6414 Addendum 1
Purchasing Department
901-B Texas St.
Denton, TX 76209
(940) 349-7100
www.dentonpurchasing.com
ADDENDUM #1
RFP # 6414
ADMINSTRATIVE SERVICE ONLY (ASO) FOR MEDICAL AND
PHARMACY BENEFITS FOR THE CITY OF DENTON
Issue Date: June 8, 2017
Response due Date and Time (Central Time):
Tuesday, July 11, 2016, 11:00 a.m.
RFP #6414
Addendum #1 to be returned with RFP Proposal
1. The following are changes to the RFP requirements:
Main RFP document, Section 15 –
SUBMITTAL INSTRUCTIONS
The City of Denton will accept electronic or hard copy submittals until the date and time
on the cover sheet of this solicitation. Any submission received after the date and/or hour
set for solicitation opening will be returned unopened.
Electronic submittals may be emailed to ebids@cityofdenton.com with the solicitation number
and name in the subject line. Please consolidate attachments as much as possible, and do not
exceed 35MB total for attachments. Emails received by the City will remain unopened until after
the due date and time. Only authorized Materials Management Staff will have access to the e-bid
email inbox. Please do not email the buyer directly to ensure security of the proposal. Electronic
proposals must be received by the City before the due date and time. The date and time
used by the City shall be the official time. It is highly recommended that respondents do
not wait until minutes before the due date and time to email their submission. It can take
significant time for the email to reach the City.
**If offer is submitted electronically, the City requests one (1) paper copy binder for
review.**
2. Following this page are questions and answers for each inquiry submitted during the
Question & Answer period.
3. Also attached, Updated Claims Exhibits.
NO OTHER CHANGES AT THIS TIME.
Please acknowledge addendum on Attachment F of the
main RFP document when submitting a proposal.
6414 – ASO Medical and Pharmacy Benefits RFP – Addendum 1
6414 – ASO Medical & Rx RFP
Addendum
Revised Solicitation Schedule
The City of Denton reserves the right to change the dates indicated below:
Issue Solicitation: 6/8/2017
Deadline for Submission of Questions: 6/29/2017 at 11:00 AM CST
Deadline for Submission of Responses: 7/11/2017 at 11:00 AM CST
New - Repricing Exercise for top ranked firms: 7/12-28/2017 at 11:00 AM CST
Revised - Evaluate and rank initial results: 8/7-8/2017
Revised - Timeframe for interview(s) with top ranked firms: 8/9-11/2017
Completion of Negotiations: 8/29/2017
Official Award: 9/19/2017
Vendor Questions and Answers
1. Are you looking for a broker to assist in the implementation of your ASO Medical and
Pharmacy Benefits RFP? – No, McGriff, Seibels & Williams is the City’s employee
benefits consultant and handles all benefit services.
2. The RFP indicates employees and retirees have the option of either the gold or silver
plans. Does this refer to under 65 retirees only? – Yes, this refers to under 65 retirees
only.
3. We received a SPD for a Retiree Choice plan. Who is eligible for this plan? Is it for over
65 retirees? – The Retiree Choice plan SPD is for under 65 retirees that are covered
by Medicare (i.e. disability). There is minimal enrollment in this plan. Over 65
retirees are enrolled in the City’s separate Medicare Supplement plan or terminate
medical coverage.
4. Should commission be included in our proposal? If so, what amount? – All proposals
should be submitted net of commissions.
5. Current admin fees. – $41.53 with the City retaining 80% of rebates (est. @ $30.94).
The City currently has a Value Based Pricing arrangement and is charged a Fixed
Fee of $24.13. If any one Participant’s claims exceed $24.13 during an Agreement
period, the fee determined above with respect to Network Savings obtained during
6414 – ASO Medical and Pharmacy Benefits RFP – Addendum 2
that Agreement period as a result of that Participant’s claims will not exceed $41.53.
The City does not intend on continuing Value Based pricing going forward and will
pay the full PEPM fee.
6. Month to month claims experience with enrollment for the period 1/1/2017 – current. –
See attached updated Claims Exhibits
7. Does your current plan/contract with UHC include shared savings? – The City pays a fee
equal to 35% of the Savings Obtained as a result of the Shared Savings Program.
This fee applies to third party contracted providers.
8. Please confirm email only submission is acceptable and that Binders are not needed – If
submitting electronically the City would prefer to have 1 hard copy binder
submitted as well. If submitting hard copy only, please provide 3 copies of your
submission.
9. Are the pre 65 retirees offered the same plans as the actives as we see the options of both
the Gold and Silver for the retirees on the census. Or are the retirees offered the one plan
provided with the RFP? Pre-65 retirees can elect the Gold or Silver plan. The
Retiree Choice plan SPD is for under 65 retirees that are covered by Medicare (i.e.
disability).
10. Is there current claims data available for 2017? If so, please provide the monthly claims
in addition to the large claims that match the same time period. - See attached updated
Claims Exhibits
11. Who is operating the clinic? – The Employee Health Center (Clinic) is managed and
operated by CareHere. The RFP for Administrative Services Only for Medical and
Pharmacy Benefits is for the employee health plan TPA and not Clinic Services.
12. What services are performed at the clinic? – Fee schedule information may be needed. –
The Clinic can perform all functions of a PCP/Family Practice.
13. Will dependents be receiving services at clinic? – All employees, retirees, and
dependents covered under the health plan have access to the Clinic.
14. What are the benefits for clinic visits? – The Clinic can perform all functions of a
PCP/Family Practice.
15. What is the client’s expectation for clinic set up? – The clinic is managed by a third-
party. It is the City’s expectation that the selected health plan TPA be able to
interface with the clinic to accept zero dollar claim feeds for reporting purposes.
16. Documentation needed: Demographic information for providers, fee schedule
information – Fee schedule to be developed after award of contract.
Current Year Medical Plan Review January 1, 2017 - May 31, 2017
EEs Mbrs Medical Rx EEs Mbrs Medical Rx EEs Mbrs Medical Rx EEs Mbrs Medical Rx
Jan 2017 643 1,654 396,442.00$ 82,603.00$ 736 1,935 1,036,409.00$ 227,929.00$ 7 8 4,105.00$ 5,660.00$ 1,386 3,597 1,436,956.00$ 316,192.00$
Feb 2017 652 1,674 526,655.00 103,207.00 731 1,927 970,008.00 226,865.00 7 8 1,763.00 5,956.00 1,390 3,609 1,498,426.00 336,028.00
Mar 2017 657 1,680 417,931.00 97,694.00 730 1,922 1,094,887.00 224,052.00 7 8 1,975.00 7,869.00 1,394 3,610 1,514,793.00 329,615.00
Apr 2017 657 1,689 313,013.00 99,809.00 730 1,917 1,004,579.00 224,973.00 7 8 3,189.00 29,461.00 1,394 3,614 1,320,781.00 354,243.00
May 2017 659 1,694 441,358.00 68,408.00 731 1,917 1,486,878.00 227,553.00 7 8 860.00 5,143.00 1,397 3,619 1,929,096.00 301,104.00
Jun 2017 - - - - - - - - - - - - - - - -
Jul 2017 - - - - - - - - - - - - - - - -
Aug 2017 - - - - - - - - - - - - - - - -
Sep 2017 - - - - - - - - - - - - - - - -
Oct 2017 - - - - - - - - - - - - - - - -
Nov 2017 - - - - - - - - - - - - - - - -
Dec 2017 - - - - - - - - - - - - - - - -
Totals 3,268 8,391 2,095,399.00$ 451,721.00$ 3,658 9,618 5,592,761.00$ 1,131,372.00$ 35 40 11,892.00$ 54,089.00$ 6,961 18,049 7,700,052.00$ 1,637,182.00$
Gross Claims
Specific SL Reimbursement
Net Claims
Avg EEs/Members Per Month 654 1,678 732 1,924 7 8 1,392 3,610
Total Net Claims PEPM/PMPM $772.94 $301.03 $1,756.51 $668.05 $1,885.17 $1,649.53 $1,295.40 $499.60
$9,017,283.58
$2,547,120.00
($21,146.81)
$2,525,973.19
$6,724,133.00
($298,803.61)
$65,981.00
$0.00
$9,337,234.00
($319,950.42)
$6,425,329.39 $65,981.00
Silver Gold Medicare Combined
City of Denton
Medical 83%
Rx 17%
Claim Mix
Medical
82%
Rx 18%
Claim Mix
Medical 18%
Rx 82%
Claim Mix
Silver 27%
Gold 72%
Medicare 1%
Claim Mix
6/27/2017 1
Medical & Rx Plan Year Review January 1, 2017 - May 31, 2017
Plan YearVendor
Specific Deductible
Specific & Aggregate Contract EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec
January 1,264 3,228 1,379,897$ 267,253$ -$ 1,294 3,326 1,330,537$ 265,575$ -$ 1,331 3,474 1,210,591$ 299,797$ -$ 1,386 3,597 1,436,956$ 316,192$ -$
February 1,268 3,230 1,079,323 242,034 - 1,300 3,346 1,286,091 292,849 - 1,337 3,496 1,230,882 322,547 - 1,390 3,609 1,498,426 336,028 9,494 March 1,264 3,218 1,011,507 237,614 7,613 1,307 3,349 1,574,901 294,321 14,298 1,337 3,507 1,159,411 280,357 - 1,394 3,610 1,514,793 329,615 91,102
April 1,263 3,226 1,624,152 252,175 19,170 1,304 3,344 1,554,775 350,564 128,857 1,345 3,528 1,465,283 345,540 - 1,394 3,614 1,320,781 354,243 90,838 May 1,266 3,238 1,359,975 268,132 57,973 1,298 3,335 1,526,196 326,669 243,158 1,355 3,559 971,497 316,824 9,288 1,397 3,619 1,929,096 301,104 128,516
June 1,264 3,241 976,040 271,916 172,435 1,306 3,360 1,490,486 299,585 199,288 1,366 3,592 1,225,336 360,162 33,926 - - - - -
July 1,272 3,246 1,275,725 287,632 300,522 1,316 3,392 1,419,257 286,252 127,700 1,369 3,605 1,064,229 416,712 47,260 - - - - - August 1,272 3,262 1,274,863 305,871 313,367 1,319 3,417 1,665,105 296,594 185,673 1,369 3,605 1,064,133 349,973 40,868 - - - - -
September 1,271 3,263 1,194,071 255,818 135,885 1,314 3,408 1,400,248 293,566 193,228 1,379 3,630 1,345,786 384,131 84,931 - - - - -
October 1,269 3,266 1,415,060 286,648 277,303 1,302 3,390 1,312,753 321,902 99,254 1,376 3,626 1,409,922 340,752 67,437 - - - - - November 1,284 3,304 1,433,882 235,425 344,463 1,309 3,412 1,588,469 317,934 118,720 1,377 3,626 1,341,058 360,493 36,333 - - - - -
December 1,279 3,272 1,970,782 268,808 274,793 1,321 3,435 1,861,365 312,405 328,575 1,380 3,625 1,346,227 360,437 118,577 - - - - -
Totals 15,236 38,994 15,995,277$ 3,179,326$ 1,903,526$ 15,690 40,514 18,010,183$ 3,658,216$ 1,638,751$ 16,321 42,873 14,834,355$ 4,137,725$ 438,620$ 6,961 18,049 7,700,052$ 1,637,182$ 319,950$
Total Claims
Spec ReimbursementTotal Net Claims
Avg EEs / Members Per Month 1,270 3,250 1,308 3,376 1,360 3,573 1,392 3,610
Total Net Claims PEPM / PMPM $1,133.57 $442.92 $1,276.59 $494.39 $1,135.56 $432.29 $1,295.40 $499.60Percent Over Prior Year ----12.62%11.62%-11.05%-12.56%14.08%15.57%
Medical & Rx Plan Year Review - Active Only January 1, 2017 - May 31, 2017
Plan Year
Vendor
Specific DeductibleSpecific & Aggregate Contract
EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec
January 1,204 3,143 1,190,146$ 221,464$ -$ 1,234 3,245 1,217,758$ 239,406$ -$ 1,275 3,395 1,178,659$ 281,429$ -$ 1,326 3,520 1,355,315$ 294,671$ -$ February 1,207 3,144 1,006,681 211,732 - 1,240 3,267 1,182,935 264,160 - 1,279 3,416 1,151,478 278,271 - 1,327 3,530 1,424,129 314,658 9,494
March 1,203 3,134 980,512 207,692 7,613 1,249 3,273 1,459,332 249,037 14,298 1,280 3,429 1,137,207 260,070 - 1,331 3,531 1,470,876 306,992 91,102
April 1,201 3,140 1,278,355 217,208 19,170 1,244 3,266 1,191,606 325,010 30,900 1,287 3,449 1,439,942 328,624 - 1,330 3,535 1,278,598 310,175 90,838 May 1,203 3,151 1,175,103 233,570 57,973 1,236 3,251 1,280,390 298,793 59,113 1,297 3,480 900,874 295,240 9,288 1,332 3,539 1,815,629 282,122 128,516
June 1,201 3,153 916,542 244,245 107,258 1,245 3,277 1,373,463 272,366 113,122 1,309 3,514 1,181,800 341,030 33,926 - - - - -
July 1,210 3,160 1,094,440 256,994 181,285 1,257 3,311 1,322,945 241,859 46,747 1,312 3,528 1,009,117 345,887 47,260 - - - - - August 1,214 3,182 1,145,917 274,365 227,129 1,260 3,335 1,563,031 269,434 109,721 1,311 3,524 1,040,699 297,924 40,868 - - - - -
September 1,213 3,183 1,134,220 226,889 128,191 1,260 3,332 1,321,196 269,008 138,980 1,323 3,554 1,321,173 334,067 84,931 - - - - - October 1,213 3,188 1,292,955 242,038 206,064 1,251 3,321 1,287,777 297,051 97,780 1,320 3,550 1,372,698 319,052 67,437 - - - - -
November 1,228 3,226 1,230,492 209,605 150,167 1,259 3,345 1,499,319 268,364 118,416 1,321 3,550 1,304,297 315,630 36,333 - - - - -
December 1,222 3,193 1,916,681 239,587 245,631 1,268 3,362 1,835,577 295,029 328,575 1,324 3,549 1,315,553 335,374 118,577 - - - - -
Totals 14,519 37,997 14,362,044$ 2,785,389$ 1,330,481$ 15,003 39,585 16,535,329$ 3,289,517$ 1,057,653$ 15,638 41,938 14,353,497$ 3,732,598$ 438,620$ 6,646 17,655 7,344,547$ 1,508,618$ 319,950$
Total Claims
Spec Reimbursement
Total Net Claims
Avg EEs / Members Per Month 1,210 3,166 1,250 3,299 1,303 3,495 1,329 3,531Total Net Claims PEPM / PMPM $1,089.40 $416.27 $1,250.90 $474.10 $1,128.50 $420.80 $1,283.96 $483.33
Percent Over Prior Year ----14.82%13.89%-9.78%-11.24%13.78%14.86%
$15,816,952 $18,767,193 $17,647,475 $8,533,215
$17,147,433 $19,824,846 $18,086,095 $8,853,165
($1,330,481)($1,057,653)($438,620)($319,950)
$185,000 $185,000 $185,000 $185,00012/15 12/15 12/15 12/15
2014 2015 2016 2017
UHC UHC UHC UHC
City of Denton
$185,000 $185,000 $185,000
2017UHC2016UHC2014UHC2015UHC
$185,000
12/1512/1512/15 12/15
$19,174,603
($1,903,526)$17,271,077
$21,668,399
($1,638,751)$20,029,648
$18,972,080
($438,620)$18,533,460
$9,337,234
($319,950)$9,017,284
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
2014 2015 2016 2017
YTD Claims
Medical Rx
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
2014 2015 2016 2017
Average Claims
PEPM PMPM
6/27/2017 2
City of Denton
Medical & Rx Plan Year Review - Retiree Only January 1, 2017 - May 31, 2017
Plan YearVendor
Specific Deductible
Specific & Aggregate Contract EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec
January 58 83 187,071$ 44,595$ -$ 57 78 33,213$ 24,965$ -$ 54 77 31,157$ 18,368$ -$ 59 76 81,452$ 21,521$ -$
February 59 84 72,519 28,979 - 57 76 34,976 28,563 - 56 78 79,934 44,276 - 62 78 74,162 21,370 - March 58 81 36,731 29,126 - 55 73 74,907 45,234 - 55 76 21,968 20,262 - 62 78 42,902 22,623 -
April 59 83 94,508 33,261 - 57 75 52,673 25,422 - 57 78 25,331 16,916 - 63 78 30,856 43,883 - May 60 84 76,683 33,107 - 58 76 61,231 27,759 - 57 78 70,623 21,584 - 64 79 112,601 18,964 -
June 59 82 (47,755) 25,652 - 57 75 28,027 26,963 - 56 77 43,442 19,132 - - - - - -
July 58 80 61,939 29,363 - 55 73 15,127 43,908 - 56 76 55,112 70,825 - - - - - - August 56 78 42,289 30,908 - 54 72 26,031 26,309 - 56 76 23,429 52,049 - - - - - -
September 56 78 52,037 28,093 - 51 69 25,290 23,498 - 55 75 24,533 50,064 - - - - - -
October 54 76 78,676 43,628 28,011 49 67 23,250 24,697 - 55 75 37,155 21,700 - - - - - - November 54 76 177,181 24,613 167,994 48 65 88,189 49,080 - 55 75 36,761 44,863 - - - - - -
December 54 76 26,862 28,022 1,844 51 71 25,788 17,552 - 55 75 30,674 25,063 - - - - - -
Totals 685 961 858,741$ 379,347$ 197,849$ 649 870 488,702$ 363,950$ -$ 667 916 480,119$ 405,102$ -$ 310 389 341,973$ 128,361$ -$
Total Claims
Spec ReimbursementTotal Net Claims
Avg EEs / Members Per Month 57 80 54 73 56 76 62 78
Total Net Claims PEPM / PMPM $1,518.60 $1,082.45 $1,313.79 $980.06 $1,327.17 $966.40 $1,517.21 $1,209.08Percent Over Prior Year -----13.49%-9.46%1.02%-1.39%14.32%25.11%
Medical & Rx Plan Year Review - COBRA Only January 1, 2017 - May 31, 2017
Plan YearVendor
Specific Deductible
Specific & Aggregate Contract EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec
January 2 2 2,680$ 1,194$ -$ 3 3 79,566$ 1,204$ -$ 2 2 775$ -$ -$ 1 1 189$ -$ -$
February 2 2 123 1,323 - 3 3 68,180 126 - 2 2 (530) - - 1 1 135 - - March 3 3 (5,736) 796 - 3 3 40,662 50 - 2 2 236 25 - 1 1 1,015 - -
April 3 3 251,289 1,706 - 3 3 310,496 132 97,957 1 1 10 - - 1 1 11,327 185 -
May 3 3 108,189 1,455 - 4 8 184,575 117 184,045 1 1 - - - 1 1 866 18 - June 4 6 107,253 2,019 65,177 4 8 88,996 256 86,166 1 1 94 - - - - - - -
July 4 6 119,346 1,275 119,237 4 8 81,185 485 80,953 1 1 - - - - - - - -
August 2 2 86,657 598 86,238 5 10 76,043 851 75,952 2 5 5 - - - - - - -
September 2 2 7,814 836 7,694 3 7 53,762 1,060 54,248 1 1 80 - - - - - - -
October 2 2 43,429 982 43,228 2 2 1,726 154 1,474 1 1 69 - - - - - - - November 2 2 26,209 1,207 26,303 2 2 961 490 304 1 1 - - - - - - - -
December 3 3 27,239 1,199 27,319 2 2 - (176) - 1 1 - - - - - - - -
Totals 32 36 774,492$ 14,590$ 375,195$ 38 59 986,152$ 4,749$ 581,099$ 16 19 739$ 25$ -$ 5 5 13,532$ 203$ -$
Total Claims
Spec ReimbursementTotal Net Claims
Avg EEs / Members Per Month 3 3 3 5 1 2 1 1
Total Net Claims PEPM / PMPM $12,933.96 $11,496.86 $10,784.27 $6,945.80 $47.75 $40.21 $2,747.00 $2,747.00Percent Over Prior Year -----16.62%-39.59%-99.56%-99.42%5652.88%6731.54%
$413,887 $409,802 $764 $13,735
$789,082 $990,901 $764 $13,735
($375,195)($581,099)$0 $0
$185,000 $185,000 $185,000 $185,000
12/15 12/15 12/15 12/15
2014 2015 2016 2017UHCUHCUHCUHC
$1,040,239 $852,652 $885,221 $470,334
$1,238,088 $852,652 $885,221 $470,334
($197,849)$0 $0 $0
$185,000 $185,000 $185,000 $185,000
12/15 12/15 12/15 12/15
2014 2015 2016 2017UHCUHCUHCUHC
6/27/2017 3
High Dollar Claimant Report January 1, 2017-May 31, 2017
Rank PY Rank Plan Class Relation Amount
Over Specific
($185,000)
1 2 Gold Active Subscriber 355,994$ 170,994$
2 3 Gold Active Child 307,455 122,455
3 --Silver Active Subscriber 206,147 21,147
4 1 Gold Active Subscriber 190,354 5,354
5 --Gold Active Subscriber 182,603 -
6 --Gold Active Spouse 171,766 -
7 --Gold Retiree Retired Subscriber 143,133 -
8 --Gold Active Child 131,026 -
9 24 Gold Active Subscriber 123,172 -
10 --Gold Active Subscriber 100,874 -
Total 1,912,524$ 319,950$
Diagnosis requested
Nerve inflammation in lower back
Diagnosis requested
Chemotherapy
Diagnosis requested
Diagnosis requested
End stage renal disease
Prostate cancer
Genetic metabolism disorder (sphingolipidosis)
City of Denton
High Dollar Claimant Summary
Diagnosis
Cancer of soft connective tissue
6/27/2017 4
Medical Utilization by Diagnosis Category January 1, 2017 - May 31, 2017
Number of Number of Current YTD Prior YTD
Diagnostic Category Claimants Services Paid Claims Paid PEPM Paid PEPM
MUSCULO CNCTV TISSUE 617 4,771 1,156,209 64.06 49.69$
CIRCULATORY SYSTEM 353 1,851 1,071,717 59.38 37.01
OTHER CONDITIONS 1,304 8,653 1,019,237 56.47 46.81
NEOPLASMS 182 1,675 637,561 35.32 23.39
ENDCR NUTRI METABOLIC IMMUN 456 3,722 601,203 33.31 28.54
INJURY AND POISONING 311 1,279 544,038 30.14 19.10
RESPIRATORY SYSTEM 994 5,903 483,357$ 26.78 24.95
GENITOURINARY SYSTEM 302 1,416 478,057 26.49 17.26
DIGESTIVE SYSTEM 247 936 454,339 25.17 32.34
NERVOUS SYS SENSE ORGANS 493 1,837 359,251 19.90 21.18
MENTAL DISORDERS 289 1,194 207,072 11.47 6.20
PREGNANCY CHILDBIRTH PUERP 98 667 180,701 10.01 12.74
PERINATAL PERIOD 26 96 140,843 7.80 2.58
SKIN & SUBCUTANEOUS TISSUE 266 916 120,783 6.69 7.54
INFECTIOUS & PARASITIC DIS 326 1,010 80,736 4.47 3.15
BLOOD & BLOOD FORM ORGANS 48 310 29,526 1.64$ 1.83
CONGENITAL ANOMALIES 25 99 18,125 1.00 1.11
Total 6,337 36,335 7,582,756.75$ 419.12$ 334.30$
Benchmark based on MSW book of business for Jan, 2014 to Dec, 2014.
City of Denton
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
6/27/2017 5
Top Drugs by Net Paid January 1, 2017 - May 31, 2017
Rank Drug Name Usage/Indication Drug Tier Claimants
Script
Count % of Scripts
Scripts/
Claimant
Avg Days
Supply Net Paid % of Paid Paid Per Script Paid Per Day
1 STELARA Treatment of plaque psoriasis Tier 2 3 5 0.02%1.67 61.40 $56,340 3.39%$11,268.00 $183.52
2 CONCERTA Treatment of ADHD Tier 1 33 111 0.51%3.36 32.70 $48,215 2.90%$434.37 $13.28
3 AUVI-Q Used in the treatment of allergic reactions Tier 3 6 7 0.03%1.17 30.00 $32,509 1.96%$4,644.14 $154.80
4 VYVANSE Treatment of ADHD Tier 2 40 125 0.58%3.13 31.74 $31,300 1.88%$250.40 $7.89
5 HUMIRA Treatment of rheumatoid arthritis and other conditions Tier 2 4 8 0.04%2.00 28.00 $29,999 1.81%$3,749.88 $133.92
6 ADDERALL XR Treatment of ADHD Tier 1 35 110 0.51%3.14 30.36 $27,483 1.65%$249.85 $8.23
7 CIALIS Treatment of erectile disfunction Tier 3 38 70 0.32%1.84 33.41 $26,588 1.60%$379.83 $11.37
8 ENBREL Treatment of psoriasis and rheumatoid arthritis Tier 3 3 6 0.03%2.00 24.00 $26,386 1.59%$4,397.67 $183.24
9 SPRYCEL Treatment of leukemia Tier 3 1 2 0.01%2.00 30.00 $24,327 1.46%$12,163.50 $405.45
10 NOXAFIL Treatment for fungal infections Tier 2 1 1 0.00%1.00 90.00 $23,765 1.43%$23,765.00 $264.06
11 VICTOZA 3-PAK Treatment of type 2 diabetes Tier 3 8 30 0.14%3.75 30.00 $23,292 1.40%$776.40 $25.88
12 DULOXETINE HCL Treatment of depression and anxiety disorders Tier 1 43 155 0.72%3.60 32.95 $21,004 1.26%$135.51 $4.11
13 INVOKANA Treatment of type 2 diabetes Tier 2 14 51 0.24%3.64 30.00 $19,875 1.20%$389.71 $12.99
14 CRESEMBA Treatment of certain rare fungal infections Tier 3 1 4 0.02%4.00 28.00 $18,578 1.12%$4,644.50 $165.88
15 IMATINIB MESYLATE Treatment of leukemia, gastrointestinal ulcers Tier 1 1 1 0.00%1.00 30.00 $18,468 1.11%$18,468.00 $615.60
16 COSENTYX PEN (2 PENS)Treatment of psoriasis, ankylosing spondylitis, and psoriatic arthritisTier 3 1 1 0.00%1.00 28.00 $17,943 1.08%$17,943.00 $640.82
17 COPAXONE Treatment of multiple sclerosis symptoms Tier 2 1 3 0.01%3.00 28.00 $17,566 1.06%$5,855.33 $209.12
18 HUMALOG Treatment of type 1 diabetes Tier 2 8 22 0.10%2.75 34.09 $17,254 1.04%$784.27 $23.01
19 NUTROPIN AQ NUSPIN Treatment for growth hormone deficiency Tier 2 3 7 0.03%2.33 23.43 $17,004 1.02%$2,429.14 $103.68
20 OSELTAMIVIR PHOSPHATE Treatment and prevention of influenza Tier 1 147 145 0.67%0.99 6.21 $16,659 1.00%$114.89 $18.50
Total Top 20 Prescription Drugs —864 4.00%—27.68 $514,555 30.96%$595.55 $21.51
All Others —20,739 96.00%—27.57 $1,147,191 69.04%$55.32 $2.01
All Prescription Drugs —21,603 100.00%—27.57 $1,661,746 100.00%$76.92 $2.79
City of Denton
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Top Drugs by Prescription Count January 1, 2017 - May 31, 2017
Rank Drug Name Usage/Indication Drug Tier Claimants
Script
Count % of Scripts
Scripts/
Claimant
Avg Days
Supply Net Paid % of Paid Paid Per Script Paid Per Day
1 LEVOTHYROXINE SODIUM Treatment of over-active thyroid Tier 1 222 778 3.60%3.50 33.37 $4,246 0.26%$5.46 $0.16
2 MONTELUKAST SODIUM Treatment of asthma, allergies (generic of Singulair)Tier 1 233 511 2.37%2.19 34.10 $5,672 0.34%$11.10 $0.33
3 LISINOPRIL Treatment of high blood pressure Tier 1 156 468 2.17%3.00 34.13 $340 0.02%$0.73 $0.02
4 AMOXICILLIN Treatment of bacterial infections Tier 1 380 413 1.91%1.09 9.26 $434 0.03%$1.05 $0.11
5 ATORVASTATIN CALCIUM Treatment of high cholesterol (Lipitor generic)Tier 1 105 318 1.47%3.03 37.88 $4,481 0.27%$14.09 $0.37
6 FLUTICASONE PROPIONATE Treatment of asthma and hay fever Tier 1 214 317 1.47%1.48 31.87 $1,579 0.10%$4.98 $0.16
7 PREDNISONE Treatment of ulcerative colitis, psoriasis, arthritis, other disorders Tier 1 252 306 1.42%1.21 10.91 $269 0.02%$0.88 $0.08
8 AZITHROMYCIN Treatment of bacterial infections Tier 1 267 298 1.38%1.12 5.83 $2,070 0.12%$6.95 $1.19
9 TESTOSTERONE CYPIONATE Treatment of hormonal imbalance Tier 1 95 278 1.29%2.93 28.53 $11,595 0.70%$41.71 $1.46
10 HYDROCODONE-ACETAMINOPHEN Relief of moderate to severe pain Tier 1 150 273 1.26%1.82 16.58 $5,024 0.30%$18.40 $1.11
11 OMEPRAZOLE Treatment of gastroesophageal reflux disease Tier 1 94 273 1.26%2.90 34.26 $2,916 0.18%$10.68 $0.31
12 AMOX TR-POTASSIUM CLAVULANATE Treatment of bacterial infections Tier 1 251 269 1.25%1.07 9.73 $2,369 0.14%$8.81 $0.91
13 AMLODIPINE BESYLATE Treatment of high blood pressure, angina (heart-caused chest pain)Tier 1 79 263 1.22%3.33 33.75 $427 0.03%$1.62 $0.05
14 SERTRALINE HCL Treatment of depression Tier 1 90 260 1.20%2.89 32.32 $1,085 0.07%$4.17 $0.13
15 PANTOPRAZOLE SODIUM Treatment of gastroesophageal reflux disease, stomach ulcers Tier 1 88 258 1.19%2.93 33.83 $2,363 0.14%$9.16 $0.27
16 METFORMIN HCL Treatment of type 2 diabetes Tier 1 91 258 1.19%2.84 36.81 $634 0.04%$2.46 $0.07
17 ROSUVASTATIN CALCIUM Treatment of high cholesterol and triglycerides (Crestor generic)Tier 1 93 248 1.15%2.67 37.50 $14,901 0.90%$60.08 $1.60
18 PRAVASTATIN SODIUM Treatment of high cholesterol Tier 1 69 243 1.12%3.52 31.79 $4,840 0.29%$19.92 $0.63
19 TRAMADOL HCL Treatment of moderate to severe pain Tier 1 141 234 1.08%1.66 17.40 $342 0.02%$1.46 $0.08
20 LISINOPRIL-HYDROCHLOROTHIAZIDE Treatment of high blood pressure Tier 1 60 225 1.04%3.75 33.33 $529 0.03%$2.35 $0.07
Total Top 20 Prescription Drugs —6,491 30.05%—27.57 $66,116 3.98%$10.19 $0.37
All Others —15,112 69.95%—27.57 $1,595,630 96.02%$105.59 $3.83
All Prescription Drugs —21,603 100.00%—27.57 $1,661,746 100.00%$76.92 $2.79
City of Denton
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Top Drug Therapeutic Classes By Net Paid January 1, 2017 - May 31, 2017
Rank Drug Class Claimants
Script
Count % of Scripts
Scripts/
Claimant
Avg Days
Supply Generic %
Generic
Substitute %Net Paid % of Paid Paid Per Script Paid Per Day
1 DIABETIC THERAPY 189 1,013 4.69%5.36 33.47 54.3%100.0%$270,768 16.29%$267.29 $7.99
2 MISCELLANEOUS 189 468 2.17%2.48 30.01 56.4%83.3%$172,000 10.35%$367.52 $12.25
3 ANTIARTHRITICS 265 502 2.32%1.89 26.77 91.6%97.7%$72,104 4.34%$143.63 $5.37
4 CNS STIMULANTS 67 214 0.99%3.19 31.73 25.7%27.6%$68,325 4.11%$319.28 $10.06
5 AMPHETAMINE PREPARATIONS 109 372 1.72%3.41 30.65 36.8%55.5%$67,236 4.05%$180.74 $5.90
6 ALL OTHER DERMATOLOGICALS 75 111 0.51%1.48 27.91 61.3%100.0%$65,727 3.96%$592.14 $21.22
7 ANTIVIRALS 269 358 1.66%1.33 16.41 85.2%100.0%$64,622 3.89%$180.51 $11.00
8 PSYCHOSTIMULANTS-ANTIDEPRESSANTS 457 1,716 7.94%3.75 32.55 96.9%99.9%$62,180 3.74%$36.24 $1.11
9 LIPOTROPICS 372 1,315 6.09%3.53 35.84 97.4%99.6%$52,098 3.14%$39.62 $1.11
10 BRONCHIAL DILATORS 402 891 4.12%2.22 29.40 65.1%100.0%$49,997 3.01%$56.11 $1.91
11 ANTINEOPLASTICS 73 215 1.00%2.95 29.17 98.1%100.0%$49,018 2.95%$227.99 $7.82
12 ADRENERGICS 41 44 0.20%1.07 13.27 9.1%100.0%$48,476 2.92%$1,101.73 $83.02
13 ANTIFUNGALS 134 181 0.84%1.35 13.27 95.0%100.0%$46,459 2.80%$256.68 $19.34
14 NON-NARCOTIC ANALGESICS 91 225 1.04%2.47 18.52 85.8%99.5%$38,225 2.30%$169.89 $9.17
15 ANTI-ULCER PREPS/GASTROINTESTINAL PREPS 258 774 3.58%3.00 33.15 94.2%99.9%$31,873 1.92%$41.18 $1.24
16 ANDROGENS 106 311 1.44%2.93 28.61 92.0%94.1%$31,142 1.87%$100.14 $3.50
17 GLUCOCORTICOIDS 528 730 3.38%1.38 13.63 90.5%99.5%$30,255 1.82%$41.45 $3.04
18 ATARACTICS-TRANQUILIZERS 165 460 2.13%2.79 27.38 96.7%98.9%$29,847 1.80%$64.88 $2.37
19 OTHER HORMONES 10 40 0.19%4.00 30.60 77.5%100.0%$29,481 1.77%$737.03 $24.09
20 ANTICONVULSANTS 174 557 2.58%3.20 31.18 94.6%99.1%$29,153 1.75%$52.34 $1.68
Total Top 20 Classes —10,497 48.59%—29.23 82.1%95.7%$1,308,986 78.77%$124.70 $4.27
All Others —11,106 51.41%—26.00 88.5%97.4%$352,760 21.23%$31.76 $1.22
All Therapeutic Classes —21,603 100.00%—27.57 85.4%96.6%$1,661,746 100.00%$76.92 $2.79
City of Denton
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