Addendum 1b Top Provider 2019.pdf
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- Attached to
- RFP #2021-03 Health and Wellness Services
- Solicitation number
- 2021 - 03
- Issued by
- Wisconsin
About this file
This is an addendum to a health insurance and wellness services proposal for Dunn County, Wisconsin, providing top provider and pharmaceutical utilization data for the 2019 plan year. The document presents detailed analysis of claims, costs, and prescription drug usage for county employees and their families during January through December 2019. The data identifies Mayo Clinic Health System-NW Wisconsin Region as the dominant provider, accounting for 56.1% of total paid claims ($1,890,611 across 7,866 events), followed by Mayo Clinic at 19.4% ($654,734). The top 25 providers collectively generated $3,257,883 in claims, representing 96.6% of total paid amounts ($3,372,803). This information serves as baseline utilization data for potential bidders responding to Dunn County's 2021 Health and Wellness Services RFP.
The pharmaceutical analysis reveals significant costs concentrated in specialty medications, with Humira (Anti-TNF-Alpha monoclonal antibody) representing the highest expenditure at $209,234 across 43 prescriptions. The top 20 drugs accounted for $644,740 or 69.5% of total pharmacy costs ($927,818), while top drug classes were led by Anti-TNF-Alpha agents at $209,234, followed by insulin therapies at $106,833. Year-over-year comparisons with prior period data show increased utilization in newer drug categories such as multiple sclerosis agents and GLP-1 receptor agonists. This historical claims and pharmacy data provides prospective vendors with critical information regarding existing member health profiles, cost drivers, and clinical trends necessary for proposal development and cost estimation under the county's health insurance RFP.
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Confidential property of Medica Health Plans. Do not reproduce or redistribute without the express written consent of Medica Health Plans.
Top Provider Summary The Top Provider table shows up to the top 25 providers with which your members have accumulated the most cost.
Top Provider Name Events Amount Paid Percent of Total Paid
MAYO CLINIC HEALTH SYSTEM-NW WISCONSIN
REGION INC 7,866 $1,890,611 56.1%
MAYO CLINIC 746 $654,734 19.4%
MCHS HOSPITALS INC 377 $183,321 5.4%
EAU CLAIRE ANESTHESIOLOGISTS LTD 130 $167,464 5.0%
MAYO CLINIC ROCHESTER 7 $54,705 1.6%
MARSHFIELD CLINIC INC 344 $41,442 1.2%
MAYO HEALTH SYSTEM NORTHWEST
WISCONSIN REGION INC 164 $39,764 1.2%
CHIPPEWA VALLEY ORTHO & SPORTS MEDICINE
CLINIC SC 39 $35,414 1.0%
UNIVERSITY OF WI MEDICAL FDN INC 77 $22,802 0.7%
OAKLEAF CLINICS SC 128 $19,685 0.6%
MARSHFIELD CLINIC 61 $17,474 0.5%
FOUNDATIONS THERAPY LLC 145 $16,969 0.5%
KIVLIN EYE CLINIC 184 $13,565 0.4%
CHIPPEWA VALLEY EYE CLINIC LTD 70 $11,558 0.3%
EAU CLAIRE HEART INSTITUTE 47 $10,529 0.3%
ORAL AND MAX SURGERY ASSOCIATES OF EAU
CLAIRE 97 $9,873 0.3%
THE DULUTH CLINIC LTD 81 $9,544 0.3%
IHC-SACRED HEART EMERGENCY PHYSICIANS
LLC 11 $8,841 0.3%
MINIMED DISTRIBUTION CORP 21 $7,869 0.2%
SACRED HEART HOSPITAL 61 $7,834 0.2%
MENOMONIE EYE AND OPTICAL LLC 129 $7,776 0.2%
BALDWIN AREA MEDICAL CENTER INC 18 $7,463 0.2%
CITY OF MENOMONIE 14 $6,939 0.2%
MAYO CLINIC HEALTH SYSTEM PHARMACY AND
HOME MEDICA 47 $6,256 0.2%
MEDICAL X-RAY CONSULTANTS LTD 27 $5,451 0.2%
Total 10,891 $3,257,883 96.6%
Grand Total 12,964 $3,372,803 100.0 %
10 | DUNN COUNTY | January 2019 - December 2019
Confidential property of Medica Health Plans. Do not reproduce or redistribute without the express written consent of Medica Health Plans.
Top Drugs by Amount Paid The chart displays the top 20 prescription drugs based on amount paid.
Current Prior
Generic Name Drug Class Rank # of Rxs Amount Paid % of Total Paid
Amount Paid/Rx
# of Rxs Amount Paid % of Total Paid
Amount Paid/Rx
Humira Anti-Tnf-Alpha - Monoclonal Antibodies
1 43 $209,234 22.6% $4,865.91 31 $122,918 16.9% $3,965.10
Tecfidera Multiple Sclerosis Agents 2 11 $78,587 8.5% $7,144.27 0 $0 0.0% $0.00
Novolog Insulin 3 70 $63,610 6.9% $908.71 78 $59,902 8.3% $767.97
Trulicity Incretin Mimetic Agents (Glp-1 Receptor Agonists)
4 59 $50,374 5.4% $853.80 21 $25,082 3.5% $1,194.38
Tresiba Insulin 5 45 $34,490 3.7% $766.44 34 $25,877 3.6% $761.09
Lamictal Anticonvulsants - Misc. 6 7 $30,378 3.3% $4,339.71 14 $49,890 6.9% $3,563.57
Biktarvy Antiretrovirals 7 9 $27,274 2.9% $3,030.44 0 $0 0.0% $0.00
Farxiga Sodium-Glucose Co- Transporter 2 (Sglt2) Inhibitors
8 25 $22,514 2.4% $900.56 36 $20,180 2.8% $560.56
Eliquis Direct Factor Xa Inhibitors 9 21 $16,142 1.7% $768.67 18 $6,673 0.9% $370.72
Advair Sympathomimetics 10 33 $14,932 1.6% $452.48 28 $10,134 1.4% $361.93
Repatha Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors
11 12 $13,883 1.5% $1,156.92 5 $5,785 0.8% $1,157.00
Myfortic Immunosuppressive Agents 12 4 $12,315 1.3% $3,078.75 16 $25,875 3.6% $1,617.19
Dexcom G6 Sensor Diabetic Supplies 13 18 $10,261 1.1% $570.06 0 $0 0.0% $0.00
Otezla Phosphodiesterase 4 (Pde4) Inhibitors 14 4 $10,173 1.1% $2,543.25 10 $27,701 3.8% $2,770.10
Lyrica Anticonvulsants - Misc. 15 19 $9,620 1.0% $506.32 6 $5,677 0.8% $946.17
Symbicort Sympathomimetics 16 27 $9,289 1.0% $344.04 29 $9,837 1.4% $339.21
Ozempic Incretin Mimetic Agents (Glp-1 Receptor Agonists) 17 10 $8,301 0.9% $830.10 0 $0 0.0% $0.00
Victoza Incretin Mimetic Agents (Glp-1 Receptor Agonists)
18 3 $7,865 0.8% $2,621.67 6 $8,047 1.1% $1,341.17
Latuda Antipsychotics - Misc. 19 7 $7,813 0.8% $1,116.14 0 $0 0.0% $0.00
Atripla Antiretrovirals 20 1 $7,687 0.8% $7,687.00 5 $28,460 3.9% $5,692.00
Total 428 $644,740 69.5% $1,506.40 337 $432,037 59.5% $1,282.01
Grand Total 6,881 $927,818 100.0% $134.84 7,801 $725,972 100.0% $93.06
11 | DUNN COUNTY | January 2019 - December 2019
Confidential property of Medica Health Plans. Do not reproduce or redistribute without the express written consent of Medica Health Plans.
Top Drug Classes by Amount Paid The chart displays up to the top 20 prescription drug classes based on amount paid.
Current Prior Drug Class Rank # of Rxs Amount Paid % of Total
Paid Amount Paid/Rx
# of Rxs Amount Paid % of Total Paid
Amount Paid/Rx
Anti-Tnf-Alpha - Monoclonal Antibodies
1 43 $209,234 22.6% $4,865.91 31 $122,918 16.9% $3,965.10
Insulin 2 144 $106,833 11.5% $741.90 143 $98,681 13.6% $690.08
Multiple Sclerosis Agents 3 11 $78,587 8.5% $7,144.27 0 $0 0.0% $0.00
Incretin Mimetic Agents (Glp-1 Receptor Agonists)
4 72 $66,539 7.2% $924.15 27 $33,128 4.6% $1,226.96
Anticonvulsants - Misc. 5 152 $42,596 4.6% $280.24 142 $70,689 9.7% $497.81
Antiretrovirals 6 13 $40,108 4.3% $3,085.23 5 $28,460 3.9% $5,692.00
Sympathomimetics 7 210 $37,183 4.0% $177.06 228 $31,549 4.3% $138.37
Sodium-Glucose Co-Transporter 2 (Sglt2) Inhibitors
8 25 $22,514 2.4% $900.56 42 $23,620 3.3% $562.38
Immunosuppressive Agents 9 24 $20,664 2.2% $861.00 44 $35,176 4.8% $799.45
Direct Factor Xa Inhibitors 10 26 $18,006 1.9% $692.58 31 $15,057 2.1% $485.71
Diabetic Supplies 11 116 $17,384 1.9% $149.86 48 $1,504 0.2% $31.33
Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors
12 12 $13,883 1.5% $1,156.92 5 $5,785 0.8% $1,157.00
Diagnostic Tests 13 86 $12,838 1.4% $149.28 90 $12,736 1.8% $141.51
Opioid Agonists 14 186 $12,388 1.3% $66.60 206 $13,217 1.8% $64.16
Hmg Coa Reductase Inhibitors 15 294 $10,334 1.1% $35.15 397 $8,671 1.2% $21.84
Phosphodiesterase 4 (Pde4) Inhibitors
16 4 $10,173 1.1% $2,543.25 10 $27,701 3.8% $2,770.10
Bronchodilators - Anticholinergics
17 19 $9,509 1.0% $500.47 18 $7,713 1.1% $428.50
Opioid Partial Agonists 18 24 $8,693 0.9% $362.21 84 $17,384 2.4% $206.95
Steroid Inhalants 19 28 $8,206 0.9% $293.07 30 $5,551 0.8% $185.03
Amphetamines 20 127 $8,029 0.9% $63.22 167 $12,444 1.7% $74.51
Total 1,616 $753,702 81.2% $466.40 1,748 $571,985 78.8% $327.22
Grand Total 6,881 $927,818 100.0% $134.84 7,801 $725,972 100.0% $93.06
12 | DUNN COUNTY | January 2019 - December 2019
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