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6414 - Administrative Servies Only (ASO) for Medical and Pharmacy Benefits, 4.Drawings/ Plans (5)Current Year Medical Plan Review January 1, 2016 - December 31, 2016 EEs Mbrs Medical Rx EEs Mbrs Medical Rx EEs Mbrs Medical Rx EEs Mbrs Medical Rx Jan 2016 556 1,447 302,980.00$ 45,940.00$ 770 2,021 905,885.00$ 248,156.00$ 5 6 1,726.00$ 5,701.00$ 1,331 3,474 1,210,591.00$ 299,797.00$ Feb 2016 558 1,455 259,297.00 61,702.00 773 2,034 968,870.00 232,367.00 6 7 2,715.00 28,478.00 1,337 3,496 1,230,882.00 322,547.00 Mar 2016 557 1,456 253,390.00 61,254.00 774 2,044 903,389.00 214,253.00 6 7 2,632.00 4,850.00 1,337 3,507 1,159,411.00 280,357.00 Apr 2016 564 1,478 368,971.00 82,231.00 775 2,043 1,094,578.00 257,623.00 6 7 1,734.00 5,686.00 1,345 3,528 1,465,283.00 345,540.00 May 2016 572 1,503 264,866.00 73,705.00 777 2,049 705,773.00 235,973.00 6 7 858.00 7,146.00 1,355 3,559 971,497.00 316,824.00 Jun 2016 582 1,513 368,323.00 81,812.00 778 2,072 856,423.00 272,811.00 6 7 590.00 5,539.00 1,366 3,592 1,225,336.00 360,162.00 Jul 2016 582 1,518 319,395.00 105,801.00 781 2,080 739,180.00 283,180.00 6 7 5,654.00 27,731.00 1,369 3,605 1,064,229.00 416,712.00 Aug 2016 583 1,526 301,435.00 117,316.00 780 2,072 759,710.00 225,563.00 6 7 2,988.00 7,094.00 1,369 3,605 1,064,133.00 349,973.00 Sep 2016 594 1,555 347,656.00 106,687.00 779 2,068 997,217.00 271,256.00 6 7 913.00 6,188.00 1,379 3,630 1,345,786.00 384,131.00 Oct 2016 595 1,555 374,035.00 68,208.00 775 2,064 1,032,879.00 259,805.00 6 7 3,008.00 12,739.00 1,376 3,626 1,409,922.00 340,752.00 Nov 2016 601 1,568 468,272.00 88,931.00 770 2,050 871,353.00 242,094.00 6 7 1,433.00 29,468.00 1,377 3,625 1,341,058.00 360,493.00 Dec 2016 603 1,564 288,832.00 78,438.00 771 2,052 1,054,128.00 273,457.00 6 7 3,267.00 8,542.00 1,380 3,623 1,346,227.00 360,437.00 Totals 6,947 18,138 3,917,452.00$ 972,025.00$ 9,303 24,649 10,889,385.00$ 3,016,538.00$ 71 83 27,518.00$ 149,162.00$ 16,321 42,870 14,834,355.00$ 4,137,725.00$ Gross Claims Specific SL Reimbursement Net Claims Avg EEs/Members Per Month 579 1,512 775 2,054 6 7 1,360 3,573 Total Net Claims PEPM/PMPM $703.83 $269.57 $1,447.63 $546.36 $2,488.45 $2,128.67 $1,135.56 $432.32 $18,533,459.98 $4,889,477.00 $0.00 $4,889,477.00 $13,905,923.00 ($438,620.02) $176,680.00 $0.00 $18,972,080.00 ($438,620.02) $13,467,302.98 $176,680.00 Silver Gold Medicare Combined City of Denton Medical 78% Rx 22% Claim Mix Medical 80% Rx 20% Claim Mix Medical 16% Rx 84% Claim Mix Silver 26% Gold 73% Medicare 1% Claim Mix 4/3/2017 1 Medical & Rx Plan Year Review January 1, 2016 - December 31, 2016 Plan YearVendor Specific Deductible Specific & Aggregate Contract EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec January 1,213 3,021 1,566,160$ 184,117$ 130,655$ 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$ -$ February 1,223 3,057 1,237,257 168,605 150,670 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 - March 1,227 3,082 1,128,780 198,591 34,413 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 - April 1,227 3,071 1,161,319 206,570 23,343 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 - May 1,231 3,081 926,764 331,102 45,141 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 June 1,230 3,079 803,182 139,046 120,276 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 1,237 3,105 1,250,875 210,895 57,725 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 1,248 3,127 1,613,506 227,100 125,617 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 1,249 3,137 942,307 238,242 163,396 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 1,252 3,143 878,513 230,810 67,710 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 1,261 3,165 1,109,501 232,021 56,217 1,284 3,304 1,433,882 235,425 344,463 1,309 3,412 1,588,469 317,934 118,720 1,377 3,625 1,341,058 360,493 36,333 December 1,262 3,169 1,281,828 201,622 203,236 1,279 3,272 1,970,782 268,808 274,793 1,321 3,435 1,861,365 312,405 328,575 1,380 3,623 1,346,227 360,437 118,577 Totals 14,860 37,237 13,899,992$ 2,568,721$ 1,178,399$ 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 42,870 14,834,355$ 4,137,725$ 438,620$ Total Claims Spec ReimbursementTotal Net Claims Avg EEs / Members Per Month 1,238 3,103 1,270 3,250 1,308 3,376 1,360 3,573 Total Net Claims PEPM / PMPM $1,028.96 $410.62 $1,133.57 $442.92 $1,276.59 $494.39 $1,135.56 $432.32Percent Over Prior Year ----10.17%7.86%12.62%11.62%-11.05%-12.56% Medical & Rx Plan Year Review - Active Only January 1, 2016 - December 31, 2016 Plan Year Vendor Specific DeductibleSpecific & Aggregate Contract EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec January 1,157 2,944 1,214,187$ 171,991$ -$ 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$ -$ February 1,165 2,976 983,689 145,374 - 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 - March 1,169 3,001 1,082,759 169,129 32,838 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 - April 1,169 2,991 1,033,184 179,788 20,733 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 - May 1,171 2,996 855,591 283,630 17,056 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 June 1,170 2,995 678,064 117,374 11,711 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 1,175 3,014 1,183,810 189,716 14,476 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 1,188 3,033 1,493,572 191,787 83,062 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 1,190 3,044 891,759 196,597 134,934 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 1,191 3,048 848,016 208,069 58,736 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 1,200 3,069 1,049,118 203,071 16,537 1,228 3,226 1,230,492 209,605 150,167 1,259 3,345 1,499,319 268,364 118,416 1,321 3,549 1,304,297 315,630 36,333 December 1,200 3,072 1,151,140 176,071 131,980 1,222 3,193 1,916,681 239,587 245,631 1,268 3,362 1,835,577 295,029 328,575 1,324 3,547 1,315,553 335,374 118,577 Totals 14,145 36,183 12,464,889$ 2,232,597$ 522,063$ 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 41,935 14,353,497$ 3,732,598$ 438,620$ Total Claims Spec Reimbursement Total Net Claims Avg EEs / Members Per Month 1,179 3,015 1,210 3,166 1,250 3,299 1,303 3,495Total Net Claims PEPM / PMPM $1,002.15 $391.77 $1,089.40 $416.27 $1,250.90 $474.10 $1,128.50 $420.83 Percent Over Prior Year ----8.71%6.25%14.82%13.89%-9.78%-11.24% $14,175,423 $15,816,952 $18,767,193 $17,647,475 $14,697,486 $17,147,433 $19,824,846 $18,086,095 ($522,063)($1,330,481)($1,057,653)($438,620) $185,000 $185,000 $185,000 $185,00012/15 12/15 12/15 12/15 2013 2014 2015 2016 UHC UHC UHC UHC City of Denton $185,000 $185,000 $185,000 2016UHC2015UHC2013UHC2014UHC $185,000 12/1512/1512/15 12/15 $16,468,713 ($1,178,399)$15,290,314 $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 $0 $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000 $12,000,000 $14,000,000 $16,000,000 $18,000,000 $20,000,000 2013 2014 2015 2016 YTD Claims Medical Rx $0 $200 $400 $600 $800 $1,000 $1,200 $1,400 2013 2014 2015 2016 Average Claims PEPM PMPM 4/3/2017 2 City of Denton Medical & Rx Plan Year Review - Retiree Only January 1, 2016 - December 31, 2016 Plan YearVendor Specific Deductible Specific & Aggregate Contract EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec January 55 76 351,973$ 12,126$ 130,655$ 58 83 187,071$ 44,595$ -$ 57 78 33,213$ 24,965$ -$ 54 77 31,157$ 18,368$ -$ February 57 80 253,568 23,231 150,670 59 84 72,519 28,979 - 57 76 34,976 28,563 - 56 78 79,934 44,276 - March 57 80 46,021 29,417 1,574 58 81 36,731 29,126 - 55 73 74,907 45,234 - 55 76 21,968 20,262 - April 56 78 123,351 26,773 2,610 59 83 94,508 33,261 - 57 75 52,673 25,422 - 57 78 25,331 16,916 - May 57 82 43,649 47,215 1,560 60 84 76,683 33,107 - 58 76 61,231 27,759 - 57 78 70,623 21,584 - June 57 81 23,715 20,035 564 59 82 (47,755) 25,652 - 57 75 28,027 26,963 - 56 77 43,442 19,132 - July 59 88 27,022 20,016 330 58 80 61,939 29,363 - 55 73 15,127 43,908 - 56 76 55,112 70,825 - August 58 92 78,837 34,028 261 56 78 42,289 30,908 - 54 72 26,031 26,309 - 56 76 23,429 52,049 - September 57 91 22,961 41,012 81 56 78 52,037 28,093 - 51 69 25,290 23,498 - 55 75 24,533 50,064 - October 58 92 21,562 22,024 245 54 76 78,676 43,628 28,011 49 67 23,250 24,697 - 55 75 37,155 21,700 - November 59 94 21,459 27,805 225 54 76 177,181 24,613 167,994 48 65 88,189 49,080 - 55 75 36,761 44,863 - December 60 95 59,432 24,998 370 54 76 26,862 28,022 1,844 51 71 25,788 17,552 - 55 75 30,674 25,063 - Totals 690 1,029 1,073,550$ 328,680$ 289,145$ 685 961 858,741$ 379,347$ 197,849$ 649 870 488,702$ 363,950$ -$ 667 916 480,119$ 405,102$ -$ Total Claims Spec ReimbursementTotal Net Claims Avg EEs / Members Per Month 58 86 57 80 54 73 56 76 Total Net Claims PEPM / PMPM $1,613.17 $1,081.72 $1,518.60 $1,082.45 $1,313.79 $980.06 $1,327.17 $966.40Percent Over Prior Year -----5.86%0.07%-13.49%-9.46%1.02%-1.39% Medical & Rx Plan Year Review - COBRA Only January 1, 2016 - December 31, 2016 Plan YearVendor Specific Deductible Specific & Aggregate Contract EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec EEs Mbrs Med Rx Spec January 1 1 -$ -$ -$ 2 2 2,680$ 1,194$ -$ 3 3 79,566$ 1,204$ -$ 2 2 775$ -$ -$ February 1 1 - - - 2 2 123 1,323 - 3 3 68,180 126 - 2 2 (530) - - March 1 1 - 45 - 3 3 (5,736) 796 - 3 3 40,662 50 - 2 2 236 25 - April 2 2 4,784 9 - 3 3 251,289 1,706 - 3 3 310,496 132 97,957 1 1 10 - - May 3 3 27,524 257 26,525 3 3 108,189 1,455 - 4 8 184,575 117 184,045 1 1 - - - June 3 3 101,403 1,637 108,002 4 6 107,253 2,019 65,177 4 8 88,996 256 86,166 1 1 94 - - July 3 3 40,043 1,163 42,919 4 6 119,346 1,275 119,237 4 8 81,185 485 80,953 1 1 - - - August 2 2 41,097 1,285 42,294 2 2 86,657 598 86,238 5 10 76,043 851 75,952 2 5 5 - - September 2 2 27,587 633 28,381 2 2 7,814 836 7,694 3 7 53,762 1,060 54,248 1 1 80 - - October 3 3 8,935 717 8,729 2 2 43,429 982 43,228 2 2 1,726 154 1,474 1 1 69 - - November 2 2 38,924 1,145 39,455 2 2 26,209 1,207 26,303 2 2 961 490 304 1 1 - - - December 2 2 71,256 553 70,886 3 3 27,239 1,199 27,319 2 2 - (176) - 1 1 - - - Totals 25 25 361,553$ 7,444$ 367,191$ 32 36 774,492$ 14,590$ 375,195$ 38 59 986,152$ 4,749$ 581,099$ 16 19 739$ 25$ -$ Total Claims Spec ReimbursementTotal Net Claims Avg EEs / Members Per Month 2 2 3 3 3 5 1 2 Total Net Claims PEPM / PMPM $72.24 $72.24 $12,933.96 $11,496.86 $10,784.27 $6,945.80 $47.75 $40.21Percent Over Prior Year ----17804.95%15815.51%-16.62%-39.59%-99.56%-99.42% $1,806 $413,887 $409,802 $764 $368,997 $789,082 $990,901 $764 ($367,191)($375,195)($581,099)$0 $185,000 $185,000 $185,000 $185,000 12/15 12/15 12/15 12/15 2013 2014 2015 2016UHCUHCUHCUHC $1,113,085 $1,040,239 $852,652 $885,221 $1,402,230 $1,238,088 $852,652 $885,221 ($289,145)($197,849)$0 $0 $185,000 $185,000 $185,000 $185,000 12/15 12/15 12/15 12/15 2013 2014 2015 2016UHCUHCUHCUHC 4/3/2017 3 Aggregate Claims January 1, 2016-December, 31, 2016 Attachment Point YTD:$27,293,445 Net Claims Paid YTD:$18,533,460 Aggregate Surplus/Deficit:$8,759,985 Month Enrollment Agg. Claims Attachment YTD Agg. Claims YTD Attachment Balance Jan-16 1,331 $1,510,388.00 $2,225,817.99 $1,510,388.00 $2,225,817.99 $715,429.99 Feb-16 1,337 $1,553,429.00 $2,235,851.73 $3,063,817.00 $4,461,669.72 $1,397,852.72 Mar-16 1,337 $1,439,768.00 $2,235,851.73 $4,503,585.00 $6,697,521.45 $2,193,936.45 Apr-16 1,345 $1,810,823.00 $2,249,230.05 $6,314,408.00 $8,946,751.50 $2,632,343.50 May-16 1,355 $1,279,032.94 $2,265,952.95 $7,593,440.94 $11,212,704.45 $3,619,263.51 Jun-16 1,366 $1,551,571.52 $2,284,348.14 $9,145,012.46 $13,497,052.59 $4,352,040.13 Jul-16 1,369 $1,433,681.46 $2,289,365.01 $10,578,693.92 $15,786,417.60 $5,207,723.68 Aug-16 1,369 $1,373,238.05 $2,289,365.01 $11,951,931.97 $18,075,782.61 $6,123,850.64 Sep-16 1,379 $1,644,986.07 $2,306,087.91 $13,596,918.04 $20,381,870.52 $6,784,952.48 Oct-16 1,376 $1,683,237.07 $2,301,071.04 $15,280,155.11 $22,682,941.56 $7,402,786.45 Nov-16 1,377 $1,665,218.06 $2,302,743.33 $16,945,373.17 $24,985,684.89 $8,040,311.72 Dec-16 1,380 $1,588,086.81 $2,307,760.20 $18,533,459.98 $27,293,445.09 $8,759,985.11 City of Denton $0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 Aggregate Claims vs. Attachment Point Attachment Claims Prior Year Attachment Prior Year Claims 4/3/2017 4 High Dollar Claimant Report January 1, 2016-December 31, 2016 Rank PY Rank Plan Class Relation Amount Over Specific ($185,000) 1 4 Gold Active Subscriber 467,523$ 282,523$ 2 15 Gold Active Subscriber 301,906 116,906 3 3 Gold Active Child 224,191 39,191 4 2 Gold Active Spouse 179,040 - 5 --Silver Active Subscriber 161,346 - 6 --Gold Active Spouse 160,509 - 7 --Gold Active Subscriber 157,470 - 8 --Gold Active Subscriber 153,450 - 9 17 Silver Active Spouse 144,133 - 10 --Gold Active Spouse 127,944 - 11 --Gold Active Subscriber 124,532 - 12 --Gold Active Spouse 114,355 - 13 34 Gold Active Subscriber 112,288 - 14 --Gold Active Spouse 104,624 - 15 --Silver Active Spouse 102,940 - 16 26 Gold Active Spouse 100,632 - 17 --Silver Active Subscriber 100,498 - 18 30 Gold Active Spouse 100,255 - 19 --Gold Active Subscriber 99,663 - 20 --Gold Active Subscriber 98,537 - 21 21 Gold Active Subscriber 96,874 - 22 --Gold Active Spouse 96,788 - 23 --Gold Active Subscriber 96,515 - 24 13 Gold Active Subscriber 91,495 - 25 --Silver Retiree Retired Subscriber 91,014 - 26 --Gold Active Spouse 89,878 - 27 --Gold Active Subscriber 84,298 - 28 --Medicare Retiree Retired Subscriber 80,115 - 29 --Gold Active Subscriber 75,984 - 30 --Gold Active Child 66,006 - 31 22 Gold Active Subscriber 65,099 - 32 --Gold Active Spouse 59,784 - 33 --Gold Active Spouse 58,063 - 34 --Silver Active Subscriber 56,412 - Total 4,244,160$ 438,620$ Osteoarthritis of knee Recurrent depressive disorder Myelodysplastic syndrome (failure to produce blood cells) Heart attack Osteoarthritis of knee Stones in bile duct Gastro-esophageal reflux disease without infection Urethral fistula (abnormal opening in urinary tract) Ulcer on lower limb Prostate cancer Breast cancer Irregular heartbeat Nerve inflammation in lower back Upper arm fracture Fractured tibia (shin bone) Breast cancer Acute myeloid leukemia Severe obesity Brain aneurysm Disc disorder in middle or lower back Diverticula of colon Burn of head, face or neck Injury to abdominal wall Severe skin infection Heart disease Malignant neoplasm of rectum Fractured finger(s) Fracture of forearm Displaced disc in back Chronic heart disease Abscess of anal and rectal regions End stage renal disease Elevated white blood cell count City of Denton High Dollar Claimant Summary Diagnosis Lipidoses 4/3/2017 5 Prior Year High Dollar Claimant Report January 1, 2015-December 31, 2015 Plan Class Relation Amount Over Specific ($185,000) 1 Gold COBRA Retired Subscriber 981,099$ 581,099$ 2 Gold Active Spouse 566,907 381,907 3 Gold Active Child 417,012 232,012 4 Gold Active Subscriber 411,695 226,695 5 Silver Active Spouse 301,385 116,385 6 Gold Active Subscriber 227,255 42,255 7 Gold Active Spouse 213,566 28,566 8 Gold Active Spouse 210,538 25,538 9 Gold Active Subscriber 189,296 4,296 10 Gold Active Spouse 183,375 - 11 Gold Active Spouse 181,757 - 12 Gold Active Subscriber 179,244 - 13 Gold Active Subscriber 176,005 - 14 Gold Active Subscriber 174,154 - 15 Gold Active Subscriber 165,185 - 16 Gold Active Subscriber 160,902 - 17 Gold Active Spouse 153,044 - 18 Gold Active Subscriber 144,317 - 19 Gold Active Spouse 134,964 - 20 Gold Active Spouse 133,043 - 21 Gold Active Subscriber 133,020 - 22 Gold Active Subscriber 131,582 - 23 Silver Retiree Retired Subscriber 128,495 - 24 Gold Active Subscriber 119,926 - 25 Silver Active Spouse 118,619 - 26 Gold Active Spouse 117,806 - 27 Gold Active Spouse 116,773 - 28 Gold Active Spouse 109,279 - 29 Gold Active Subscriber 104,942 - 30 Gold Active Spouse 100,318 - 31 Gold Retiree Retired Subscriber 100,156 - 32 Gold Active Spouse 97,850 - 33 Gold Active Subscriber 96,137 - 34 Gold Active Subscriber 92,618 - Total 6,872,262$ 1,638,751$ *Large Claims Reports reflect claims paid and incurred within the current plan year* Complication of unspecified infection (sepsis) Malignant neoplasm of rectum Breast cancer (female) Unspecified effects of radiation Malignant neoplasm of breast (female) Prostate cancer Malignant neoplasm of genital organs Human immunodeficiency virus Severe skin infection Back/disc disorder Degenerative joint disease, unspecified location Diverticula of colon Congenital anomalies of spine Malignant neoplasm of female breast Degenerative disc in lower back Overweight and obesity Viral hepatitis Enlarged or damaged airways in lungs (Bronchiectasis) Abscess of anal and rectal regions Spondylosis (degenerative disease of spine) Multiple myeloma Malignant neoplasm of rectosigmoid junction (colon) Nerve inflammation in lower back Diabetes Elevated white blood cell count End stage renal disease Lipidoses Disc disorder Spondylosis (degenerative disease of spine) Breast cancer Tongue cancer Cancer of bile ducts Closed fracture of clavicle City of Denton High Dollar Claimant Summary Diagnosis Case Status End stage renal disease ($400k laser) 4/3/2017 6 Medical Utilization by Diagnosis Category January 1, 2016 - December 31, 2016 Number of Number of Current YTD Prior YTD Diagnostic Category Claimants Services Paid Claims Paid PEPM Paid PEPM MUSKULO CNCTV TISSUE 1,079 13,966 2,228,133$ 51.97$ 72.26$ OTHER CONDITIONS 2,287 20,679 1,951,550 45.52 49.65 CIRCULATORY SYSTEM 528 3,870 1,501,535 35.03 27.02 DIGESTIVE SYSTEM 498 2,357 1,296,418 30.24 29.66 ENDCR NUTRI METABOLIC IMMUN 761 9,392 1,201,890 28.04 45.12 INJURY AND POISONING 640 2,862 1,186,097 27.67 27.08 NEOPLASMS 326 3,517 1,139,664 26.58 58.05 RESPIRATORY SYSTEM 1,418 12,210 866,647 20.22 24.02 GENITOURINARY SYSTEM 609 4,158 865,629 20.19 46.02 NERVOUS SYS SENSE ORGANS 930 4,238 785,197 18.32 19.82 PREGNANCY CHILDBIRTH PUERP 187 1,963 760,052 17.73 14.14 MENTAL DISORDERS 404 2,479 343,622 8.02 6.92 SKIN & SUBCUTANEOUS TISSUE 560 2,271 237,391 5.54 9.23 PERINATAL PERIOD 85 320 209,046 4.88 3.52 INFECTIOUS & PARASITIC DIS 1,072 3,608 176,056 4.11 6.21 CONGENITAL ANOMALIES 40 225 51,951 1.21 5.68 BLOOD & BLOOD FORM ORGANS 91 739 51,635 1.20 3.72 Total 11,515 88,854 14,852,513.36$ 345.25$ 444.41$ Benchmark based on MSW book of business for Jan, 2014 to Dec, 2014. City of Denton $0 $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 4/3/2017 7 Pharmacy Costs By Source January 1, 2016 - December 31, 2016 Current YTD Number of Scripts Retail Mail Order Total Rx Plan Cost Retail Mail Order Total Rx Tier 1 38,800 1,658 40,458 Tier 1 1,225,705$ 149,576$ 1,375,280$ Tier 2 1,954 88 2,042 Tier 2 1,192,444$ 108,968$ 1,301,412$ Tier 3 3,940 142 4,082 Tier 3 1,208,818$ 78,763$ 1,287,581$ Total 44,694 1,888 46,582 Total 3,626,967$ 337,307$ 3,964,273$ Prior YTD Number of Scripts Retail Mail Order Total Rx Plan Cost Retail Mail Order Total Rx Tier 1 39,989 1,624 41,613 Tier 1 1,092,311$ 159,266$ 1,251,578$ Tier 2 2,453 113 2,566 Tier 2 985,154$ 108,885$ 1,094,040$ Tier 3 4,399 115 4,514 Tier 3 1,287,479$ 52,032$ 1,339,511$ Total 46,841 1,852 48,693 Total 3,364,944$ 320,184$ 3,685,129$ City of Denton Tier 1 87% Tier 2 4% Tier 3 9% Brand vs. Generic - No. of Scripts Tier 1 35% Tier 2 33% Tier 3 32% Brand vs. Generic - Plan Costs Tier 1 86% Tier 2 5% Tier 3 9% Brand vs. Generic - No. of Scripts Tier 1 34% Tier 2 30% Tier 3 36% Brand vs. Generic - Plan Costs 4/3/2017 8 Top Drugs by Net Paid January 1, 2016 - December 31, 2016 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 HUMIRA Treatment of rheumatoid arthritis and other conditions Tier 2 8 44 0.09%5.50 28.00 $179,272 4.52%$4,074.36 $145.51 2 HARVONI Treatment of hepatitis C Tier 2 1 3 0.01%3.00 28.00 $97,036 2.45%$32,345.33 $1,155.19 3 SOVALDI Ttreatment of hepatitis C Tier 2 1 3 0.01%3.00 28.00 $87,215 2.20%$29,071.67 $1,038.27 4 CONCERTA Treatment of ADHD Tier 1 37 212 0.46%5.73 31.20 $79,262 2.00%$373.88 $11.98 5 GLEEVEC Treatment of certain types of leukemia, other neoplasms Tier 1 1 7 0.02%7.00 30.00 $71,552 1.80%$10,221.71 $340.72 6 ENBREL Treatment of psoriasis and rheumatoid arthritis Tier 3 4 17 0.04%4.25 28.00 $67,497 1.70%$3,970.41 $141.80 7 NOXAFIL Treatment for fungal infections Tier 2 1 3 0.01%3.00 90.00 $64,121 1.62%$21,373.67 $237.49 8 VYVANSE Treatment of ADHD Tier 2 58 277 0.59%4.78 31.89 $63,114 1.59%$227.85 $7.14 9 CIALIS Treatment of erectile disfunction Tier 3 57 203 0.44%3.56 27.81 $62,078 1.57%$305.80 $11.00 10 LANTUS SOLOSTAR Treatment of type 1 diabetes Tier 3 22 125 0.27%5.68 30.60 $50,954 1.29%$407.63 $13.32 11 SOLODYN Treatment of bacterial infections Tier 3 13 46 0.10%3.54 30.00 $47,581 1.20%$1,034.37 $34.48 12 DULOXETINE HCL Treatment of depression and anxiety disorders Tier 1 54 364 0.78%6.74 33.16 $46,755 1.18%$128.45 $3.87 13 CRESEMBA Treatment of certain rare fungal infections Tier 3 1 11 0.02%11.00 29.09 $46,741 1.18%$4,249.18 $146.07 14 CRESTOR Treatment of high cholesterol Tier 2 71 185 0.40%2.61 36.48 $46,180 1.16%$249.62 $6.84 15 ADDERALL XR Treatment of ADHD Tier 1 31 179 0.38%5.77 31.32 $45,534 1.15%$254.38 $8.12 16 STIVARGA Chemotherapy for gastrointestinal tumors Tier 2 1 3 0.01%3.00 28.67 $41,799 1.05%$13,933.00 $485.98 17 LIVIXIL PAK Treatmtment for topical pain Tier 3 10 16 0.03%1.60 20.94 $41,273 1.04%$2,579.56 $123.19 18 LIDOCAINE Numbing agent for multiple medical procedures Tier 1 51 122 0.26%2.39 22.37 $40,764 1.03%$334.13 $14.94 19 INVOKANA Treatment of type 2 diabetes Tier 2 19 103 0.22%5.42 32.91 $40,473 1.02%$392.94 $11.94 20 LIALDA Treatment of ulcerative colitis Tier 2 7 43 0.09%6.14 30.00 $39,679 1.00%$922.77 $30.76 Total Top 20 Prescription Drugs —1,966 4.22%—31.14 $1,258,880 31.76%$640.33 $20.56 All Others —44,616 95.78%—27.51 $2,705,393 68.24%$60.64 $2.20 All Prescription Drugs —46,582 100.00%—27.66 $3,964,273 100.00%$85.10 $3.08 City of Denton 4/3/2017 9 Top Drugs by Prescription Count January 1, 2016 - December 31, 2016 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 1 256 1,717 3.69%6.71 33.08 $9,652 0.24%$5.62 $0.17 2 LISINOPRIL Treatment of high blood pressure Tier 1 169 945 2.03%5.59 34.74 $1,484 0.04%$1.57 $0.05 3 MONTELUKAST SODIUM Treatment of asthma, allergies (generic of Singulair)Tier 1 256 873 1.87%3.41 33.86 $10,065 0.25%$11.53 $0.34 4 AMOXICILLIN Treatment of bacterial infections Tier 1 645 780 1.67%1.21 9.45 $673 0.02%$0.86 $0.09 5 FLUTICASONE PROPIONATE Treatment of asthma and hay fever Tier 1 375 776 1.67%2.07 32.69 $2,630 0.07%$3.39 $0.10 6 OMEPRAZOLE Treatment of gastroesophageal reflux disease Tier 1 157 712 1.53%4.54 34.12 $9,229 0.23%$12.96 $0.38 7 HYDROCODONE-ACETAMINOPHEN Relief of moderate to severe pain Tier 1 311 685 1.47%2.20 16.05 $9,737 0.25%$14.21 $0.89 8 ATORVASTATIN CALCIUM Treatment of high cholesterol (Lipitor generic)Tier 1 128 618 1.33%4.83 37.67 $10,791 0.27%$17.46 $0.46 9 AMLODIPINE BESYLATE Treatment of high blood pressure, angina (heart-caused chest pain)Tier 1 101 613 1.32%6.07 33.10 $1,504 0.04%$2.45 $0.07 10 AZITHROMYCIN Treatment of bacterial infections Tier 1 511 609 1.31%1.19 5.37 $2,510 0.06%$4.12 $0.77 11 METFORMIN HCL Treatment of type 2 diabetes Tier 1 121 570 1.22%4.71 36.50 $1,702 0.04%$2.99 $0.08 12 PRAVASTATIN SODIUM Treatment of high cholesterol Tier 1 87 567 1.22%6.52 32.99 $10,377 0.26%$18.30 $0.55 13 PREDNISONE Treatment of ulcerative colitis, psoriasis, arthritis, other disorders Tier 1 396 521 1.12%1.32 11.50 $626 0.02%$1.20 $0.10 14 SERTRALINE HCL Treatment of depression Tier 1 101 516 1.11%5.11 32.99 $2,426 0.06%$4.70 $0.14 15 TESTOSTERONE CYPIONATE Treatment of hormonal imbalance Tier 1 97 502 1.08%5.18 28.05 $16,437 0.41%$32.74 $1.17 16 AMOX TR-POTASSIUM CLAVULANATE Treatment of bacterial infections Tier 1 426 496 1.06%1.16 9.66 $2,896 0.07%$5.84 $0.60 17 LISINOPRIL-HYDROCHLOROTHIAZIDE Treatment of high blood pressure Tier 1 70 490 1.05%7.00 32.89 $902 0.02%$1.84 $0.06 18 PANTOPRAZOLE SODIUM Treatment of gastroesophageal reflux disease, stomach ulcers Tier 1 120 473 1.02%3.94 33.83 $4,745 0.12%$10.03 $0.30 19 SIMVASTATIN Treatment of high cholesterol Tier 1 86 471 1.01%5.48 35.86 $4,334 0.11%$9.20 $0.26 20 GABAPENTIN Treatment of seizures, restless leg syndrome, pain Tier 1 96 433 0.93%4.51 30.05 $6,364 0.16%$14.70 $0.49 Total Top 20 Prescription Drugs —13,367 28.70%—28.24 $109,084 2.75%$8.16 $0.29 All Others —33,215 71.30%—27.43 $3,855,189 97.25%$116.07 $4.23 All Prescription Drugs —46,582 100.00%—27.66 $3,964,273 100.00%$85.10 $3.08 City of Denton 4/3/2017 10