12-NISD 906022 Top Drug Utilization.xlsx

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Medical and Pharmacy Reinsurance
Solicitation number
RFP 2025-133
Issued by
Bexar County, Texas

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Cover Page

Top Drug Utilization Ranked by Net Paid
October 15, 2025

Customer Name: Northside Independent School District

Member Group ID: 000906022

Originating Member Group Contract ID: 906022

All Filter Details: Report Filter:

{Process Year/Month}=2025-09, 2025-08, 2025-07, 2025-06, 2025-05, 2025-04, 2025-03, 2025-02, 2025-01, 2024-12, 2024-11, 2024-10, 2024-09, 2024-08, 2024-07, 2024-06, 2024-05, 2024-04, 2024-03, 2024-02, 2024-01, 2023-12, 2023-11, 2023-10, 2023-09, 2023-08, 2023-07, 2023-06, 2023-05, 2023-04, 2023-03, 2023-02, 2023-01 And {Funding Arrangement Category}=Administrative Services Only And {Payment Arrangement Category} <> Capitated Arrangement And Rank of {Total Net Paid for Top Drug Filter} Top 100 And {Member Group ID}=000906022 - Northside Independent School District And {CER User ID} (ID) = "jaggers010" And {Access Lvl CD}=EXPANDED, LEVEL 4, SELECT

Prompt 1: SELECT A MEMBER GROUP ID {Member Group ID}=000906022 - Northside Independent School District Prompt 2: SELECT A DATE TYPE Process Dates Prompt 3: ADD MORE DETAILS TO THIS REPORT NDC Number, Specialty Drug List Status Prompt 4: LIMIT THE REPORT'S CUSTOMER STRUCTURE

Prompt 5: LIMIT THE REPORT'S RESULTS

Prompt 6: SET A THRESHOLD FOR THIS REPORT Prompt 7: SELECT PROCESS DATES 2025-09, 2025-08, 2025-07, 2025-06, 2025-05, 2025-04, 2025-03, 2025-02, 2025-01, 2024-12, 2024-11, 2024-10, 2024-09, 2024-08, 2024-07, 2024-06, 2024-05, 2024-04, 2024-03, 2024-02, 2024-01, 2023-12, 2023-11, 2023-10, 2023-09, 2023-08, 2023-07, 2023-06, 2023-05, 2023-04, 2023-03, 2023-02, 2023-01

This document contains UnitedHealthcare's confidential and/or proprietary business information (PBI). PBI may only be used by the recipient person/entity to which it is addressed. Recipient is liable for using and protecting UnitedHealthcare's PBI from further disclosure or misuse, consistent with recipient's contractual obligations under any applicable administrative services agreement, group policy contract, non-disclosure agreement or other applicable contract or law, including but not limited to the U.S. Freedom of Information Act and state freedom of information law exemptions for 'trade secrets'. The document may also contain protected health information (PHI) and must be handled according to applicable state and federal law, including, but not limited to HIPAA. Recipients who misuse information may be subject to both civil and criminal penalties.

Top Drug Util Ranked by TNP-Sum

Top Drugs
Drug NameGPI GroupNDC NumberSpecialty Drug List StatusNumber 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 Bill Amount per Day of Therapy
MOUNJAROANTIDIABETICS*00002145780Non-Specialty Drug118871$1,104,366$0$1,104,3660.3%1.8%0.0%1.8%$1,267.93$0.00$1,267.9336.97$36.34
00002146080Non-Specialty Drug173836$1,007,855$0$1,007,8550.3%1.6%0.0%1.6%$1,205.57$0.00$1,205.5735.09$36.38
00002147180Non-Specialty Drug2781,133$1,296,556$0$1,296,5560.4%2.1%0.0%2.1%$1,144.36$0.00$1,144.3633.87$36.42
00002148480Non-Specialty Drug3651,544$1,734,350$0$1,734,3500.6%2.8%0.0%2.8%$1,123.28$0.00$1,123.2833.09$36.48
00002149580Non-Specialty Drug4191,459$1,593,386$0$1,593,3860.5%2.6%0.0%2.6%$1,092.11$0.00$1,092.1132.62$36.52
00002150680Non-Specialty Drug351851$829,468$0$829,4680.3%1.3%0.0%1.3%$974.70$0.00$974.7029.80$36.66
Subtotal'--6,694$7,565,981$0$7,565,9812.4%12.2%0.0%12.2%$1,130.26$0.00$1,130.2633.45$36.46
OZEMPICANTIDIABETICS*00169413013Non-Specialty Drug2921,470$1,617,607$0$1,617,6070.5%2.6%0.0%2.6%$1,100.41$0.00$1,100.4135.50$32.49
00169418113Non-Specialty Drug3651,355$1,466,552$0$1,466,5520.5%2.4%0.0%2.4%$1,082.33$0.00$1,082.3337.42$30.50
00169477212Non-Specialty Drug2061,507$1,610,071$0$1,610,0710.5%2.6%0.0%2.6%$1,068.39$0.00$1,068.3933.75$33.12
Subtotal'--4,332$4,694,230$0$4,694,2301.6%7.6%0.0%7.6%$1,083.62$0.00$1,083.6235.49$32.05
HUMIRA PENANALGESICS - ANTI-INFLAMMATORY*00074012402Specialty Drug757$761,382$0$761,3820.0%1.2%0.0%1.2%$13,357.57$0.00$13,357.5728.00$482.26
00074055402Specialty Drug41386$2,825,263$0$2,825,2630.1%4.5%0.0%4.5%$7,319.33$0.00$7,319.3328.01$263.89
00074433902Specialty Drug437$239,560$0$239,5600.0%0.4%0.0%0.4%$6,474.59$0.00$6,474.5928.00$237.71
Subtotal'--480$3,826,205$0$3,826,2050.2%6.2%0.0%6.2%$7,971.26$0.00$7,971.2628.01$287.80
JARDIANCEANTIDIABETICS*00597015230Non-Specialty Drug198650$812,119$0$812,1190.2%1.3%0.0%1.3%$1,249.41$0.00$1,249.4168.99$19.26
00597015330Non-Specialty Drug2671,191$1,437,688$0$1,437,6880.4%2.3%0.0%2.3%$1,207.13$0.00$1,207.1367.09$19.24
Subtotal'--1,841$2,249,807$0$2,249,8070.7%3.6%0.0%3.6%$1,222.06$0.00$1,222.0667.76$19.25
TRIKAFTARESPIRATORY AGENTS - MISC.*51167010602Specialty Drug116$396,060$0$396,0600.0%0.6%0.0%0.6%$24,753.77$0.00$24,753.7728.00$957.96
51167033101Specialty Drug364$1,673,774$0$1,673,7740.0%2.7%0.0%2.7%$26,152.72$0.00$26,152.7228.00$956.93
51167044601Specialty Drug15$130,834$0$130,8340.0%0.2%0.0%0.2%$26,166.83$0.00$26,166.8328.00$936.32
Subtotal'--85$2,200,669$0$2,200,6690.0%3.5%0.0%3.5%$25,890.22$0.00$25,890.2228.00$955.91
DUPIXENTDERMATOLOGICALS*00024591401Specialty Drug28268$951,426$0$951,4260.1%1.5%0.0%1.5%$3,550.10$0.00$3,550.1028.22$142.61
00024591502Specialty Drug34242$927,291$0$927,2910.1%1.5%0.0%1.5%$3,831.78$0.00$3,831.7827.91$152.93
00024591902Specialty Drug737$129,614$0$129,6140.0%0.2%0.0%0.2%$3,503.07$0.00$3,503.0727.24$140.37
Subtotal'--547$2,008,331$0$2,008,3310.2%3.2%0.0%3.2%$3,671.54$0.00$3,671.5428.01$147.01
TREMFYADERMATOLOGICALS*57894064001Specialty Drug429$362,056$0$362,0560.0%0.6%0.0%0.6%$12,484.70$0.00$12,484.7051.69$266.42
57894064011Specialty Drug23123$1,604,998$0$1,604,9980.0%2.6%0.0%2.6%$13,048.76$0.00$13,048.7649.15$283.04
Subtotal'--152$1,967,054$0$1,967,0540.1%3.2%0.0%3.2%$12,941.15$0.00$12,941.1549.64$279.74
SKYRIZI PENDERMATOLOGICALS*00074210001Specialty Drug2079$1,688,450$0$1,688,4500.0%2.7%0.0%2.7%$21,372.78$0.00$21,372.7862.82$346.17
Subtotal'--79$1,688,450$0$1,688,4500.0%2.7%0.0%2.7%$21,372.78$0.00$21,372.7862.82$346.17
STELARADERMATOLOGICALS*57894006003Specialty Drug312$140,395$0$140,3950.0%0.2%0.0%0.2%$11,699.55$0.00$11,699.5581.33$171.94
57894006103Specialty Drug748$1,336,154$0$1,336,1540.0%2.2%0.0%2.2%$27,836.55$0.00$27,836.5558.92$477.27
Subtotal'--60$1,476,549$0$1,476,5490.0%2.4%0.0%2.4%$24,609.15$0.00$24,609.1563.40$398.93
RINVOQANALGESICS - ANTI-INFLAMMATORY*00074104328Specialty Drug410$115,673$0$115,6730.0%0.2%0.0%0.2%$11,567.28$0.00$11,567.2828.00$414.47
00074230630Specialty Drug17175$1,099,101$0$1,099,1010.1%1.8%0.0%1.8%$6,280.58$0.00$6,280.5830.00$214.19
00074231030Specialty Drug325$160,871$0$160,8710.0%0.3%0.0%0.3%$6,434.83$0.00$6,434.8330.00$215.32
Subtotal'--210$1,375,645$0$1,375,6450.1%2.2%0.0%2.2%$6,550.69$0.00$6,550.6929.90$223.26
VERZENIOANTINEOPLASTICS AND ADJUNCTIVE THER00002481554Specialty Drug548$609,703$0$609,7030.0%1.0%0.0%1.0%$12,702.14$0.00$12,702.1422.46$565.59
00002533754Specialty Drug531$370,175$0$370,1750.0%0.6%0.0%0.6%$11,941.14$0.00$11,941.1421.23$562.58
Subtotal'--79$979,878$0$979,8780.0%1.6%0.0%1.6%$12,403.52$0.00$12,403.5221.97$564.45
ENBREL SURECLICKANALGESICS - ANTI-INFLAMMATORY*58406003204Specialty Drug16127$918,164$0$918,1640.0%1.5%0.0%1.5%$7,229.63$0.00$7,229.6328.00$269.19
Subtotal'--127$918,164$0$918,1640.0%1.5%0.0%1.5%$7,229.63$0.00$7,229.6328.00$269.19
PAXLOVIDANTIVIRALS*00069504530Non-Specialty Drug10593$123,951$0$123,9510.0%0.2%0.0%0.2%$1,332.81$0.00$1,332.815.00$286.90
00069532130Non-Specialty Drug702654$785,305$0$785,3050.2%1.3%0.0%1.3%$1,200.77$0.00$1,200.775.05$275.25
Subtotal'--747$909,256$0$909,2560.3%1.5%0.0%1.5%$1,217.21$0.00$1,217.215.04$276.69
BIKTARVYANTIVIRALS*61958250101Non-Specialty Drug15182$803,419$0$803,4190.1%1.3%0.0%1.3%$4,414.39$0.00$4,414.3935.93$129.81
Subtotal'--182$803,419$0$803,4190.1%1.3%0.0%1.3%$4,414.39$0.00$4,414.3935.93$129.81
KORLYMANTIDIABETICS*76346007302Specialty Drug212$748,735$0$748,7350.0%1.2%0.0%1.2%$62,394.62$0.00$62,394.6230.00$2,087.30
Subtotal'--12$748,735$0$748,7350.0%1.2%0.0%1.2%$62,394.62$0.00$62,394.6230.00$2,087.30
VITRAKVIANTINEOPLASTICS AND ADJUNCTIVE THER50419039101Specialty Drug120$588,781$0$588,7810.0%0.9%0.0%0.9%$29,439.03$0.00$29,439.0323.40$1,258.08
Subtotal'--20$588,781$0$588,7810.0%0.9%0.0%0.9%$29,439.03$0.00$29,439.0323.40$1,258.08
TRULICITYANTIDIABETICS*00002143480Non-Specialty Drug53184$213,200$0$213,2000.1%0.3%0.0%0.3%$1,158.70$0.00$1,158.7037.81$33.08
00002223680Non-Specialty Drug40196$224,008$0$224,0080.1%0.4%0.0%0.4%$1,142.90$0.00$1,142.9036.82$33.16
00002318280Non-Specialty Drug2594$114,644$0$114,6440.0%0.2%0.0%0.2%$1,219.62$0.00$1,219.6238.72$33.18
Subtotal'--474$551,853$0$551,8530.2%0.9%0.0%0.9%$1,164.25$0.00$1,164.2537.58$33.13
MIFEPRISTONEANTIDIABETICS*76346065403Specialty Drug212$539,403$0$539,4030.0%0.9%0.0%0.9%$44,950.24$0.00$44,950.2430.00$1,508.82
Subtotal'--12$539,403$0$539,4030.0%0.9%0.0%0.9%$44,950.24$0.00$44,950.2430.00$1,508.82
COSENTYX UNOREADYDERMATOLOGICALS*00078107068Specialty Drug754$524,225$0$524,2250.0%0.8%0.0%0.8%$9,707.86$0.00$9,707.8628.26$353.71
Subtotal'--54$524,225$0$524,2250.0%0.8%0.0%0.8%$9,707.86$0.00$9,707.8628.26$353.71
LO LOESTRIN FECONTRACEPTIVES*00430042014Non-Specialty Drug2691,190$510,841$0$510,8410.4%0.8%0.0%0.8%$429.28$0.00$429.2869.71$6.16
Subtotal'--1,190$510,841$0$510,8410.4%0.8%0.0%0.8%$429.28$0.00$429.2869.71$6.16
OTEZLAANALGESICS - ANTI-INFLAMMATORY*55513013760Specialty Drug8109$503,488$0$503,4880.0%0.8%0.0%0.8%$4,619.16$0.00$4,619.1630.00$168.11
Subtotal'--109$503,488$0$503,4880.0%0.8%0.0%0.8%$4,619.16$0.00$4,619.1630.00$168.11
COSENTYX SENSOREADY PENDERMATOLOGICALS*00078063941Specialty Drug1161$495,227$0$495,2270.0%0.8%0.0%0.8%$8,118.48$0.00$8,118.4828.00$298.32
Subtotal'--61$495,227$0$495,2270.0%0.8%0.0%0.8%$8,118.48$0.00$8,118.4828.00$298.32
SYNJARDY XRANTIDIABETICS*00597029588Non-Specialty Drug27114$141,496$0$141,4960.0%0.2%0.0%0.2%$1,241.20$0.00$1,241.2069.47$19.24
00597030045Non-Specialty Drug52180$220,344$0$220,3440.1%0.4%0.0%0.4%$1,224.13$0.00$1,224.1376.50$17.11
00597030093Non-Specialty Drug3591$117,754$0$117,7540.0%0.2%0.0%0.2%$1,294.00$0.00$1,294.0078.45$17.78
Subtotal'--385$479,594$0$479,5940.1%0.8%0.0%0.8%$1,245.70$0.00$1,245.7074.88$17.86
RYBELSUSANTIDIABETICS*00169430730Non-Specialty Drug50149$220,660$0$220,6600.1%0.4%0.0%0.4%$1,480.94$0.00$1,480.9451.34$30.60
00169431430Non-Specialty Drug34118$236,292$0$236,2920.0%0.4%0.0%0.4%$2,002.47$0.00$2,002.4770.17$30.43
Subtotal'--267$456,951$0$456,9510.1%0.7%0.0%0.7%$1,711.43$0.00$1,711.4359.66$30.51
NURTECMIGRAINE PRODUCTS*72618300002Non-Specialty Drug65363$451,390$0$451,3900.1%0.7%0.0%0.7%$1,243.50$0.00$1,243.5030.05$43.77
Subtotal'--363$451,390$0$451,3900.1%0.7%0.0%0.7%$1,243.50$0.00$1,243.5030.05$43.77
WAKIXADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/A72028017803Specialty Drug230$441,607$0$441,6070.0%0.7%0.0%0.7%$14,720.24$0.00$14,720.2430.00$499.84
Subtotal'--30$441,607$0$441,6070.0%0.7%0.0%0.7%$14,720.24$0.00$14,720.2430.00$499.84
HUMIRAANALGESICS - ANTI-INFLAMMATORY*00074024302Specialty Drug552$437,361$0$437,3610.0%0.7%0.0%0.7%$8,410.79$0.00$8,410.7928.00$305.81
Subtotal'--52$437,361$0$437,3610.0%0.7%0.0%0.7%$8,410.79$0.00$8,410.7928.00$305.81
BESREMIANTINEOPLASTICS AND ADJUNCTIVE THER73536050001Specialty Drug123$391,180$0$391,1800.0%0.6%0.0%0.6%$17,007.81$0.00$17,007.8128.00$610.13
Subtotal'--23$391,180$0$391,1800.0%0.6%0.0%0.6%$17,007.81$0.00$17,007.8128.00$610.13
SIMPONIANALGESICS - ANTI-INFLAMMATORY*57894007002Specialty Drug666$374,123$0$374,1230.0%0.6%0.0%0.6%$5,668.52$0.00$5,668.5229.21$209.22
Subtotal'--66$374,123$0$374,1230.0%0.6%0.0%0.6%$5,668.52$0.00$5,668.5229.21$209.22
ORENCIA CLICKJECTANALGESICS - ANTI-INFLAMMATORY*00003218851Specialty Drug665$362,354$0$362,3540.0%0.6%0.0%0.6%$5,574.68$0.00$5,574.6828.00$202.62
Subtotal'--65$362,354$0$362,3540.0%0.6%0.0%0.6%$5,574.68$0.00$5,574.6828.00$202.62
KESIMPTAPSYCHOTHERAPEUTIC AND NEUROLOGICAL00078100768Specialty Drug340$353,727$0$353,7270.0%0.6%0.0%0.6%$8,843.17$0.00$8,843.1729.95$306.02
Subtotal'--40$353,727$0$353,7270.0%0.6%0.0%0.6%$8,843.17$0.00$8,843.1729.95$306.02
DOVATOANTIVIRALS*49702024613Non-Specialty Drug891$334,871$0$334,8710.0%0.5%0.0%0.5%$3,679.90$0.00$3,679.9042.53$94.93
Subtotal'--91$334,871$0$334,8710.0%0.5%0.0%0.5%$3,679.90$0.00$3,679.9042.53$94.93
ELIQUISANTICOAGULANTS*00003089421Non-Specialty Drug80389$328,928$0$328,9280.1%0.5%0.0%0.5%$845.57$0.00$845.5752.47$18.28
Subtotal'--389$328,928$0$328,9280.1%0.5%0.0%0.5%$845.57$0.00$845.5752.47$18.28
SKYRIZIGASTROINTESTINAL AGENTS - MISC.*00074107001Specialty Drug314$311,289$0$311,2890.0%0.5%0.0%0.5%$22,234.92$0.00$22,234.9230.79$730.15
Subtotal'--14$311,289$0$311,2890.0%0.5%0.0%0.5%$22,234.92$0.00$22,234.9230.79$730.15
ENBRELANALGESICS - ANTI-INFLAMMATORY*58406002104Specialty Drug443$306,475$0$306,4750.0%0.5%0.0%0.5%$7,127.33$0.00$7,127.3328.00$268.05
Subtotal'--43$306,475$0$306,4750.0%0.5%0.0%0.5%$7,127.33$0.00$7,127.3328.00$268.05
DESCOVYANTIVIRALS*61958200201Non-Specialty Drug18113$300,746$0$300,7460.0%0.5%0.0%0.5%$2,661.47$0.00$2,661.4740.88$69.41
Subtotal'--113$300,746$0$300,7460.0%0.5%0.0%0.5%$2,661.47$0.00$2,661.4740.88$69.41
PALYNZIQENDOCRINE AND METABOLIC AGENTS - MI68135067345Specialty Drug111$282,176$0$282,1760.0%0.5%0.0%0.5%$25,652.33$0.00$25,652.3330.00$858.90
Subtotal'--11$282,176$0$282,1760.0%0.5%0.0%0.5%$25,652.33$0.00$25,652.3330.00$858.90
LUPKYNISMISCELLANEOUS THERAPEUTIC CLASSES*75626000102Specialty Drug118$262,109$0$262,1090.0%0.4%0.0%0.4%$14,561.63$0.00$14,561.6330.00$496.05
Subtotal'--18$262,109$0$262,1090.0%0.4%0.0%0.4%$14,561.63$0.00$14,561.6330.00$496.05
TRELEGY ELLIPTAANTIASTHMATIC AND BRONCHODILATOR AG00173088710Non-Specialty Drug65200$137,560$0$137,5600.1%0.2%0.0%0.2%$687.80$0.00$687.8037.95$21.07
00173089310Non-Specialty Drug36170$124,330$0$124,3300.1%0.2%0.0%0.2%$731.35$0.00$731.3539.00$21.01
Subtotal'--370$261,890$0$261,8900.1%0.4%0.0%0.4%$707.81$0.00$707.8138.43$21.04
XELJANZ XRANALGESICS - ANTI-INFLAMMATORY*00069050130Specialty Drug347$259,097$0$259,0970.0%0.4%0.0%0.4%$5,512.70$0.00$5,512.7030.00$195.73
Subtotal'--47$259,097$0$259,0970.0%0.4%0.0%0.4%$5,512.70$0.00$5,512.7030.00$195.73
ZENPEPDIGESTIVE AIDS*73562011401Non-Specialty Drug654$252,377$0$252,3770.0%0.4%0.0%0.4%$4,673.64$0.00$4,673.6434.81$136.91
Subtotal'--54$252,377$0$252,3770.0%0.4%0.0%0.4%$4,673.64$0.00$4,673.6434.81$136.91
BIMZELXDERMATOLOGICALS*50474078284Specialty Drug315$235,356$0$235,3560.0%0.4%0.0%0.4%$15,690.37$0.00$15,690.3729.20$540.15
Subtotal'--15$235,356$0$235,3560.0%0.4%0.0%0.4%$15,690.37$0.00$15,690.3729.20$540.15
TALTZDERMATOLOGICALS*00002144511Specialty Drug331$216,519$0$216,5190.0%0.3%0.0%0.3%$6,984.50$0.00$6,984.5028.00$253.97
Subtotal'--31$216,519$0$216,5190.0%0.3%0.0%0.3%$6,984.50$0.00$6,984.5028.00$253.97
AUSTEDOPSYCHOTHERAPEUTIC AND NEUROLOGICAL68546017160Specialty Drug120$213,676$0$213,6760.0%0.3%0.0%0.3%$10,683.82$0.00$10,683.8230.00$368.72
Subtotal'--20$213,676$0$213,6760.0%0.3%0.0%0.3%$10,683.82$0.00$10,683.8230.00$368.72
COMIRNATY 2024-25VACCINES*00069243210Non-Specialty Drug1,3561,360$206,158$0$206,1580.5%0.3%0.0%0.3%$151.59$0.00$151.591.00$147.25
Subtotal'--1,360$206,158$0$206,1580.5%0.3%0.0%0.3%$151.59$0.00$151.591.00$147.25
PULMOZYMERESPIRATORY AGENTS - MISC.*50242010040Specialty Drug432$201,912$0$201,9120.0%0.3%0.0%0.3%$6,309.74$0.00$6,309.7430.00$213.87
Subtotal'--32$201,912$0$201,9120.0%0.3%0.0%0.3%$6,309.74$0.00$6,309.7430.00$213.87
CREONDIGESTIVE AIDS*00032301613Non-Specialty Drug544$195,721$0$195,7210.0%0.3%0.0%0.3%$4,448.21$0.00$4,448.2142.02$107.19
Subtotal'--44$195,721$0$195,7210.0%0.3%0.0%0.3%$4,448.21$0.00$4,448.2142.02$107.19
CIMZIAGASTROINTESTINAL AGENTS - MISC.*50474071079Specialty Drug542$189,762$0$189,7620.0%0.3%0.0%0.3%$4,518.14$0.00$4,518.1428.86$198.20
Subtotal'--42$189,762$0$189,7620.0%0.3%0.0%0.3%$4,518.14$0.00$4,518.1428.86$198.20
NEULASTAHEMATOPOIETIC AGENTS*55513019001Specialty Drug425$183,723$0$183,7230.0%0.3%0.0%0.3%$7,348.91$0.00$7,348.9111.12$665.58
Subtotal'--25$183,723$0$183,7230.0%0.3%0.0%0.3%$7,348.91$0.00$7,348.9111.12$665.58
OMNIPOD 5 DEXCOM G7G6 PODUNKNOWN08508300021Non-Specialty Drug29256$177,121$0$177,1210.1%0.3%0.0%0.3%$691.88$0.00$691.8834.47$22.21
Subtotal'--256$177,121$0$177,1210.1%0.3%0.0%0.3%$691.88$0.00$691.8834.47$22.21
NUCALAANTIASTHMATIC AND BRONCHODILATOR AG00173089201Specialty Drug358$176,940$0$176,9400.0%0.3%0.0%0.3%$3,050.69$0.00$3,050.6928.00$130.68
Subtotal'--58$176,940$0$176,9400.0%0.3%0.0%0.3%$3,050.69$0.00$3,050.6928.00$130.68
EMGALITYMIGRAINE PRODUCTS*00002143611Non-Specialty Drug25214$167,793$0$167,7930.1%0.3%0.0%0.3%$784.08$0.00$784.0836.62$23.16
Subtotal'--214$167,793$0$167,7930.1%0.3%0.0%0.3%$784.08$0.00$784.0836.62$23.16
BENLYSTAMISCELLANEOUS THERAPEUTIC CLASSES*49401008835Specialty Drug334$160,846$0$160,8460.0%0.3%0.0%0.3%$4,730.76$0.00$4,730.7628.00$173.61
Subtotal'--34$160,846$0$160,8460.0%0.3%0.0%0.3%$4,730.76$0.00$4,730.7628.00$173.61
DEXCOM G7 SENSORUNKNOWN08627007701Non-Specialty Drug93398$160,777$0$160,7770.1%0.3%0.0%0.3%$403.96$0.00$403.9640.69$12.31
Subtotal'--398$160,777$0$160,7770.1%0.3%0.0%0.3%$403.96$0.00$403.9640.69$12.31
THIOLA ECGENITOURINARY AGENTS - MISCELLANEOU00178090190Specialty Drug121$160,715$0$160,7150.0%0.3%0.0%0.3%$7,653.08$0.00$7,653.0830.00$257.21
Subtotal'--21$160,715$0$160,7150.0%0.3%0.0%0.3%$7,653.08$0.00$7,653.0830.00$257.21
AIMOVIGMIGRAINE PRODUCTS*55513084301Non-Specialty Drug21169$146,421$0$146,4210.1%0.2%0.0%0.2%$866.39$0.00$866.3938.47$24.82
Subtotal'--169$146,421$0$146,4210.1%0.2%0.0%0.2%$866.39$0.00$866.3938.47$24.82
POMALYSTANTINEOPLASTICS AND ADJUNCTIVE THER59572050321Specialty Drug16$144,499$0$144,4990.0%0.2%0.0%0.2%$24,083.18$0.00$24,083.1828.00$860.11
Subtotal'--6$144,499$0$144,4990.0%0.2%0.0%0.2%$24,083.18$0.00$24,083.1828.00$860.11
QULIPTAMIGRAINE PRODUCTS*00074709430Non-Specialty Drug18126$144,400$0$144,4000.0%0.2%0.0%0.2%$1,146.03$0.00$1,146.0334.29$36.02
Subtotal'--126$144,400$0$144,4000.0%0.2%0.0%0.2%$1,146.03$0.00$1,146.0334.29$36.02
SPRAVATO 84MG DOSEANTIDEPRESSANTS*50458002803Specialty Drug8114$139,938$0$139,9380.0%0.2%0.0%0.2%$1,227.53$0.00$1,227.534.80$262.82
Subtotal'--114$139,938$0$139,9380.0%0.2%0.0%0.2%$1,227.53$0.00$1,227.534.80$262.82
TOUJEO SOLOSTARANTIDIABETICS*00024586903Non-Specialty Drug43151$138,780$0$138,7800.1%0.2%0.0%0.2%$919.07$0.00$919.0767.03$13.71
Subtotal'--151$138,780$0$138,7800.1%0.2%0.0%0.2%$919.07$0.00$919.0767.03$13.71
TAGRISSOANTINEOPLASTICS AND ADJUNCTIVE THER00310135030Specialty Drug111$133,827$0$133,8270.0%0.2%0.0%0.2%$12,166.08$0.00$12,166.0821.82$557.61
Subtotal'--11$133,827$0$133,8270.0%0.2%0.0%0.2%$12,166.08$0.00$12,166.0821.82$557.61
JYNARQUEENDOCRINE AND METABOLIC AGENTS - MI59148008213Specialty Drug113$133,818$0$133,8180.0%0.2%0.0%0.2%$10,293.71$0.00$10,293.7130.00$344.79
Subtotal'--13$133,818$0$133,8180.0%0.2%0.0%0.2%$10,293.71$0.00$10,293.7130.00$344.79
NORDITROPIN FLEXPROENDOCRINE AND METABOLIC AGENTS - MI00169770521Specialty Drug319$132,007$0$132,0070.0%0.2%0.0%0.2%$6,947.75$0.00$6,947.7526.84$261.78
Subtotal'--19$132,007$0$132,0070.0%0.2%0.0%0.2%$6,947.75$0.00$6,947.7526.84$261.78
TIBSOVOANTINEOPLASTICS AND ADJUNCTIVE THER72694061760Specialty Drug17$129,731$0$129,7310.0%0.2%0.0%0.2%$18,533.04$0.00$18,533.0417.14$1,081.09
Subtotal'--7$129,731$0$129,7310.0%0.2%0.0%0.2%$18,533.04$0.00$18,533.0417.14$1,081.09
ORENCIAANALGESICS - ANTI-INFLAMMATORY*00003218811Specialty Drug324$129,572$0$129,5720.0%0.2%0.0%0.2%$5,398.83$0.00$5,398.8328.00$203.12
Subtotal'--24$129,572$0$129,5720.0%0.2%0.0%0.2%$5,398.83$0.00$5,398.8328.00$203.12
REPATHA SURECLICKANTIHYPERLIPIDEMICS*72511076002Non-Specialty Drug25191$128,452$0$128,4520.1%0.2%0.0%0.2%$672.52$0.00$672.5238.99$19.39
Subtotal'--191$128,452$0$128,4520.1%0.2%0.0%0.2%$672.52$0.00$672.5238.99$19.39
XALKORIANTINEOPLASTICS AND ADJUNCTIVE THER00069814020Specialty Drug18$122,387$0$122,3870.0%0.2%0.0%0.2%$15,298.35$0.00$15,298.3518.75$815.91
Subtotal'--8$122,387$0$122,3870.0%0.2%0.0%0.2%$15,298.35$0.00$15,298.3518.75$815.91
UBRELVYMIGRAINE PRODUCTS*00023650110Non-Specialty Drug31136$121,073$0$121,0730.0%0.2%0.0%0.2%$890.24$0.00$890.2431.48$30.38
Subtotal'--136$121,073$0$121,0730.0%0.2%0.0%0.2%$890.24$0.00$890.2431.48$30.38
LANTUS SOLOSTARANTIDIABETICS*00088221905Non-Specialty Drug185828$119,511$0$119,5110.3%0.2%0.0%0.2%$144.34$0.00$144.3458.63$2.46
Subtotal'--828$119,511$0$119,5110.3%0.2%0.0%0.2%$144.34$0.00$144.3458.63$2.46
VRAYLARANTIPSYCHOTICS/ANTIMANIC AGENTS*61874013030Non-Specialty Drug1358$118,294$0$118,2940.0%0.2%0.0%0.2%$2,039.56$0.00$2,039.5649.66$46.20
Subtotal'--58$118,294$0$118,2940.0%0.2%0.0%0.2%$2,039.56$0.00$2,039.5649.66$46.20
SHINGRIXVACCINES*58160082311Non-Specialty Drug418546$112,173$0$112,1730.2%0.2%0.0%0.2%$205.45$0.00$205.451.65$121.77
Subtotal'--546$112,173$0$112,1730.2%0.2%0.0%0.2%$205.45$0.00$205.451.65$121.77
OPZELURADERMATOLOGICALS*50881000705Specialty Drug2863$105,249$0$105,2490.0%0.2%0.0%0.2%$1,670.61$0.00$1,670.6130.03$67.70
Subtotal'--63$105,249$0$105,2490.0%0.2%0.0%0.2%$1,670.61$0.00$1,670.6130.03$67.70
TOUJEO MAX SOLOSTARANTIDIABETICS*00024587102Non-Specialty Drug27138$103,292$0$103,2920.0%0.2%0.0%0.2%$748.49$0.00$748.4952.22$14.32
Subtotal'--138$103,292$0$103,2920.0%0.2%0.0%0.2%$748.49$0.00$748.4952.22$14.32
ACTEMRAANALGESICS - ANTI-INFLAMMATORY*50242013801Specialty Drug123$102,551$0$102,5510.0%0.2%0.0%0.2%$4,458.76$0.00$4,458.7628.00$164.05
Subtotal'--23$102,551$0$102,5510.0%0.2%0.0%0.2%$4,458.76$0.00$4,458.7628.00$164.05
Subtotal'--25,169$48,827,428$0$48,827,4289.0%78.6%0.0%78.6%$1,939.98$0.00$1,939.9837.11$55.00
Total'--25,169$48,827,428$0$48,827,4289.0%78.6%0.0%78.6%$1,939.98$0.00$1,939.9837.11$55.00
All Other Drugs
NDC NumberSpecialty Drug List StatusNumber 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 Bill Amount per Day of Therapy
00597016860Non-Specialty Drug1699$102,036$0$102,0360.0%0.2%0.0%0.2%$1,030.66$0.00$1,030.6663.94$17.63
00074003828Non-Specialty Drug1065$101,856$0$101,8560.0%0.2%0.0%0.2%$1,567.01$0.00$1,567.0141.78$39.77
00456120230Non-Specialty Drug23112$98,409$0$98,4090.0%0.2%0.0%0.2%$878.66$0.00$878.6658.13$16.73
00074061602Specialty Drug115$98,124$0$98,1240.0%0.2%0.0%0.2%$6,541.59$0.00$6,541.5928.00$234.88
00456120130Non-Specialty Drug45133$97,161$0$97,1610.0%0.2%0.0%0.2%$730.54$0.00$730.5445.34$17.36
59148008828Specialty Drug15$94,750$0$94,7500.0%0.2%0.0%0.2%$18,950.08$0.00$18,950.0828.00$677.20
70539000102Specialty Drug441$94,292$0$94,2920.0%0.2%0.0%0.2%$2,299.81$0.00$2,299.8130.00$89.33
00078063968Specialty Drug513$94,262$0$94,2620.0%0.2%0.0%0.2%$7,250.89$0.00$7,250.8928.00$273.40
00002820705Non-Specialty Drug1467$91,465$0$91,4650.0%0.1%0.0%0.1%$1,365.15$0.00$1,365.1552.15$26.17
00469062599Specialty Drug17$90,687$0$90,6870.0%0.1%0.0%0.1%$12,955.24$0.00$12,955.2427.86$465.06
45629013401Specialty Drug13$90,047$0$90,0470.0%0.1%0.0%0.1%$30,015.52$0.00$30,015.5228.00$1,071.98
00597014560Specialty Drug210$89,814$0$89,8140.0%0.1%0.0%0.1%$8,981.40$0.00$8,981.4021.00$430.19
68135030002Specialty Drug16$89,162$0$89,1620.0%0.1%0.0%0.1%$14,860.40$0.00$14,860.4030.00$497.68
70700015691Non-Specialty Drug79272$87,963$0$87,9630.1%0.1%0.0%0.1%$323.39$0.00$323.3968.62$4.71
50474078184Specialty Drug211$86,610$0$86,6100.0%0.1%0.0%0.1%$7,873.61$0.00$7,873.6128.00$282.11
71715000227Non-Specialty Drug213$86,111$0$86,1110.0%0.1%0.0%0.1%$6,623.93$0.00$6,623.9313.00$517.01
08627005303Non-Specialty Drug39242$85,718$0$85,7180.1%0.1%0.0%0.1%$354.21$0.00$354.2138.67$12.14
00002822259Non-Specialty Drug84254$85,522$0$85,5220.1%0.1%0.0%0.1%$336.70$0.00$336.7059.15$5.69
00003416060Specialty Drug13$84,740$0$84,7400.0%0.1%0.0%0.1%$28,246.74$0.00$28,246.7430.00$941.55
50242021501Specialty Drug332$84,051$0$84,0510.0%0.1%0.0%0.1%$2,626.58$0.00$2,626.5828.00$98.44
00169430330Non-Specialty Drug3777$82,872$0$82,8720.0%0.1%0.0%0.1%$1,076.26$0.00$1,076.2636.23$31.24
50242014301Specialty Drug522$82,623$0$82,6230.0%0.1%0.0%0.1%$3,755.61$0.00$3,755.6128.18$147.41
00093598627Non-Specialty Drug159182$81,530$0$81,5300.1%0.1%0.0%0.1%$447.97$0.00$447.9718.08$24.76
73362000801Specialty Drug112$80,097$0$80,0970.0%0.1%0.0%0.1%$6,674.73$0.00$6,674.7328.00$255.38
00002143380Non-Specialty Drug38102$79,016$0$79,0160.0%0.1%0.0%0.1%$774.66$0.00$774.6629.16$33.57
50458057930Non-Specialty Drug2084$79,015$0$79,0150.0%0.1%0.0%0.1%$940.66$0.00$940.6657.38$17.75
00310183030Specialty Drug416$76,945$0$76,9450.0%0.1%0.0%0.1%$4,809.05$0.00$4,809.0552.50$115.40
00597015390Non-Specialty Drug3464$75,162$0$75,1620.0%0.1%0.0%0.1%$1,174.40$0.00$1,174.4079.69$17.28
73362000901Specialty Drug39$72,192$0$72,1920.0%0.1%0.0%0.1%$8,021.30$0.00$8,021.3028.00$302.49
63004871204Specialty Drug14$71,118$0$71,1180.0%0.1%0.0%0.1%$17,779.45$0.00$17,779.4512.00$1,487.45
62856071430Specialty Drug13$70,832$0$70,8320.0%0.1%0.0%0.1%$23,610.79$0.00$23,610.7930.00$787.03
00078065920Non-Specialty Drug1363$69,496$0$69,4960.0%0.1%0.0%0.1%$1,103.12$0.00$1,103.1268.57$18.51
55513012301Specialty Drug115$68,908$0$68,9080.0%0.1%0.0%0.1%$4,593.86$0.00$4,593.8628.00$166.48
63304011613Specialty Drug16$68,176$0$68,1760.0%0.1%0.0%0.1%$11,362.70$0.00$11,362.7030.00$378.76
00480418489Specialty Drug18$68,175$0$68,1750.0%0.1%0.0%0.1%$8,521.88$0.00$8,521.8822.50$378.75
59572050421Specialty Drug13$67,729$0$67,7290.0%0.1%0.0%0.1%$22,576.33$0.00$22,576.3328.00$806.30
61958210101Non-Specialty Drug121$67,080$0$67,0800.0%0.1%0.0%0.1%$3,194.31$0.00$3,194.3130.00$119.16
65649030302Non-Specialty Drug1726$66,430$0$66,4300.0%0.1%0.0%0.1%$2,554.98$0.00$2,554.9823.46$124.36
61958190101Non-Specialty Drug29$66,393$0$66,3930.0%0.1%0.0%0.1%$7,377.00$0.00$7,377.0063.33$125.03
50458057989Non-Specialty Drug1549$65,370$0$65,3700.0%0.1%0.0%0.1%$1,334.09$0.00$1,334.0979.18$17.95
68180096301Non-Specialty Drug1,0231,672$64,894$0$64,8940.6%0.1%0.0%0.1%$38.81$0.00$38.8127.20$1.41
00597014030Non-Specialty Drug1852$64,028$0$64,0280.0%0.1%0.0%0.1%$1,231.31$0.00$1,231.3180.77$16.28
00642747001Non-Specialty Drug48166$62,944$0$62,9440.1%0.1%0.0%0.1%$379.18$0.00$379.1861.83$6.56
00310461612Non-Specialty Drug29110$62,767$0$62,7670.0%0.1%0.0%0.1%$570.61$0.00$570.6131.91$20.92
61874011530Non-Specialty Drug1835$61,425$0$61,4250.0%0.1%0.0%0.1%$1,755.01$0.00$1,755.0146.00$45.33
58406004404Specialty Drug29$61,142$0$61,1420.0%0.1%0.0%0.1%$6,793.55$0.00$6,793.5528.00$258.07
00078091112Non-Specialty Drug2768$59,807$0$59,8070.0%0.1%0.0%0.1%$879.51$0.00$879.5154.26$22.01
00074012403Specialty Drug33$58,989$0$58,9890.0%0.1%0.0%0.1%$19,662.96$0.00$19,662.9628.00$703.68
61958110101Non-Specialty Drug117$58,973$0$58,9730.0%0.1%0.0%0.1%$3,468.97$0.00$3,468.9730.00$117.95
63402020830Non-Specialty Drug110$57,563$0$57,5630.0%0.1%0.0%0.1%$5,756.27$0.00$5,756.2748.00$121.63
80777011096Non-Specialty Drug387382$57,168$0$57,1680.1%0.1%0.0%0.1%$149.66$0.00$149.663.17$45.17
00597014090Non-Specialty Drug1645$56,892$0$56,8920.0%0.1%0.0%0.1%$1,264.27$0.00$1,264.2786.00$16.22
00310908012Non-Specialty Drug116156$56,169$0$56,1690.1%0.1%0.0%0.1%$360.05$0.00$360.0527.27$20.79
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