Exhibit 69 - Cal Yr 2024 City of Miami RX CAP Report Plan Exec Summ and Top 20 Therapeutic Drugs.ppt
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- Attached to
- RFP No. 2130386 - Employee Health Benefits Plan
- Solicitation number
- RFP No. 2130386 - Employee Health Benefits Plan
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- Florida
About this file
This document is a PowerPoint presentation (Exhibit 69) detailing a specialty pharmacy and medical drug plan analysis for the City of Miami for Calendar Year 2024. The report, prepared by Cigna, provides a comprehensive review of pharmacy and medical drug spending, focusing on specialty prescription drugs across various therapeutic classes. The analysis covers claims incurred between January 2024 and December 2024, with comparative data from the base period of January 2023 to December 2023.
The report reveals that the total specialty prescription drug spend increased by 21.5% to $196.00 per member per month (PMPM), with the top ten therapeutic classes accounting for 93.4% of the total specialty plan spend of $10,401,300. Key findings include significant spending in cancer treatments (58.1%), rheumatoid arthritis/psoriasis/Crohn's disease (8.2%), and immune-related conditions. The top three specialty drugs by spend were Stelara ($20.85 PMPM), Biktarvy ($7.71 PMPM), and Enhertu ($7.39 PMPM). The analysis also highlights trends in drug utilization, unique members using specialty medications, and changes in spending across different therapeutic categories.
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Text version
Month Day, Year Presenter Name
Copyright 2025 Cigna - Confidential and Privileged - Not for Distribution EXHIBIT 69 Specialty Pharmacy PPT
Table of Contents
• Pharmacy
Specialty Pharmacy Executive Summary Specialty Pharmacy PPT
Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Mar. 2025 Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Mar. 2024
CITY OF MIAMI-Request 1569498-View 1942458-RPT_ID 401_BCN-Tier 4 Pharmacy and medical drug plan spend 100% 75% 50% 25% 0%
RA/Psoriasis/Crohn's
Cancer
Antivirals, HIV Specific
Growth Hormone Deficiency
Asthma Related
All Other 44.9% 15.7% 13.3% 4.4% 4.4% 17.3%
Cancer
RA/Psoriasis/Crohn's
Immune Related
IVIG/Immune-related
Ophthalmic Conditions
All Other 58.1% 8.2% 7.4% 6.4% 5.1% 14.8% Medical Specialty Rx-HCP / Home Infusion & OP/IP Percent of current plan spend by condition Base Current Norm Pharmacy Specialty Rx - Percent of current plan spend by condition
Account summary(PMPM basis)
Base Current Trend Norm
Plan Spend
Pharmacy Specialty Rx $106.90 $130.12 21.7% $102.79
Medical SRx HCP/Home Infusion $12.35 $18.28 48.0% $19.56
Medical SRx Outpatient/Inpatient $42.10 $47.60 13.1% $17.15
Total Specialty Rx $161.36 $196.00 21.5% $139.50
Other Pharmacy $97.26 $122.56 26.0% $94.00
Specialty Pharmacy & Medical - Top Therapeutic Class Trend
Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Mar. 2025 Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Mar. 2024
CITY OF MIAMI-Request 1569498-View 1942458-RPT_ID 402_BCN-Tier 4 Therapeutic class trend driver analysis by plan spend Comments
· The top ten therapy classes accounted for 93.4% ($9,715,611) of the total specialty plan spend ($10,401,300) in the current period.
Rank
Plan Spend PMPM
Benefit Drug Spend Current PMPM
Unique Members
Utilizing Members Base Current
Therapeutic Class Condition Base Current Trend Norm
Pharmacy
Medical
Current
Trend
Antineoplastics Cancer $38.85 $58.62 50.9% $25.83
$20.43
$38.18
12.1%
Anti-Inflam Disease Modifiers RA/Psoriasis/Crohn's $46.85 $54.03 15.3% $34.40
$49.31
$4.72
19.4%
Antivirals, HIV Specific Antivirals, HIV Specific $16.01 $19.98 24.8% $8.72
$19.98
24.4%
Immune Related IVIG/Immune-related $6.95 $10.76 55.0% $1.89
$1.62
$9.14
Seborrhea/Psoriasis RA/Psoriasis/Crohn's $6.99 $9.45 35.2% $12.85
$9.14
$0.31
100.0%
Multiple/Lateral Sclerosis Multiple Sclerosis $6.72 $9.22 37.2% $4.98
$6.45
$2.77
33.3%
Asthma Related Asthma Related $4.55 $6.22 36.6% $8.30
$5.67
$0.54
37.5%
Pituitary Growth Hormone Deficiency $3.95 $5.93 50.2% $2.43
$5.91
$0.02
133.3%
Vasodilators Pulmonary Hypertension $6.32 $4.89 -22.6% $1.31
$4.89
Eye Ophthalmic Conditions $0.86 $3.98 364.1% $0.23
$3.98
22.2%
All Other Specialty
$23.32 $12.92 -44.6% $38.54
$6.71
$6.21
46.2%
Total
$196.00 21.5% $139.48
$130.12
$65.88
31.9%
Specialty Pharmacy & Medical - Top Drug Spend
Current Period reflects claims incurred between Jan. 2024 and Dec. 2024, paid through Mar. 2025 Base Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Mar. 2024
CITY OF MIAMI-Request 1569498-View 1942458-RPT_ID 403_BCN-Tier 4 Top drugs by spend Comments
· The top fifteen Specialty Pharmacy and Medical drugs accounted for 46.0% ($4,785,862) of the total Specialty plan spend ($10,401,300) in the current period.
· The Specialty Top Drugs by Plan Spend(PMPM) are: Stelara ($20.85), Biktarvy ($7.71), and Enhertu ($7.39).
Rank
Plan Spend (PMPM)
Members
Claims Base Current Drug Name Condition Base Current Trend Norm
Plan Spend
Base
Current
Base Current Stelara(SRx) RA/Psoriasis/Crohn's $23.39 $20.85 -10.9% $7.88
$1,106,355
Biktarvy(SRx) Antivirals, HIV Specific $6.12 $7.71 26.0% $3.02
$408,960
Enhertu Cancer $7.39 $0.35
$392,417
Humira(Cf) Pen(SRx) RA/Psoriasis/Crohn's $6.86 $6.87 0.1% $9.31
$364,663
Verzenio(SRx) Cancer $5.57 $1.48
$295,650
Rinvoq(SRx) RA/Psoriasis/Crohn's $4.46 $5.28 18.3% $2.88
$279,928
Phesgo Cancer $5.03 $0.23
$266,860
Kisqali(SRx) Cancer $1.94 $4.98 156.4% $0.53
$264,272
Opdivo Cancer $4.63 $0.71
$245,901
Ruxience Cancer $4.33 $0.13
$229,737
Genotropin(SRx) Growth Hormone Deficiency $1.07 $3.78 254.6% $0.98
$200,686
Dupixent Pen(SRx) Asthma Related $2.18 $3.66 67.9% $4.61
$193,943
Gamunex-C IVIG/Immune-related $1.11 $3.64 227.1% $0.22
$192,998
Tepezza Ophthalmic Conditions $3.38 $0.04
$179,604
Kesimpta Pen(SRx) Multiple Sclerosis $3.21 $3.09 -3.8% $1.18
$163,887
All Other Specialty
$111.02 $105.82 -4.7% $105.96
$5,615,438
1,397 1,770
Total
$196.00 21.5% $139.49
$10,401,300
1,705 2,213
Glossary
Brand Name The proprietary or trade name of the medication.
Cost Share Benefit plan arrangement requiring that the participant pay a portion of the costs. This includes copayments, coinsurance and deductibles.
Generic Drug A prescription drug that has the same active-ingredient formula as a brand-name drug.
Generic Efficiency This metric illustrates the rate of generic utilization for drugs in which a generic option is available.
Lipotropics Drugs which are designed to lower cholesterol and triglyceride levels which help reduce amount of overall fatty substances in the blood.
Mail Order Drugs A feature of a pharmacy program that enables a participant to send their prescription (and any applicable copay) directly to a mail-order vendor.
Maintenance Drugs Medications that are prescribed for long-term treatment of chronic conditions, such as diabetes, high blood pressure or asthma.
Non-Preferred Brand Drug Drugs in the third tier of a pharmacy program, brand-name drugs that either have generic equivalents or may have one or more preferred brand options.
Norm Norm refers to the comparison group based on book of business or industry experience for the defined parameters. Norms are annualized unless otherwise stated.
Pharmacy Payments Includes prescription drug expenses paid under a pharmacy program. These expenses would not include drugs covered under the medical benefit plan.
Preferred Brand Drug Drugs in the second tier of a Cigna HealthCare two or three tier pharmacy program which have no generic equivalent.
Rebate Discount The dollar value of pharmaceutical manufacturer rebates used to lower prescription drug ingredient cost.
Script A dispensed prescription.
Therapeutic Class Major therapeutic classes include Central Nervous System, Cardiovascular, Hormonal, Anti-infectives, Pain, Allergy/Respiratory and other drugs.
SaveOnSP tertiary Part of the SaveOnSP program fee, for any residual copay required by the manufacturer program billed back to the plan, any remaining drug cost after program benefits are exhausted, or pass through claims for ineligible members.
Report Parameters
Global Parameters
Overall Dates
Current Base
Incurred 01/2024 to 12/2024 01/2023 to 12/2023
Incurred Runout 01/2024 to 03/2025 01/2023 to 03/2024
Catastrophic Threshold $50,000 Exclude Pharmacy No Package :1942458
Package Name:
Structure:
Status = *, Division = *, Product Codes = DHMO,DPPO,HMO,HMOOA,IND,NET,NETOA,NETPOS,NETPOSOA,OAP,RX
Package Parameters PMPM,BCN,Override:No
Normative Values
NETPOS ,HMOOA ,NET ,RX ,NETPOSOA ,DPPO ,IND ,NETOA ,HMO ,DHMO ,OAP ,202412
CITY OF MIAMI:3202272
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