Addendum 1d Top Drugs.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 Addendum 1d to a health insurance and wellness services request for proposal issued by Dunn County, Wisconsin, providing a formulary drug list that details the top pharmaceuticals and medical devices covered under the health plan as of March 30, 2021. The addendum lists 27 brand-name medications and devices with their National Drug Codes (NDCs), formulary status, and utilization metrics. The drugs span multiple therapeutic categories including diabetes management (Trulicity, Ozempic, Victoza, Saxenda), cardiovascular treatment (Eliquis, Farxiga), immunology (Humira, Tecfidera), oncology (Ibrance), infectious disease (Biktarvy), and injectable insulin products (Novolog, Tresiba). Additionally, the list includes diagnostic devices such as Dexcom G6 continuous glucose monitor and Accu-Chek Aviva Plus blood glucose meter, along with vaccines (Shingrix) and psychiatric medication (Adderall and Lamictal).
The formulary data indicates paid amounts ranging from $120,754.85 to $5,872.61, with prescription counts between 5 and 55 and member utilization between 4 and 27 members where data is disclosed. Most drugs carry a "Brand Formulary" designation indicating coverage under the standard formulary, while Tecfidera, Myfortic, Saxenda, and Lamictal are designated as "Non-Formulary," suggesting higher cost-sharing requirements or restricted coverage. The data suppresses specific member and prescription counts for drugs with fewer than 4 members or prescriptions to protect privacy. This formulary list establishes the baseline drug coverage and utilization patterns that service providers responding to Dunn County's health insurance proposal should anticipate managing and potentially negotiating as part of their health plan offerings.
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Text version
NDC Number Drug Name Drug Tier Formulary
Indicator
00074-0554-02 HUMIRA Brand Formulary
00069-0688-03 IBRANCE Brand Formulary
00074-4339-02 HUMIRA Brand Formulary
64406-0006-02 TECFIDERA Brand Formulary
00074-3799-02 HUMIRA Brand Formulary
00002-1434-80 TRULICITY Brand Formulary
61958-2501-01 BIKTARVY Brand Formulary
00169-6339-10 NOVOLOG Brand Formulary
00310-6210-30 FARXIGA Brand Formulary
00169-2550-13 TRESIBA Brand Formulary
64406-0006-02 TECFIDERA Brand Non-Formulary
00002-1433-80 TRULICITY Brand Formulary
00169-7501-11 NOVOLOG Brand Formulary
00024-5871-02 TOUJEO MAX Brand Formulary
00078-0386-66 MYFORTIC Brand Non-Formulary
00003-0894-21 ELIQUIS Brand Formulary
00002-1436-11 EMGALITY Brand Formulary
08627-0053-03 DEXCOM G6 SENSOR Brand Formulary
00169-4136-02 OZEMPIC Brand Formulary
54092-0383-01 ADDERALL Brand Formulary
00169-4060-13 VICTOZA Brand Formulary
00169-2800-15 SAXENDA Brand Non-Formulary
58160-0823-11 SHINGRIX Brand Formulary
00173-0756-00 LAMICTAL Brand Non-Formulary
65702-0408-10 ACCU-CHEK AVIVA PLUS Brand Formulary
Top Drugs by NDC
Number of prescriptions and / or Number of Members is less than 4. Therefore these values are not displayed.
Date run: 3/30/2021
Paid Amount Number of
Prescriptions
Members
$120,754.85 24
$106,554.15 11
$87,412.43 31
$83,574.07 11
$59,215.80 12
$41,654.58 55 8
$38,586.40 19
$37,525.65 53 6
$18,337.78 21
$16,384.42 21
$15,740.74
$14,606.83 25 8
$14,449.15 8 4
$14,194.46 16
$13,996.22 8
$11,444.50 15 5
$9,460.38 20
$9,445.41 25
$9,222.26 5
$8,689.88 20
$8,394.53 5
$7,692.43 13
$6,275.61 48 27
$5,882.72 5
$5,872.61 24 6
Top Drugs by NDC
Number of prescriptions and / or Number of Members is less than 4. Therefore these values are not displayed.
Date run: 3/30/2021
File details come from the government source that posted it. Updated .