
00009519101Brand DrugTier 3RetailDETROL LAANTISPASMODIC AND ANTICHOLINERGIC AGENTS14$1,151$0$1,1510.0%0.1%0.0%0.1%$287.83$0.00$287.8330.00$12.23
Subtotal--4$1,151$0$1,1510.0%0.1%0.0%0.1%$287.83$0.00$287.8330.00$12.23
Subtotal --4$1,151$0$1,1510.0%0.1%0.0%0.1%$287.83$0.00$287.8330.00$12.23
00013215036Brand DrugTier 2RetailESTRINGESTROGENS11$289$0$2890.0%0.0%0.0%0.0%$288.91$0.00$288.9190.00$4.54
Subtotal--1$289$0$2890.0%0.0%0.0%0.0%$288.91$0.00$288.9190.00$4.54
Subtotal --1$289$0$2890.0%0.0%0.0%0.0%$288.91$0.00$288.9190.00$4.54
00023320503Brand DrugTier 2RetailLUMIGANOPHTHALMIC PREPARATIONS12$282$0$2820.0%0.0%0.0%0.0%$140.99$0.00$140.9925.00$7.21
Subtotal--2$282$0$2820.0%0.0%0.0%0.0%$140.99$0.00$140.9925.00$7.21
Subtotal --2$282$0$2820.0%0.0%0.0%0.0%$140.99$0.00$140.9925.00$7.21
00023320505Brand DrugTier 2RetailLUMIGANOPHTHALMIC PREPARATIONS12$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0015.00$24.09
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0015.00$24.09
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0015.00$24.09
00023520660Brand DrugTier 3RetailACZONEALL OTHER DERMATOLOGICALS46$1,686$0$1,6860.0%0.1%0.0%0.1%$281.01$0.00$281.0130.00$19.87
Subtotal--6$1,686$0$1,6860.0%0.1%0.0%0.1%$281.01$0.00$281.0130.00$19.87
Subtotal --6$1,686$0$1,6860.0%0.1%0.0%0.1%$281.01$0.00$281.0130.00$19.87
00023915530Brand DrugTier 3RetailTAZORACALL OTHER DERMATOLOGICALS10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal--0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal --0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
00023915630Brand DrugTier 1RetailTAZORACALL OTHER DERMATOLOGICALS22$783$0$7830.0%0.0%0.0%0.0%$391.39$0.00$391.3930.00$13.25
Subtotal--2$783$0$7830.0%0.0%0.0%0.0%$391.39$0.00$391.3930.00$13.25
Subtotal --2$783$0$7830.0%0.0%0.0%0.0%$391.39$0.00$391.3930.00$13.25
00023916360Brand DrugTier 3RetailRESTASISOPHTHALMIC PREPARATIONS22$433$0$4330.0%0.0%0.0%0.0%$216.44$0.00$216.4430.00$17.04
Subtotal--2$433$0$4330.0%0.0%0.0%0.0%$216.44$0.00$216.4430.00$17.04
Subtotal --2$433$0$4330.0%0.0%0.0%0.0%$216.44$0.00$216.4430.00$17.04
00023921105Brand DrugTier 2RetailCOMBIGANOPHTHALMIC PREPARATIONS12$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0021.50$7.53
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0021.50$7.53
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0021.50$7.53
00023932105Brand DrugTier 2RetailALPHAGAN POPHTHALMIC PREPARATIONS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0014.00$10.49
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0014.00$10.49
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0014.00$10.49
00024414260Brand DrugTier 3RetailMULTAQOTHER CARDIOVASCULAR PREPS13$1,664$0$1,6640.0%0.1%0.0%0.1%$554.81$0.00$554.8130.00$21.13
Subtotal--3$1,664$0$1,6640.0%0.1%0.0%0.1%$554.81$0.00$554.8130.00$21.13
Subtotal --3$1,664$0$1,6640.0%0.1%0.0%0.1%$554.81$0.00$554.8130.00$21.13
00024576105Brand DrugTier 2RetailSOLIQUA 100-33DIABETIC THERAPY25$3,409$0$3,4090.0%0.2%0.0%0.2%$681.71$0.00$681.7130.40$22.39
Subtotal--5$3,409$0$3,4090.0%0.2%0.0%0.2%$681.71$0.00$681.7130.40$22.39
Subtotal --5$3,409$0$3,4090.0%0.2%0.0%0.2%$681.71$0.00$681.7130.40$22.39
00024590102Brand DrugTier 2RetailPRALUENT PENLIPOTROPICS13$3,409$0$3,4090.0%0.2%0.0%0.2%$1,136.49$0.00$1,136.4928.00$40.59
Subtotal--3$3,409$0$3,4090.0%0.2%0.0%0.2%$1,136.49$0.00$1,136.4928.00$40.59
Subtotal --3$3,409$0$3,4090.0%0.2%0.0%0.2%$1,136.49$0.00$1,136.4928.00$40.59
00024590202Brand DrugTier 2RetailPRALUENT PENLIPOTROPICS25$5,587$0$5,5870.0%0.3%0.0%0.3%$1,117.48$0.00$1,117.4828.00$40.48
Subtotal--5$5,587$0$5,5870.0%0.3%0.0%0.3%$1,117.48$0.00$1,117.4828.00$40.48
Subtotal --5$5,587$0$5,5870.0%0.3%0.0%0.3%$1,117.48$0.00$1,117.4828.00$40.48
00032121201Brand DrugTier 2RetailCREONENZYMES11$490$0$4900.0%0.0%0.0%0.0%$489.72$0.00$489.7230.00$17.63
Subtotal--1$490$0$4900.0%0.0%0.0%0.0%$489.72$0.00$489.7230.00$17.63
Subtotal --1$490$0$4900.0%0.0%0.0%0.0%$489.72$0.00$489.7230.00$17.63
00032122401Brand DrugTier 2RetailCREONENZYMES11$1,009$0$1,0090.0%0.1%0.0%0.1%$1,009.11$0.00$1,009.1130.00$34.94
Subtotal--1$1,009$0$1,0090.0%0.1%0.0%0.1%$1,009.11$0.00$1,009.1130.00$34.94
Subtotal --1$1,009$0$1,0090.0%0.1%0.0%0.1%$1,009.11$0.00$1,009.1130.00$34.94
00032301613Brand DrugTier 2RetailCREONENZYMES11$1,552$0$1,5520.0%0.1%0.0%0.1%$1,552.47$0.00$1,552.4730.00$53.05
Subtotal--1$1,552$0$1,5520.0%0.1%0.0%0.1%$1,552.47$0.00$1,552.4730.00$53.05
Subtotal --1$1,552$0$1,5520.0%0.1%0.0%0.1%$1,552.47$0.00$1,552.4730.00$53.05
00046087221Brand DrugTier 3RetailPREMARINESTROGENS32$278$0$2780.0%0.0%0.0%0.0%$138.91$0.00$138.9130.50$11.70
Subtotal--2$278$0$2780.0%0.0%0.0%0.0%$138.91$0.00$138.9130.50$11.70
Subtotal --2$278$0$2780.0%0.0%0.0%0.0%$138.91$0.00$138.9130.50$11.70
00046110081Brand DrugTier 3RetailPREMARINESTROGENS23$255$0$2550.0%0.0%0.0%0.0%$85.05$0.00$85.0550.00$5.18
Subtotal--3$255$0$2550.0%0.0%0.0%0.0%$85.05$0.00$85.0550.00$5.18
Subtotal --3$255$0$2550.0%0.0%0.0%0.0%$85.05$0.00$85.0550.00$5.18
00046110181Brand DrugTier 3RetailPREMARINESTROGENS12$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$5.37
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$5.37
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$5.37
00046110281Brand DrugTier 3RetailPREMARINESTROGENS13$246$0$2460.0%0.0%0.0%0.0%$82.06$0.00$82.0630.00$5.37
Subtotal--3$246$0$2460.0%0.0%0.0%0.0%$82.06$0.00$82.0630.00$5.37
Subtotal --3$246$0$2460.0%0.0%0.0%0.0%$82.06$0.00$82.0630.00$5.37
00046110381Brand DrugTier 3RetailPREMARINESTROGENS13$82$0$820.0%0.0%0.0%0.0%$27.48$0.00$27.4830.00$5.38
Subtotal--3$82$0$820.0%0.0%0.0%0.0%$27.48$0.00$27.4830.00$5.38
Subtotal --3$82$0$820.0%0.0%0.0%0.0%$27.48$0.00$27.4830.00$5.38
00046110511Brand DrugTier 3Home DeliveryPREMPROESTROGENS11$321$0$3210.0%0.0%0.0%0.0%$321.14$0.00$321.1484.00$6.20
Subtotal--1$321$0$3210.0%0.0%0.0%0.0%$321.14$0.00$321.1484.00$6.20
Subtotal --1$321$0$3210.0%0.0%0.0%0.0%$321.14$0.00$321.1484.00$6.20
00051846231Brand DrugTier 3RetailANDROGELANDROGENS25$11,076$0$11,0760.0%0.7%0.0%0.7%$2,215.22$0.00$2,215.2230.00$76.46
Subtotal--5$11,076$0$11,0760.0%0.7%0.0%0.7%$2,215.22$0.00$2,215.2230.00$76.46
Subtotal --5$11,076$0$11,0760.0%0.7%0.0%0.7%$2,215.22$0.00$2,215.2230.00$76.46
00051846233Brand DrugTier 3RetailANDROGELANDROGENS35$4,673$0$4,6730.0%0.3%0.0%0.3%$934.53$0.00$934.5330.00$37.41
Subtotal--5$4,673$0$4,6730.0%0.3%0.0%0.3%$934.53$0.00$934.5330.00$37.41
Subtotal --5$4,673$0$4,6730.0%0.3%0.0%0.3%$934.53$0.00$934.5330.00$37.41
00052027301Brand DrugTier 2RetailNUVARINGSYSTEMIC CONTRACEPTIVES45$1,350$0$1,3500.0%0.1%0.0%0.1%$270.03$0.00$270.0348.80$5.52
Subtotal--5$1,350$0$1,3500.0%0.1%0.0%0.1%$270.03$0.00$270.0348.80$5.52
Subtotal --5$1,350$0$1,3500.0%0.1%0.0%0.1%$270.03$0.00$270.0348.80$5.52
00052027303Brand DrugTier 2RetailNUVARINGSYSTEMIC CONTRACEPTIVES1115$4,801$0$4,8010.1%0.3%0.0%0.3%$320.08$0.00$320.0862.53$5.11
Subtotal--15$4,801$0$4,8010.1%0.3%0.0%0.3%$320.08$0.00$320.0862.53$5.11
Subtotal --15$4,801$0$4,8010.1%0.3%0.0%0.3%$320.08$0.00$320.0862.53$5.11
00054001025Generic DrugTier 1RetailFLECAINIDE ACETATEOTHER CARDIOVASCULAR PREPS13$2$0$20.0%0.0%0.0%0.0%$0.74$0.00$0.7430.00$0.37
Subtotal--3$2$0$20.0%0.0%0.0%0.0%$0.74$0.00$0.7430.00$0.37
Subtotal --3$2$0$20.0%0.0%0.0%0.0%$0.74$0.00$0.7430.00$0.37
00054001725Generic DrugTier 1RetailPREDNISONEGLUCOCORTICOIDS1724$40$0$400.1%0.0%0.0%0.0%$1.65$0.00$1.6515.42$0.44
Subtotal--24$40$0$400.1%0.0%0.0%0.0%$1.65$0.00$1.6515.42$0.44
Subtotal --24$40$0$400.1%0.0%0.0%0.0%$1.65$0.00$1.6515.42$0.44
00054001825Generic DrugTier 1RetailPREDNISONEGLUCOCORTICOIDS2121$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.007.57$0.33
Subtotal--21$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.007.57$0.33
Subtotal --21$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.007.57$0.33
00054001829Generic DrugTier 1RetailPREDNISONEGLUCOCORTICOIDS44$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.005.50$0.29
Subtotal--4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.005.50$0.29
Subtotal --4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.005.50$0.29
00054001925Generic DrugTier 1RetailPREDNISONEGLUCOCORTICOIDS2121$7$0$70.1%0.0%0.0%0.0%$0.35$0.00$0.355.10$0.45
Subtotal--21$7$0$70.1%0.0%0.0%0.0%$0.35$0.00$0.355.10$0.45
Subtotal --21$7$0$70.1%0.0%0.0%0.0%$0.35$0.00$0.355.10$0.45
00054002025Generic DrugTier 1RetailLITHIUM CARBONATE ERPSYCHOSTIMULANTS-ANTIDEPRESSANTS12$43$0$430.0%0.0%0.0%0.0%$21.57$0.00$21.5730.00$1.02
Subtotal--2$43$0$430.0%0.0%0.0%0.0%$21.57$0.00$21.5730.00$1.02
Subtotal --2$43$0$430.0%0.0%0.0%0.0%$21.57$0.00$21.5730.00$1.02
00054002125Generic DrugTier 1RetailLITHIUM CARBONATE ERPSYCHOSTIMULANTS-ANTIDEPRESSANTS13$81$0$810.0%0.0%0.0%0.0%$26.96$0.00$26.9630.00$1.20
Subtotal--3$81$0$810.0%0.0%0.0%0.0%$26.96$0.00$26.9630.00$1.20
Subtotal --3$81$0$810.0%0.0%0.0%0.0%$26.96$0.00$26.9630.00$1.20
00054004641Generic DrugTier 1Home DeliveryIPRATROPIUM BROMIDETOPICAL NASAL AND OTIC PREPARATIONS11$134$0$1340.0%0.0%0.0%0.0%$134.36$0.00$134.3690.00$1.77
Subtotal--1$134$0$1340.0%0.0%0.0%0.0%$134.36$0.00$134.3690.00$1.77
Subtotal --1$134$0$1340.0%0.0%0.0%0.0%$134.36$0.00$134.3690.00$1.77
RetailIPRATROPIUM BROMIDETOPICAL NASAL AND OTIC PREPARATIONS12$17$0$170.0%0.0%0.0%0.0%$8.59$0.00$8.5930.50$0.86
Subtotal--2$17$0$170.0%0.0%0.0%0.0%$8.59$0.00$8.5930.50$0.86
Subtotal --2$17$0$170.0%0.0%0.0%0.0%$8.59$0.00$8.5930.50$0.86
00054008525Generic DrugTier 1RetailZALEPLONSEDATIVE NON-BARBITURATE12$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.25
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.25
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.25
00054010929Generic DrugTier 1RetailRAMIPRILOTHER ANTIHYPERTENSIVES23$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.11
Subtotal--3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.11
Subtotal --3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.11
00054028913Generic DrugTier 1RetailMONTELUKAST SODIUMBRONCHIAL DILATORS22$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
00054034807Generic DrugTier 1RetailTINIDAZOLEANTIPARASITICS22$114$0$1140.0%0.0%0.0%0.0%$56.88$0.00$56.884.50$14.65
Subtotal--2$114$0$1140.0%0.0%0.0%0.0%$56.88$0.00$56.884.50$14.65
Subtotal --2$114$0$1140.0%0.0%0.0%0.0%$56.88$0.00$56.884.50$14.65
00054039063Generic DrugTier 1RetailOXYCODONE HCLNARCOTIC ANALGESICS45$133$0$1330.0%0.0%0.0%0.0%$26.64$0.00$26.645.60$6.69
Subtotal--5$133$0$1330.0%0.0%0.0%0.0%$26.64$0.00$26.645.60$6.69
Subtotal --5$133$0$1330.0%0.0%0.0%0.0%$26.64$0.00$26.645.60$6.69
00054040013Generic DrugTier 1RetailDESVENLAFAXINE SUCCINATE ERPSYCHOSTIMULANTS-ANTIDEPRESSANTS14$170$0$1700.0%0.0%0.0%0.0%$42.38$0.00$42.3830.00$1.72
Subtotal--4$170$0$1700.0%0.0%0.0%0.0%$42.38$0.00$42.3830.00$1.72
Subtotal --4$170$0$1700.0%0.0%0.0%0.0%$42.38$0.00$42.3830.00$1.72
00054054618Generic DrugTier 1RetailTELMISARTAN-HYDROCHLOROTHIAZIDOTHER ANTIHYPERTENSIVES415$882$0$8820.1%0.1%0.0%0.1%$58.79$0.00$58.7930.00$2.96
Subtotal--15$882$0$8820.1%0.1%0.0%0.1%$58.79$0.00$58.7930.00$2.96
Subtotal --15$882$0$8820.1%0.1%0.0%0.1%$58.79$0.00$58.7930.00$2.96
00054309036Generic DrugTier 1RetailBUTORPHANOL TARTRATENARCOTIC ANALGESICS13$90$0$900.0%0.0%0.0%0.0%$29.89$0.00$29.8930.00$1.30
Subtotal--3$90$0$900.0%0.0%0.0%0.0%$29.89$0.00$29.8930.00$1.30
Subtotal --3$90$0$900.0%0.0%0.0%0.0%$29.89$0.00$29.8930.00$1.30
00054317763Generic DrugTier 1RetailDEXAMETHASONEGLUCOCORTICOIDS14$7$0$70.0%0.0%0.0%0.0%$1.66$0.00$1.6610.00$1.08
Subtotal--4$7$0$70.0%0.0%0.0%0.0%$1.66$0.00$1.6610.00$1.08
Subtotal --4$7$0$70.0%0.0%0.0%0.0%$1.66$0.00$1.6610.00$1.08
00054327099Generic DrugTier 1RetailFLUTICASONE PROPIONATETOPICAL NASAL AND OTIC PREPARATIONS131167$131$0$1310.8%0.0%0.0%0.0%$0.78$0.00$0.7829.98$0.35
Subtotal--167$131$0$1310.8%0.0%0.0%0.0%$0.78$0.00$0.7829.98$0.35
Subtotal --167$131$0$1310.8%0.0%0.0%0.0%$0.78$0.00$0.7829.98$0.35
00054350049Generic DrugTier 1RetailLIDOCAINE HCL VISCOUSANESTHETIC LOCAL TOPICAL55$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.009.20$0.45
Subtotal--5$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.009.20$0.45
Subtotal --5$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.009.20$0.45
00054417925Generic DrugTier 1RetailDEXAMETHASONEGLUCOCORTICOIDS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.05
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.05
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.05
00054418425Generic DrugTier 1RetailDEXAMETHASONEGLUCOCORTICOIDS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0010.00$0.26
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0010.00$0.26
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0010.00$0.26
00054429731Generic DrugTier 1RetailFUROSEMIDEDIURETICS1640$0$0$00.2%0.0%0.0%0.0%$0.00$0.00$0.0028.00$0.01
Subtotal--40$0$0$00.2%0.0%0.0%0.0%$0.00$0.00$0.0028.00$0.01
Subtotal --40$0$0$00.2%0.0%0.0%0.0%$0.00$0.00$0.0028.00$0.01
00054429931Generic DrugTier 1RetailFUROSEMIDEDIURETICS1229$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.01
Subtotal--29$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.01
Subtotal --29$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.01
00054430125Generic DrugTier 1RetailFUROSEMIDEDIURETICS22$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.13
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.13
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.13
00054455025Generic DrugTier 1Home DeliveryMETHOTREXATEANTINEOPLASTICS22$137$0$1370.0%0.0%0.0%0.0%$68.68$0.00$68.6887.00$1.58
Subtotal--2$137$0$1370.0%0.0%0.0%0.0%$68.68$0.00$68.6887.00$1.58
Subtotal --2$137$0$1370.0%0.0%0.0%0.0%$68.68$0.00$68.6887.00$1.58
RetailMETHOTREXATEANTINEOPLASTICS26$86$0$860.0%0.0%0.0%0.0%$14.26$0.00$14.2628.00$1.85
Subtotal--6$86$0$860.0%0.0%0.0%0.0%$14.26$0.00$14.2628.00$1.85
Subtotal --6$86$0$860.0%0.0%0.0%0.0%$14.26$0.00$14.2628.00$1.85
00054472831Generic DrugTier 1RetailPREDNISONEGLUCOCORTICOIDS38$6$0$60.0%0.0%0.0%0.0%$0.69$0.00$0.6930.00$0.19
Subtotal--8$6$0$60.0%0.0%0.0%0.0%$0.69$0.00$0.6930.00$0.19
Subtotal --8$6$0$60.0%0.0%0.0%0.0%$0.69$0.00$0.6930.00$0.19
00054474125Generic DrugTier 1RetailPREDNISONEGLUCOCORTICOIDS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.70
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.70
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.70
00054474225Generic DrugTier 1RetailPREDNISONEGLUCOCORTICOIDS14$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.06
Subtotal--4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.06
Subtotal --4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.06
00065026025Brand DrugTier 2RetailTRAVATAN ZOPHTHALMIC PREPARATIONS47$922$0$9220.0%0.1%0.0%0.1%$131.77$0.00$131.7723.29$7.34
Subtotal--7$922$0$9220.0%0.1%0.0%0.1%$131.77$0.00$131.7723.29$7.34
Subtotal --7$922$0$9220.0%0.1%0.0%0.1%$131.77$0.00$131.7723.29$7.34
Home DeliveryTRAVATAN ZOPHTHALMIC PREPARATIONS11$382$0$3820.0%0.0%0.0%0.0%$382.35$0.00$382.3590.00$5.36
Subtotal--1$382$0$3820.0%0.0%0.0%0.0%$382.35$0.00$382.3590.00$5.36
Subtotal --1$382$0$3820.0%0.0%0.0%0.0%$382.35$0.00$382.3590.00$5.36
00065064835Brand DrugTier 3RetailTOBRADEXOPHTHALMIC PREPARATIONS10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal--0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal --0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
00065853302Brand DrugTier 3RetailCIPRODEXTOPICAL NASAL AND OTIC PREPARATIONS44$266$0$2660.0%0.0%0.0%0.0%$66.60$0.00$66.6012.25$17.92
Subtotal--4$266$0$2660.0%0.0%0.0%0.0%$66.60$0.00$66.6012.25$17.92
Subtotal --4$266$0$2660.0%0.0%0.0%0.0%$66.60$0.00$66.6012.25$17.92
00065924007Brand DrugTier 3RetailDUREZOLOPHTHALMIC PREPARATIONS10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal--0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal --0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
00069018921Brand DrugTier 2RetailIBRANCEANTINEOPLASTICS11$11,639$0$11,6390.0%0.7%0.0%0.7%$11,639.03$0.00$11,639.0328.00$417.11
Subtotal--1$11,639$0$11,6390.0%0.7%0.0%0.7%$11,639.03$0.00$11,639.0328.00$417.11
Subtotal --1$11,639$0$11,6390.0%0.7%0.0%0.7%$11,639.03$0.00$11,639.0328.00$417.11
00069024230Brand DrugTier 3RetailTOVIAZANTISPASMODIC AND ANTICHOLINERGIC AGENTS11$238$0$2380.0%0.0%0.0%0.0%$237.81$0.00$237.8130.00$10.56
Subtotal--1$238$0$2380.0%0.0%0.0%0.0%$237.81$0.00$237.8130.00$10.56
Subtotal --1$238$0$2380.0%0.0%0.0%0.0%$237.81$0.00$237.8130.00$10.56
00069024430Brand DrugTier 3RetailTOVIAZANTISPASMODIC AND ANTICHOLINERGIC AGENTS28$1,897$0$1,8970.0%0.1%0.0%0.1%$237.18$0.00$237.1830.00$10.55
Subtotal--8$1,897$0$1,8970.0%0.1%0.0%0.1%$237.18$0.00$237.1830.00$10.55
Subtotal --8$1,897$0$1,8970.0%0.1%0.0%0.1%$237.18$0.00$237.1830.00$10.55
00069046903Brand DrugTier 3RetailCHANTIXCNS STIMULANTS810$4,038$0$4,0380.0%0.2%0.0%0.2%$403.80$0.00$403.8028.00$14.39
Subtotal--10$4,038$0$4,0380.0%0.2%0.0%0.2%$403.80$0.00$403.8028.00$14.39
Subtotal --10$4,038$0$4,0380.0%0.2%0.0%0.2%$403.80$0.00$403.8028.00$14.39
00069046956Brand DrugTier 3Home DeliveryCHANTIXCNS STIMULANTS11$1,137$0$1,1370.0%0.1%0.0%0.1%$1,136.82$0.00$1,136.8284.00$13.53
Subtotal--1$1,137$0$1,1370.0%0.1%0.0%0.1%$1,136.82$0.00$1,136.8284.00$13.53
Subtotal --1$1,137$0$1,1370.0%0.1%0.0%0.1%$1,136.82$0.00$1,136.8284.00$13.53
00069047103Brand DrugTier 3RetailCHANTIXCNS STIMULANTS87$2,822$0$2,8220.0%0.2%0.0%0.2%$403.12$0.00$403.1228.14$14.29
Subtotal--7$2,822$0$2,8220.0%0.2%0.0%0.2%$403.12$0.00$403.1228.14$14.29
Subtotal --7$2,822$0$2,8220.0%0.2%0.0%0.2%$403.12$0.00$403.1228.14$14.29
00069421030Brand DrugTier 1RetailVIAGRAMISCELLANEOUS47$1,443$0$1,4430.0%0.1%0.0%0.1%$206.08$0.00$206.0817.00$14.82
Subtotal--7$1,443$0$1,4430.0%0.1%0.0%0.1%$206.08$0.00$206.0817.00$14.82
Subtotal --7$1,443$0$1,4430.0%0.1%0.0%0.1%$206.08$0.00$206.0817.00$14.82
00069422030Brand DrugTier 1RetailVIAGRAMISCELLANEOUS914$2,774$0$2,7740.1%0.2%0.0%0.2%$198.17$0.00$198.1722.86$14.19
Subtotal--14$2,774$0$2,7740.1%0.2%0.0%0.2%$198.17$0.00$198.1722.86$14.19
Subtotal --14$2,774$0$2,7740.1%0.2%0.0%0.2%$198.17$0.00$198.1722.86$14.19
Home DeliveryVIAGRAMISCELLANEOUS11$929$0$9290.0%0.1%0.0%0.1%$929.08$0.00$929.0890.00$10.60
Subtotal--1$929$0$9290.0%0.1%0.0%0.1%$929.08$0.00$929.0890.00$10.60
Subtotal --1$929$0$9290.0%0.1%0.0%0.1%$929.08$0.00$929.0890.00$10.60
Tier 3RetailVIAGRAMISCELLANEOUS11$328$0$3280.0%0.0%0.0%0.0%$328.17$0.00$328.175.00$67.48
Subtotal--1$328$0$3280.0%0.0%0.0%0.0%$328.17$0.00$328.175.00$67.48
Subtotal --1$328$0$3280.0%0.0%0.0%0.0%$328.17$0.00$328.175.00$67.48
00071101268Brand DrugTier 3RetailLYRICAANTICONVULSANTS12$815$0$8150.0%0.0%0.0%0.0%$407.63$0.00$407.6330.00$14.89
Subtotal--2$815$0$8150.0%0.0%0.0%0.0%$407.63$0.00$407.6330.00$14.89
Subtotal --2$815$0$8150.0%0.0%0.0%0.0%$407.63$0.00$407.6330.00$14.89
00071101368Brand DrugTier 3RetailLYRICAANTICONVULSANTS24$2,143$0$2,1430.0%0.1%0.0%0.1%$535.79$0.00$535.7930.00$20.50
Subtotal--4$2,143$0$2,1430.0%0.1%0.0%0.1%$535.79$0.00$535.7930.00$20.50
Subtotal --4$2,143$0$2,1430.0%0.1%0.0%0.1%$535.79$0.00$535.7930.00$20.50
00071101468Brand DrugTier 3RetailLYRICAANTICONVULSANTS11$1,292$0$1,2920.0%0.1%0.0%0.1%$1,292.36$0.00$1,292.3630.00$45.70
Subtotal--1$1,292$0$1,2920.0%0.1%0.0%0.1%$1,292.36$0.00$1,292.3630.00$45.70
Subtotal --1$1,292$0$1,2920.0%0.1%0.0%0.1%$1,292.36$0.00$1,292.3630.00$45.70
00071101568Brand DrugTier 3RetailLYRICAANTICONVULSANTS23$882$0$8820.0%0.1%0.0%0.1%$294.13$0.00$294.1330.00$12.44
Subtotal--3$882$0$8820.0%0.1%0.0%0.1%$294.13$0.00$294.1330.00$12.44
Subtotal --3$882$0$8820.0%0.1%0.0%0.1%$294.13$0.00$294.1330.00$12.44
00071101668Brand DrugTier 3RetailLYRICAANTICONVULSANTS618$4,054$0$4,0540.1%0.2%0.0%0.2%$225.23$0.00$225.2330.00$13.25
Subtotal--18$4,054$0$4,0540.1%0.2%0.0%0.2%$225.23$0.00$225.2330.00$13.25
Subtotal --18$4,054$0$4,0540.1%0.2%0.0%0.2%$225.23$0.00$225.2330.00$13.25
00071101768Brand DrugTier 3RetailLYRICAANTICONVULSANTS13$1,103$0$1,1030.0%0.1%0.0%0.1%$367.53$0.00$367.5330.00$14.89
Subtotal--3$1,103$0$1,1030.0%0.1%0.0%0.1%$367.53$0.00$367.5330.00$14.89
Subtotal --3$1,103$0$1,1030.0%0.1%0.0%0.1%$367.53$0.00$367.5330.00$14.89
00074310832Generic DrugTier 1RetailGENGRAFMISCELLANEOUS12$212$0$2120.0%0.0%0.0%0.0%$105.75$0.00$105.7530.00$3.86
Subtotal--2$212$0$2120.0%0.0%0.0%0.0%$105.75$0.00$105.7530.00$3.86
Subtotal --2$212$0$2120.0%0.0%0.0%0.0%$105.75$0.00$105.7530.00$3.86
00074372790Brand DrugTier 2Home DeliverySYNTHROIDTHYROID PREPS11$0$0$00.0%0.0%0.0%0.0%$0.34$0.00$0.3490.00$1.11
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.34$0.00$0.3490.00$1.11
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.34$0.00$0.3490.00$1.11
RetailSYNTHROIDTHYROID PREPS24$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
Subtotal--4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
Subtotal --4$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
00074379902Brand DrugTier 2RetailHUMIRAANTIARTHRITICS38$38,611$0$38,6110.0%2.3%0.0%2.3%$4,826.43$0.00$4,826.4328.00$173.33
Subtotal--8$38,611$0$38,6110.0%2.3%0.0%2.3%$4,826.43$0.00$4,826.4328.00$173.33
Subtotal --8$38,611$0$38,6110.0%2.3%0.0%2.3%$4,826.43$0.00$4,826.4328.00$173.33
00074433902Brand DrugTier 2RetailHUMIRA PENANTIARTHRITICS618$76,554$0$76,5540.1%4.6%0.0%4.6%$4,253.03$0.00$4,253.0328.00$173.24
Subtotal--18$76,554$0$76,5540.1%4.6%0.0%4.6%$4,253.03$0.00$4,253.0328.00$173.24
Subtotal --18$76,554$0$76,5540.1%4.6%0.0%4.6%$4,253.03$0.00$4,253.0328.00$173.24
00074455290Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS310$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
Subtotal--10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
Subtotal --10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
00074518219Brand DrugTier 2Home DeliverySYNTHROIDTHYROID PREPS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0090.00$1.11
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0090.00$1.11
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0090.00$1.11
00074518290Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS25$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
Subtotal--5$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
Subtotal --5$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.19
00074662419Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS12$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.21
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.21
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.21
00074662490Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.21
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.21
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.21
00074706890Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS611$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0027.18$1.02
Subtotal--11$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0027.18$1.02
Subtotal --11$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0027.18$1.02
00074706990Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS39$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.25
Subtotal--9$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.25
Subtotal --9$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.25
00074707090Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS27$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
Subtotal--7$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
Subtotal --7$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
00074712613Brand DrugTier 3RetailDEPAKOTE ERANTICONVULSANTS13$772$0$7720.0%0.0%0.0%0.0%$257.49$0.00$257.4930.00$11.22
Subtotal--3$772$0$7720.0%0.0%0.0%0.0%$257.49$0.00$257.4930.00$11.22
Subtotal --3$772$0$7720.0%0.0%0.0%0.0%$257.49$0.00$257.4930.00$11.22
00074714890Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS38$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
Subtotal--8$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
Subtotal --8$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$1.18
00074929619Brand DrugTier 2Home DeliverySYNTHROIDTHYROID PREPS11$0$0$00.0%0.0%0.0%0.0%$0.28$0.00$0.2890.00$1.11
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.28$0.00$0.2890.00$1.11
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.28$0.00$0.2890.00$1.11
00074929690Brand DrugTier 2RetailSYNTHROIDTHYROID PREPS26$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0027.33$0.86
Subtotal--6$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0027.33$0.86
Subtotal --6$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0027.33$0.86
00076011101Brand DrugTier 3RetailURIBELURINARY ANTIBACTERIALS11$122$0$1220.0%0.0%0.0%0.0%$122.32$0.00$122.3215.00$8.76
Subtotal--1$122$0$1220.0%0.0%0.0%0.0%$122.32$0.00$122.3215.00$8.76
Subtotal --1$122$0$1220.0%0.0%0.0%0.0%$122.32$0.00$122.3215.00$8.76
00076090101Generic DrugTier 1RetailHYOPHENURINARY ANTIBACTERIALS11$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.008.00$7.26
Subtotal--1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.008.00$7.26
Subtotal --1$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.008.00$7.26
00078034342Brand DrugTier 1Home DeliveryVIVELLE-DOTESTROGENS11$319$0$3190.0%0.0%0.0%0.0%$318.53$0.00$318.5384.00$4.09
Subtotal--1$319$0$3190.0%0.0%0.0%0.0%$318.53$0.00$318.5384.00$4.09
Subtotal --1$319$0$3190.0%0.0%0.0%0.0%$318.53$0.00$318.5384.00$4.09
00078034442Brand DrugTier 1RetailVIVELLE-DOTESTROGENS13$339$0$3390.0%0.0%0.0%0.0%$112.95$0.00$112.9528.00$4.36
Subtotal--3$339$0$3390.0%0.0%0.0%0.0%$112.95$0.00$112.9528.00$4.36
Subtotal --3$339$0$3390.0%0.0%0.0%0.0%$112.95$0.00$112.9528.00$4.36
00078034545Brand DrugTier 1RetailVIVELLE-DOTESTROGENS14$452$0$4520.0%0.0%0.0%0.0%$113.11$0.00$113.1128.00$4.36
Subtotal--4$452$0$4520.0%0.0%0.0%0.0%$113.11$0.00$113.1128.00$4.36
Subtotal --4$452$0$4520.0%0.0%0.0%0.0%$113.11$0.00$113.1128.00$4.36
00078034642Brand DrugTier 1RetailVIVELLE-DOTESTROGENS411$1,110$0$1,1100.1%0.1%0.0%0.1%$100.95$0.00$100.9533.64$4.23
Subtotal--11$1,110$0$1,1100.1%0.1%0.0%0.1%$100.95$0.00$100.9533.64$4.23
Subtotal --11$1,110$0$1,1100.1%0.1%0.0%0.1%$100.95$0.00$100.9533.64$4.23
Home DeliveryVIVELLE-DOTESTROGENS22$639$0$6390.0%0.0%0.0%0.0%$319.26$0.00$319.2684.00$4.10
Subtotal--2$639$0$6390.0%0.0%0.0%0.0%$319.26$0.00$319.2684.00$4.10
Subtotal --2$639$0$6390.0%0.0%0.0%0.0%$319.26$0.00$319.2684.00$4.10
00078034645Brand DrugTier 1RetailVIVELLE-DOTESTROGENS10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal--0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal --0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
00078063998Brand DrugTier 3RetailCOSENTYX (2 SYRINGES)ALL OTHER DERMATOLOGICALS15$20,695$0$20,6950.0%1.2%0.0%1.2%$4,139.10$0.00$4,139.1028.00$168.25
Subtotal--5$20,695$0$20,6950.0%1.2%0.0%1.2%$4,139.10$0.00$4,139.1028.00$168.25
Subtotal --5$20,695$0$20,6950.0%1.2%0.0%1.2%$4,139.10$0.00$4,139.1028.00$168.25
00078065920Brand DrugTier 3RetailENTRESTOOTHER CARDIOVASCULAR PREPS26$824$0$8240.0%0.0%0.0%0.0%$137.29$0.00$137.2930.00$15.54
Subtotal--6$824$0$8240.0%0.0%0.0%0.0%$137.29$0.00$137.2930.00$15.54
Subtotal --6$824$0$8240.0%0.0%0.0%0.0%$137.29$0.00$137.2930.00$15.54
00078069620Brand DrugTier 3RetailENTRESTOOTHER CARDIOVASCULAR PREPS26$1,928$0$1,9280.0%0.1%0.0%0.1%$321.40$0.00$321.4030.00$15.50
Subtotal--6$1,928$0$1,9280.0%0.1%0.0%0.1%$321.40$0.00$321.4030.00$15.50
Subtotal --6$1,928$0$1,9280.0%0.1%0.0%0.1%$321.40$0.00$321.4030.00$15.50
00078077720Brand DrugTier 3RetailENTRESTOOTHER CARDIOVASCULAR PREPS25$773$0$7730.0%0.0%0.0%0.0%$154.63$0.00$154.6330.00$15.70
Subtotal--5$773$0$7730.0%0.0%0.0%0.0%$154.63$0.00$154.6330.00$15.70
Subtotal --5$773$0$7730.0%0.0%0.0%0.0%$154.63$0.00$154.6330.00$15.70
00085113201Brand DrugTier 3RetailPROVENTIL HFABRONCHIAL DILATORS10$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal--0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
Subtotal --0$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.000.00$0.00
00085134101Brand DrugTier 1RetailASMANEXGLUCOCORTICOIDS13$942$0$9420.0%0.1%0.0%0.1%$314.03$0.00$314.0330.00$10.77
Subtotal--3$942$0$9420.0%0.1%0.0%0.1%$314.03$0.00$314.0330.00$10.77
Subtotal --3$942$0$9420.0%0.1%0.0%0.1%$314.03$0.00$314.0330.00$10.77
00085134102Brand DrugTier 1Home DeliveryASMANEXGLUCOCORTICOIDS22$612$0$6120.0%0.0%0.0%0.0%$305.93$0.00$305.9390.00$7.08
Subtotal--2$612$0$6120.0%0.0%0.0%0.0%$305.93$0.00$305.9390.00$7.08
Subtotal --2$612$0$6120.0%0.0%0.0%0.0%$305.93$0.00$305.9390.00$7.08
00085433301Brand DrugTier 1RetailASMANEX HFAGLUCOCORTICOIDS22$183$0$1830.0%0.0%0.0%0.0%$91.66$0.00$91.6630.50$6.30
Subtotal--2$183$0$1830.0%0.0%0.0%0.0%$91.66$0.00$91.6630.50$6.30
Subtotal --2$183$0$1830.0%0.0%0.0%0.0%$91.66$0.00$91.6630.50$6.30
00085433401Brand DrugTier 1RetailASMANEX HFAGLUCOCORTICOIDS22$436$0$4360.0%0.0%0.0%0.0%$218.06$0.00$218.0630.00$7.52
Subtotal--2$436$0$4360.0%0.0%0.0%0.0%$218.06$0.00$218.0630.00$7.52
Subtotal --2$436$0$4360.0%0.0%0.0%0.0%$218.06$0.00$218.0630.00$7.52
00088250033Brand DrugTier 3RetailAPIDRADIABETIC THERAPY310$9,873$0$9,8730.0%0.6%0.0%0.6%$987.32$0.00$987.3228.90$34.13
Subtotal--10$9,873$0$9,8730.0%0.6%0.0%0.6%$987.32$0.00$987.3228.90$34.13
Subtotal --10$9,873$0$9,8730.0%0.6%0.0%0.6%$987.32$0.00$987.3228.90$34.13
00088250205Brand DrugTier 3RetailAPIDRA SOLOSTARDIABETIC THERAPY24$812$0$8120.0%0.0%0.0%0.0%$202.93$0.00$202.9330.00$11.99
Subtotal--4$812$0$8120.0%0.0%0.0%0.0%$202.93$0.00$202.9330.00$11.99
Subtotal --4$812$0$8120.0%0.0%0.0%0.0%$202.93$0.00$202.9330.00$11.99
00093001298Generic DrugTier 1RetailPANTOPRAZOLE SODIUMANTI-ULCER PREPS/GASTROINTESTINAL PREPS2664$15$0$150.3%0.0%0.0%0.0%$0.24$0.00$0.2430.00$0.31
Subtotal--64$15$0$150.3%0.0%0.0%0.0%$0.24$0.00$0.2430.00$0.31
Subtotal --64$15$0$150.3%0.0%0.0%0.0%$0.24$0.00$0.2430.00$0.31
00093003901Generic DrugTier 1RetailLAMOTRIGINEANTICONVULSANTS22$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0029.00$0.18
Subtotal--2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0029.00$0.18
Subtotal --2$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0029.00$0.18
00093005105Generic DrugTier 1RetailCARVEDILOLOTHER CARDIOVASCULAR PREPS13$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.07
Subtotal--3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.07
Subtotal --3$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0030.00$0.07
00093005301Generic DrugTier 1RetailBUSPIRONE HCLATARACTICS-TRANQUILIZERS59$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0020.44$0.19
Subtotal--9$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0020.44$0.19
Subtotal --9$0$0$00.0%0.0%0.0%0.0%$0.00$0.00$0.0020.44$0.19
00093005401Generic DrugTier 1RetailBUSPIRONE HCLATARACTICS-TRANQUILIZERS39$8$0$80.0%0.0%0.0%0.0%$0.87$0.00$0.8730.00$0.26
Subtotal--9$8$0$80.0%0.0%0.0%0.0%$0.87$0.00$0.8730.00$0.26
Subtotal --9$8$0$80.0%0.0%0.0%0.0%$0.87$0.00$0.8730.00$0.26
00093005805Generic DrugTier 1RetailTRAMADOL HCLNARCOTIC ANALGESICS1018$51$0$510.1%0.0%0.0%0.0%$2.82$0.00$2.8220.56$0.45
Subtotal--18$51$0$510.1%0.0%0.0%0.0%$2.82$0.00$2.8220.56$0.45
Subtotal --18$51$0$510.1%0.0%0.0%0.0%$2.82$0.00$2.8220.56$0.45
00093007301Generic DrugTier 1RetailZOLPIDEM TARTRATESEDATIVE NON-BARBITURATE812$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0028.75$0.04
Subtotal--12$0$0$00.1%0.0%0.0%0.0%$0.00$0.00$0.0028.75$0.04
 
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All Drugs
NDC NumberGeneric/Brand CategoryPrescription TierSubmission Method CategoryMetricsNumber of ClaimantsNumber of PrescriptionsPlan Net PaidHRA Net PaidTotal Net Paid% of Total Prescriptions% of Plan Net Paid% of HRA Net Paid% of Total Net PaidPlan Net Paid per PrescriptionHRA Net Paid per PrescriptionTotal Net Paid per PrescriptionAverage Days SupplyIngredient Cost Paid per Day Of Therapy
61958180101Brand DrugTier 2Retail13$94,392$0$94,3920.0%5.7%0.0%5.7%$31,464.00$0.00$31,464.0028.00$1,123.89
00074433902Brand DrugTier 2Retail618$76,554$0$76,5540.1%4.6%0.0%4.6%$4,253.03$0.00$4,253.0328.00$173.24
68546032512Brand DrugTier 1Retail513$73,643$0$73,6430.1%4.4%0.0%4.4%$5,664.82$0.00$5,664.8228.00$209.92
64842102003Brand DrugTier 2Retail14$49,108$0$49,1080.0%2.9%0.0%2.9%$12,277.06$0.00$12,277.0628.00$439.90
00169406013Brand DrugTier 3Retail2765$46,875$0$46,8750.3%2.8%0.0%2.8%$721.15$0.00$721.1529.77$27.21
00003085222Brand DrugTier 3Retail14$46,505$0$46,5050.0%2.8%0.0%2.8%$11,626.36$0.00$11,626.3630.00$429.27
59572063106Brand DrugTier 2Retail614$41,648$0$41,6480.1%2.5%0.0%2.5%$2,974.88$0.00$2,974.8830.00$105.81
00074379902Brand DrugTier 2Retail38$38,611$0$38,6110.0%2.3%0.0%2.3%$4,826.43$0.00$4,826.4328.00$173.33
00002771559Brand DrugTier 1Retail3583$37,505$0$37,5050.4%2.2%0.0%2.2%$451.87$0.00$451.8728.41$17.38
00469012599Brand DrugTier 3Retail13$33,117$0$33,1170.0%2.0%0.0%2.0%$11,039.05$0.00$11,039.0530.00$368.86
00597014560Brand DrugTier 3Retail23$28,132$0$28,1320.0%1.7%0.0%1.7%$9,377.18$0.00$9,377.1830.00$313.46
50242007601Brand DrugTier 2Retail13$27,738$0$27,7380.0%1.7%0.0%1.7%$9,246.09$0.00$9,246.0929.00$350.28
44087334401Brand DrugTier 3Retail14$26,944$0$26,9440.0%1.6%0.0%1.6%$6,735.99$0.00$6,735.9928.00$255.48
00169633910Brand DrugTier 3Retail1632$26,251$0$26,2510.1%1.6%0.0%1.6%$820.34$0.00$820.3428.75$28.50
50474071079Brand DrugTier 2Retail26$23,798$0$23,7980.0%1.4%0.0%1.4%$3,966.28$0.00$3,966.2828.00$142.13
00078063998Brand DrugTier 3Retail15$20,695$0$20,6950.0%1.2%0.0%1.2%$4,139.10$0.00$4,139.1028.00$168.25
00169643810Brand DrugTier 2Retail2155$19,513$0$19,5130.3%1.2%0.0%1.2%$354.79$0.00$354.7925.82$14.44
00597014360Brand DrugTier 3Retail12$18,710$0$18,7100.0%1.1%0.0%1.1%$9,354.99$0.00$9,354.9930.00$314.50
50419048858Brand DrugTier 2Retail11$17,609$0$17,6090.0%1.1%0.0%1.1%$17,609.47$0.00$17,609.4730.00$588.32
50242012205Brand DrugTier 2Retail12$17,091$0$17,0910.0%1.0%0.0%1.0%$8,545.74$0.00$8,545.7430.00$286.19
50458014130Brand DrugTier 2Retail1237$16,871$0$16,8710.2%1.0%0.0%1.0%$455.97$0.00$455.9730.08$15.54
58406044504Brand DrugTier 3Retail24$16,708$0$16,7080.0%1.0%0.0%1.0%$4,176.93$0.00$4,176.9328.00$175.85
49702023113Brand DrugTier 2Retail27$16,341$0$16,3410.0%1.0%0.0%1.0%$2,334.50$0.00$2,334.5030.00$90.33
00006027731Brand DrugTier 3Retail1540$15,572$0$15,5720.2%0.9%0.0%0.9%$389.30$0.00$389.3030.00$14.35
64406000602Brand DrugTier 2Retail12$14,756$0$14,7560.0%0.9%0.0%0.9%$7,377.96$0.00$7,377.9630.00$246.60
00002879959Brand DrugTier 2Retail1125$14,224$0$14,2240.1%0.9%0.0%0.9%$568.96$0.00$568.9626.80$21.19
57894007001Brand DrugTier 2Retail13$13,515$0$13,5150.0%0.8%0.0%0.8%$4,505.07$0.00$4,505.0730.00$151.50
50458057930Brand DrugTier 2Retail1434$12,187$0$12,1870.2%0.7%0.0%0.7%$358.45$0.00$358.4530.00$14.00
57894007002Brand DrugTier 2Retail13$11,643$0$11,6430.0%0.7%0.0%0.7%$3,880.87$0.00$3,880.8730.00$152.51
00069018921Brand DrugTier 2Retail11$11,639$0$11,6390.0%0.7%0.0%0.7%$11,639.03$0.00$11,639.0328.00$417.11
00051846231Brand DrugTier 3Retail25$11,076$0$11,0760.0%0.7%0.0%0.7%$2,215.22$0.00$2,215.2230.00$76.46
00173069600Brand DrugTier 3Retail1733$10,736$0$10,7360.2%0.6%0.0%0.6%$325.34$0.00$325.3430.00$13.17
00093760141Generic DrugTier 1Retail13$10,295$0$10,2950.0%0.6%0.0%0.6%$3,431.69$0.00$3,431.6930.00$114.72
57894015012Brand DrugTier 2Retail11$10,274$0$10,2740.0%0.6%0.0%0.6%$10,274.02$0.00$10,274.0230.00$343.80
00088250033Brand DrugTier 3Retail310$9,873$0$9,8730.0%0.6%0.0%0.6%$987.32$0.00$987.3228.90$34.13
00186037020Brand DrugTier 3Retail2043$8,875$0$8,8750.2%0.5%0.0%0.5%$206.39$0.00$206.3929.98$10.98
00169750111Brand DrugTier 3Retail616$8,795$0$8,7950.1%0.5%0.0%0.5%$549.69$0.00$549.6928.81$22.87
00002143480Brand DrugTier 3Retail920$7,884$0$7,8840.1%0.5%0.0%0.5%$394.21$0.00$394.2128.10$25.19
00169406012Brand DrugTier 2Retail718$7,586$0$7,5860.1%0.5%0.0%0.5%$421.45$0.00$421.4527.83$19.37
00169633910Brand DrugTier 3Home Delivery33$7,539$0$7,5390.0%0.5%0.0%0.5%$2,513.13$0.00$2,513.1389.67$28.03
66658023407Brand DrugTier 3Retail12$7,474$0$7,4740.0%0.4%0.0%0.4%$3,736.93$0.00$3,736.9328.00$140.92
00002143380Brand DrugTier 3Retail514$7,098$0$7,0980.1%0.4%0.0%0.4%$507.03$0.00$507.0328.07$24.97
00002771559Brand DrugTier 1Home Delivery78$7,089$0$7,0890.0%0.4%0.0%0.4%$886.11$0.00$886.1190.00$11.13
58406045504Brand DrugTier 3Retail12$7,037$0$7,0370.0%0.4%0.0%0.4%$3,518.28$0.00$3,518.2828.00$176.72
00597015230Brand DrugTier 2Retail819$7,016$0$7,0160.1%0.4%0.0%0.4%$369.27$0.00$369.2730.00$15.56
00169406013Brand DrugTier 3Home Delivery23$6,856$0$6,8560.0%0.4%0.0%0.4%$2,285.45$0.00$2,285.4590.00$25.39
61958070101Brand DrugTier 3Retail14$6,561$0$6,5610.0%0.4%0.0%0.4%$1,640.13$0.00$1,640.1330.00$55.32
59572063106Brand DrugTier 3Retail22$6,170$0$6,1700.0%0.4%0.0%0.4%$3,084.99$0.00$3,084.9930.00$104.17
00002446430Brand DrugTier 3Retail1426$6,086$0$6,0860.1%0.4%0.0%0.4%$234.08$0.00$234.0821.88$14.74
00002751001Brand DrugTier 1Retail39$6,070$0$6,0700.0%0.4%0.0%0.4%$674.40$0.00$674.4029.67$26.83
 
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