HCC_with_no_PHI_-_City_of_Edinburg_.xlsx
XLSX spreadsheet 40 KB Posted
- Attached to
- Pharmacy Benefits 2025-2026
- Solicitation number
- 2025-011
- Issued by
- Hidalgo County, Texas
About this file
The file is a healthcare claims cost (HCC) spreadsheet for the City of Edinburg, Texas, covering a three-year contract period from June 2022 to May 2025. The contract encompasses pharmacy benefits management services across multiple benefit categories including facility inpatient, facility outpatient, professional services, and pharmacy coverage. The related Request for Proposal (RFP) specifically seeks a 100% Pass-Through Modeling pharmacy benefit management vendor, excluding traditional modeling approaches.
The spreadsheet provides a detailed member-level analysis, highlighting a specific male subscriber aged 65+ with a primary diagnosis of prostate hyperplasia. The total paid medical costs for this member are $61,282.69, broken down across different service categories such as inpatient ($60,504.58), outpatient ($18,126.03), professional services ($32,372.35), emergency room ($10,006.20), and pharmacy ($1,069.62). The member's prescription includes Nifedipine 60mg ER tablets, and the data reflects one inpatient admission, one inpatient day, 72 professional visits, and 149 prescriptions during the analysis period.
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Text version
Sheet1
6/25/2025
| (Paid) | ||||||||||||||||||||
| (CITY OF EDINBURG 000243483: ALL) | ||||||||||||||||||||
| ($50,000) | ||||||||||||||||||||
| (Jun 2022 - May 2023, Jun 2023 - May 2024, Jun 2024 - May 2025) | ||||||||||||||||||||
| (FACILITY INPATIENT, FACILITY OUTPATIENT, PROFESSIONAL, PHARMACY) | ||||||||||||||||||||
| Member Age/Gender Band | Member Relationship Description | Currently Enrolled Indicator | Benefit Package | Paid | Medical Paid | IP Paid | OP Paid | Prof Paid | ER Paid | Pharmacy Paid | Primary Diagnosis | Primary CCSR Dx Level 2 | Primary CCSR Dx Level 1 | IP Admissions | IP Days | OP Visits | ER Visits | Professional Visits | Prescriptions | Primary Drug |
| Male 65+ | Subscriber | Yes | PPO ACTIVE | 61,282.69 | 60,504.58 | 18,126.03 | 32,372.35 | 10,006.20 | 1,069.62 | 778.11 | N40 - Hyperplasia of prostate | Hyperplasia of prostate | Diseases of the Genitourinary System | 1 | 1 | 18 | 1 | 72 | 149 | NIFEDIPINE TAB 60MG ER |
| Male <1-19 | Dependent Child | Yes | PPO ACTIVE | 54,447.48 | 54,420.88 | 1,915.89 | 49,256.74 | 3,248.25 | 4,559.80 | 26.60 | Q66 - Congenital deformities of feet | Musculoskeletal congenital conditions | Congenital Malformations, Deformations and Chromosomal Abnormalities | 0 | 0 | 3 | 2 | 15 | 3 | OSELTAMIVIR SUS 6MG/ML |
| Male 60-64 | Subscriber | Yes | HMO RETIREE PRE 65 | 65,295.55 | 64,728.94 | 48,440.00 | 12,170.80 | 4,118.14 | 0.00 | 566.61 | G61 - Inflammatory polyneuropathy | Polyneuropathies | Diseases of the Nervous System | 1 | 7 | 31 | 39 | 25 | LISINOPRIL TAB 20MG | |
| Female 50-59 | Spouse | Yes | PPO ACTIVE | 56,540.47 | 11,342.00 | 0.00 | 3,878.77 | 7,463.23 | 2,904.04 | 45,198.47 | K52 - Other noninfective gastroenteritis and colitis | Noninfectious gastroenteritis | Factors Influencing Health Status and Contact with Health Services | 5 | 1 | 40 | 136 | JARDIANCE TAB 25MG | ||
| Male 40-49 | Subscriber | No | PPO ACTIVE | 62,027.04 | 46,607.23 | 37,032.51 | 3,220.59 | 6,354.13 | 1,752.04 | 15,419.81 | I63 - Cerebral infarction | Cerebral infarction | Diseases of the Circulatory System | 3 | 9 | 3 | 1 | 60 | 82 | OZEMPIC INJ 8MG/3ML |
| Male 60-64 | Subscriber | Yes | PPO ACTIVE | 88,544.58 | 77,513.29 | 59,192.85 | 0.00 | 18,320.44 | 0.00 | 11,031.29 | I25 - Chronic ischaemic heart disease | Coronary atherosclerosis and other heart disease | Diseases of the Circulatory System | 2 | 10 | 1 | 132 | 53 | MOUNJARO INJ 5MG/0.5 | |
| Female 50-59 | Subscriber | Yes | PPO ACTIVE | 64,658.24 | 61,979.61 | 0.00 | 47,354.83 | 14,624.78 | 5,192.09 | 2,678.63 | Z51 - Other medical care | Breast cancer - all other types | Neoplasms | 51 | 3 | 111 | 93 | LETROZOLE TAB 2.5MG | ||
| Male 50-59 | Spouse | Yes | PPO ACTIVE | 138,360.46 | 138,178.77 | 98,240.79 | 22,927.33 | 17,010.65 | 0.00 | 181.69 | K57 - Diverticular disease of intestine | Gastrointestinal and biliary perforation | Diseases of the Digestive System | 2 | 14 | 9 | 55 | 19 | CLOTRIM/BETA CRE 1-0.05% | |
| Male 60-64 | Subscriber | Yes | PPO ACTIVE | 59,649.23 | 15,789.04 | 0.00 | 11,917.21 | 3,871.83 | 0.00 | 43,860.19 | H25 - Senile cataract | Cataract and other lens disorders | Diseases of the Eye and Adnexa | 16 | 38 | 91 | TRULICITY INJ 3/0.5 | |||
| Male 50-59 | Subscriber | No | HMO ACTIVE | 86,523.16 | 3,210.14 | 0.00 | 0.00 | 3,210.14 | 0.00 | 83,313.02 | M17 - Gonarthrosis [arthrosis of knee] | Osteoarthritis | Diseases of the Musculoskeletal System and Connective Tissue | 13 | 66 | SPRYCEL TAB 100MG | ||||
| Male 50-59 | Subscriber | Yes | PPO RETIREE PRE 65 | 54,424.92 | 18,143.20 | 0.00 | 11,895.21 | 6,247.99 | 0.00 | 36,281.72 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus without complication | Endocrine, Nutritional and Metabolic Diseases | 27 | 116 | 55 | MOUNJARO INJ 15MG/0.5 | |||
| Female <1-19 | Dependent Child | Yes | PPO ACTIVE | 96,852.43 | 22,038.81 | 0.00 | 19,277.95 | 2,760.86 | 0.00 | 74,813.62 | L94 - Other localized connective tissue disorders | Other specified and unspecified skin disorders | Diseases of the Skin and Subcutaneous Tissue | 13 | 1 | 35 | 56 | ACTEMRA INJ ACTPEN | ||
| Male 20-29 | Subscriber | Yes | PPO ACTIVE | 536,916.60 | 536,772.03 | 0.00 | 526,929.37 | 9,842.66 | 5,763.80 | 144.57 | Z51 - Other medical care | Hodgkin lymphoma | Neoplasms | 75 | 1 | 71 | 17 | DEXAMETHASON TAB 4MG | ||
| Male 50-59 | Subscriber | Yes | PPO ACTIVE | 57,833.92 | 12,608.79 | 0.00 | 11,153.74 | 1,455.05 | 0.00 | 45,225.13 | M17 - Gonarthrosis [arthrosis of knee] | Osteoarthritis | Diseases of the Musculoskeletal System and Connective Tissue | 19 | 34 | 75 | TRULICITY INJ 0.75/0.5 | |||
| Female <1-19 | Dependent Child | No | HMO ACTIVE | 112,248.19 | 112,248.19 | 104,209.75 | 0.00 | 8,038.44 | 0.00 | 0.00 | Z38 - Liveborn infants according to place of birth | Liveborn | Certain Conditions Originating in the Perinatal Period | 1 | 31 | 27 | ||||
| Male 50-59 | Subscriber | No | PPO ACTIVE | 145,187.95 | 145,029.39 | 135,575.42 | 4,416.92 | 5,037.05 | 3,017.42 | 158.56 | I48 - Atrial fibrillation and flutter | Cardiac dysrhythmias | Diseases of the Circulatory System | 2 | 15 | 5 | 1 | 25 | 5 | ELIQUIS TAB 5MG |
| Male 60-64 | Subscriber | Yes | HMO RETIREE PRE 65 | 75,896.16 | 63,014.21 | 0.00 | 14,159.55 | 48,854.66 | 4,250.81 | 12,881.95 | C20 - Malignant neoplasm of rectum | Gastrointestinal cancers - colorectal | Neoplasms | 9 | 1 | 68 | 53 | JARDIANCE TAB 10MG | ||
| Female 50-59 | Subscriber | Yes | PPO RETIREE PRE 65 | 110,326.55 | 6,116.59 | 0.00 | 1,661.85 | 4,454.74 | 0.00 | 104,209.96 | H25 - Senile cataract | Cataract and other lens disorders | Diseases of the Eye and Adnexa | 3 | 47 | 116 | ENBREL SRCLK INJ 50MG/ML | |||
| Male 40-49 | Spouse | Yes | PPO ACTIVE | 245,944.24 | 244,546.72 | 81,341.49 | 148,309.02 | 14,896.21 | 12,193.97 | 1,397.52 | Z51 - Other medical care | Bone cancer | Neoplasms | 2 | 12 | 14 | 1 | 46 | 5 | PAXLOVID TAB 300-100 |
| Female 50-59 | Subscriber | Yes | PPO ACTIVE | 51,269.55 | 13,029.01 | 0.00 | 498.61 | 12,530.40 | 0.00 | 38,240.54 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus with complication | Endocrine, Nutritional and Metabolic Diseases | 1 | 73 | 57 | SYNJARDY XR TAB | |||
| Male 60-64 | Subscriber | No | PPO ACTIVE | 61,747.94 | 50,467.67 | 0.00 | 22,046.35 | 28,421.32 | 0.00 | 11,280.27 | T87 - Complications peculiar to reattachment and amputation | Complication of other surgical or medical care, injury, initial encounter | Injury, Poisoning and Certain Other Consequences of External Causes | 97 | 311 | 60 | JARDIANCE TAB 25MG | |||
| Female 60-64 | Subscriber | Yes | PPO ACTIVE | 92,649.10 | 51,733.84 | 0.00 | 35,515.28 | 16,218.56 | 232.02 | 40,915.26 | Z51 - Other medical care | Breast cancer - all other types | Neoplasms | 37 | 1 | 94 | 67 | JARDIANCE TAB 10MG | ||
| Male <1-19 | Dependent Child | Yes | PPO ACTIVE | 53,755.32 | 47,581.14 | 0.00 | 38,007.57 | 9,573.57 | 6,781.42 | 6,174.18 | J32 - Chronic sinusitis | Sinusitis | Diseases of the Respiratory System | 17 | 2 | 104 | 78 | BUDES/FORMOT AER 160-4.5 | ||
| Male 40-49 | Subscriber | No | PPO ACTIVE | 112,152.53 | 19.20 | 0.00 | 0.00 | 19.20 | 0.00 | 112,133.33 | L40 - Psoriasis | Other specified inflammatory condition of skin | Diseases of the Skin and Subcutaneous Tissue | 1 | 11 | TREMFYA INJ 100MG/ML | ||||
| Female 50-59 | Subscriber | Yes | PPO RETIREE PRE 65 | 408,911.70 | 122,490.07 | 0.00 | 112,933.16 | 9,556.91 | 3,304.05 | 286,421.63 | I25 - Chronic ischaemic heart disease | Myocarditis and cardiomyopathy | Diseases of the Circulatory System | 12 | 1 | 66 | 286 | ENBREL SRCLK INJ 50MG/ML | ||
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 266,367.12 | 264,290.97 | 27,181.75 | 207,921.03 | 29,188.19 | 11,687.76 | 2,076.15 | C18 - Malignant neoplasm of colon | Gastrointestinal cancers - colorectal | Neoplasms | 2 | 6 | 52 | 2 | 88 | 33 | VYVANSE CAP 40MG |
| Male 50-59 | Subscriber | No | HMO ACTIVE | 361,970.23 | 319,856.71 | 19,730.00 | 115,056.64 | 185,070.07 | 8,853.21 | 42,113.52 | C25 - Malignant neoplasm of pancreas | Endocrine system cancers - pancreas | Neoplasms | 1 | 5 | 29 | 2 | 109 | 65 | CREON CAP 36000UNT |
| Male 60-64 | Subscriber | Yes | PPO RETIREE PRE 65 | 169,779.72 | 167,316.26 | 77,507.91 | 66,346.96 | 23,461.39 | 6,538.40 | 2,463.46 | M16 - Coxarthrosis [arthrosis of hip] | Urinary tract infections | Diseases of the Genitourinary System | 6 | 14 | 70 | 2 | 194 | 118 | FOSFOMYCIN POW 3GM |
| Female 50-59 | Subscriber | Yes | PPO ACTIVE | 108,417.51 | 95,712.83 | 70,031.25 | 1,192.90 | 24,488.68 | 0.00 | 12,704.68 | T50 - Poisoning by diuretics and other and unspecified drugs, medicaments and biological substances | External cause codes: poisoning by drug | External Causes of Morbidity | 3 | 10 | 4 | 149 | 434 | EPINEPHRINE INJ 0.3MG | |
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 157,971.58 | 15,233.24 | 0.00 | 7,330.77 | 7,902.47 | 2,024.05 | 142,738.34 | J45 - Asthma | Respiratory signs and symptoms | Diseases of the Respiratory System | 6 | 1 | 111 | 86 | SKYRIZI PEN INJ 150MG/ML | ||
| Female 60-64 | Spouse | Yes | PPO ACTIVE | 110,595.13 | 7,881.46 | 0.00 | 3,289.27 | 4,592.19 | 1,944.03 | 102,713.67 | I87 - Other disorders of veins | Postthrombotic syndrome and venous insufficiency/hypertension | Diseases of the Circulatory System | 4 | 1 | 53 | 62 | DUPIXENT INJ 300/2ML | ||
| Male <1-19 | Dependent Child | Yes | PPO ACTIVE | 68,674.61 | 68,086.25 | 0.00 | 32,769.73 | 35,316.52 | 1,631.21 | 588.36 | J03 - Acute tonsillitis | Neurodevelopmental disorders | Mental, Behavioral and Neurodevelopmental Disorders | 29 | 2 | 417 | 37 | OSELTAMIVIR SUS 6MG/ML | ||
| Male 50-59 | Subscriber | No | PPO ACTIVE | 456,814.57 | 207,980.22 | 126,018.00 | 60,285.66 | 21,676.56 | 1,433.64 | 248,834.35 | D64 - Other anaemias | Secondary malignancies | Neoplasms | 3 | 25 | 34 | 1 | 89 | 59 | CABOMETYX TAB 60MG |
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 52,523.44 | 37,420.62 | 24,476.02 | 3,384.86 | 9,559.74 | 0.00 | 15,102.82 | K42 - Umbilical hernia | Abdominal hernia | Diseases of the Digestive System | 1 | 2 | 5 | 82 | 51 | OZEMPIC INJ 4MG/3ML | |
| Male 65+ | Subscriber | No | PPO RETIREE PRE 65 | 140,407.25 | 137,415.32 | 100,166.07 | 11,282.37 | 25,966.88 | 2,780.00 | 2,991.93 | I13 - Hypertensive heart and renal disease | Hypertension with complications and secondary hypertension | Diseases of the Circulatory System | 6 | 25 | 10 | 1 | 220 | 87 | BREZTRI AERO AER SPHERE |
| Male 50-59 | Subscriber | Yes | PPO ACTIVE | 61,069.24 | 8,114.62 | 0.00 | 2,435.37 | 5,679.25 | 0.00 | 52,954.62 | K22 - Other diseases of oesophagus | Esophageal disorders | Diseases of the Digestive System | 5 | 103 | 162 | OZEMPIC INJ 4MG/3ML | |||
| Male 30-39 | Subscriber | Yes | PPO ACTIVE | 50,316.78 | 1,270.06 | 0.00 | 0.00 | 1,270.06 | 0.00 | 49,046.72 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus without complication | Endocrine, Nutritional and Metabolic Diseases | 29 | 53 | TRULICITY INJ 1.5/0.5 | ||||
| Male <1-19 | Dependent Child | No | PPO ACTIVE | 128,798.43 | 128,679.11 | 109,458.57 | 9,776.77 | 9,443.77 | 4,750.00 | 119.32 | Q23 - Congenital malformations of aortic and mitral valves | Cardiac and circulatory congenital anomalies | Congenital Malformations, Deformations and Chromosomal Abnormalities | 1 | 28 | 5 | 2 | 25 | 1 | FAMOTIDINE SUS 40MG/5ML |
| Male <1-19 | Dependent Child | No | PPO ACTIVE | 142,035.89 | 142,035.89 | 122,663.32 | 0.00 | 19,372.57 | 0.00 | 0.00 | Z38 - Liveborn infants according to place of birth | Liveborn | Certain Conditions Originating in the Perinatal Period | 1 | 23 | 24 | ||||
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 312,601.34 | 277,132.88 | 53,733.38 | 181,626.59 | 41,772.91 | 4,724.02 | 35,468.46 | C20 - Malignant neoplasm of rectum | Gastrointestinal cancers - colorectal | Neoplasms | 5 | 18 | 65 | 2 | 183 | 145 | MOUNJARO INJ 5MG/0.5 |
| Female 30-39 | Subscriber | Yes | PPO ACTIVE | 98,696.60 | 33,969.96 | 15,799.27 | 7,946.42 | 10,224.27 | 0.00 | 64,726.64 | C64 - Malignant neoplasm of kidney, except renal pelvis | Urinary system cancers - kidney | Neoplasms | 1 | 1 | 17 | 82 | 105 | STELARA INJ 45MG/0.5 | |
| Male 50-59 | Subscriber | Yes | PPO ACTIVE | 69,060.85 | 12,452.77 | 0.00 | 6,612.19 | 5,840.58 | 0.00 | 56,608.08 | N18 - Chronic renal failure | Chronic kidney disease | Diseases of the Genitourinary System | 16 | 55 | 159 | OZEMPIC INJ 2MG/3ML | |||
| Female 50-59 | Subscriber | Yes | PPO RETIREE PRE 65 | 650,476.24 | 79,432.50 | 26,965.32 | 38,773.50 | 13,693.68 | 3,208.06 | 571,043.74 | A40 - Streptococcal septicaemia | Septicemia | Certain Infectious and Parasitic Diseases | 1 | 6 | 15 | 1 | 138 | 84 | REVLIMID CAP 10MG |
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 359,878.24 | 359,205.67 | 0.00 | 110,084.82 | 249,120.85 | 0.00 | 672.57 | G35 - Multiple sclerosis | Multiple sclerosis | Diseases of the Nervous System | 54 | 71 | 31 | MODAFINIL TAB 100MG | |||
| Male 60-64 | Subscriber | Yes | PPO RETIREE PRE 65 | 73,232.10 | 10,198.66 | 0.00 | 547.70 | 9,650.96 | 0.00 | 63,033.44 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus with complication | Endocrine, Nutritional and Metabolic Diseases | 1 | 95 | 115 | OZEMPIC INJ 8MG/3ML | |||
| Male 60-64 | Subscriber | Yes | HMO RETIREE PRE 65 | 59,300.97 | 7,030.40 | 0.00 | 1,304.23 | 5,726.17 | 0.00 | 52,270.57 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus with complication | Endocrine, Nutritional and Metabolic Diseases | 11 | 55 | 115 | MOUNJARO INJ 2.5/0.5 | |||
| Male 65+ | Subscriber | No | PPO ACTIVE | 50,006.53 | 47,545.34 | 0.00 | 43,827.58 | 3,717.76 | 3,768.20 | 2,461.19 | I70 - Atherosclerosis | Peripheral and visceral vascular disease | Diseases of the Circulatory System | 13 | 1 | 34 | 50 | TELMISA/HCTZ TAB 40-12.5 | ||
| Male 20-29 | Subscriber | No | PPO ACTIVE | 71,225.49 | 6,967.15 | 0.00 | 5,173.03 | 1,794.12 | 5,173.03 | 64,258.34 | U07 - Emergency use of U07 | COVID-19 | Certain Infectious and Parasitic Diseases | 5 | 5 | 21 | 29 | TALTZ INJ 80MG/ML | ||
| Male <1-19 | Dependent Child | Yes | PPO ACTIVE | 126,472.41 | 2,146.51 | 0.00 | 543.59 | 1,602.92 | 0.00 | 124,325.90 | R62 - Lack of expected normal physiological development | Other general signs and symptoms | Factors Influencing Health Status and Contact with Health Services | 2 | 16 | 24 | GENOTROPIN INJ 12MG | |||
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 101,423.87 | 23,636.28 | 0.00 | 10,500.81 | 13,135.47 | 1,191.22 | 77,787.59 | G47 - Sleep disorders | Sleep wake disorders | Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified | 16 | 2 | 173 | 155 | HUMULIN R INJ U-500 | ||
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 69,490.74 | 57,433.85 | 23,597.31 | 25,372.39 | 8,464.15 | 0.00 | 12,056.89 | I21 - Acute myocardial infarction | Acute myocardial infarction | Diseases of the Circulatory System | 1 | 2 | 2 | 36 | 58 | OZEMPIC INJ 8MG/3ML | |
| Female <1-19 | Dependent Child | Yes | PPO ACTIVE | 111,061.03 | 111,052.15 | 101,340.70 | 5,797.22 | 3,914.23 | 0.00 | 8.88 | S42 - Fracture of shoulder and upper arm | Fracture of the upper limb, initial encounter | Injury, Poisoning and Certain Other Consequences of External Causes | 1 | 1 | 2 | 35 | 1 | NEO/POLY/DEX OIN 0.1% OP | |
| Male 50-59 | Subscriber | No | PPO ACTIVE | 393,662.40 | 387,916.65 | 280,727.58 | 17,388.71 | 89,800.36 | 0.00 | 5,745.75 | A41 - Other septicaemia | Septicemia | Certain Infectious and Parasitic Diseases | 1 | 35 | 40 | 323 | 97 | TACROLIMUS CAP 0.5MG | |
| Female 30-39 | Subscriber | No | PPO ACTIVE | 51,346.34 | 50,553.31 | 21,495.35 | 19,224.07 | 9,833.89 | 4,154.17 | 793.03 | K80 - Cholelithiasis | Biliary tract disease | Pregnancy, Childbirth and the Puerperium | 2 | 7 | 14 | 2 | 68 | 6 | OZEMPIC INJ 2MG/3ML |
| Female <1-19 | Dependent Child | Yes | PPO ACTIVE | 51,371.05 | 48,321.08 | 4,008.01 | 37,613.09 | 6,699.98 | 3,897.90 | 3,049.97 | M89 - Other disorders of bone | Other specified bone disease and musculoskeletal deformities | Diseases of the Musculoskeletal System and Connective Tissue | 1 | 5 | 45 | 1 | 76 | 78 | SYMBICORT AER 80-4.5 |
| Female 40-49 | Subscriber | Yes | PPO ACTIVE | 153,378.52 | 4,503.27 | 0.00 | 1,160.36 | 3,342.91 | 0.00 | 148,875.25 | E78 - Disorders of lipoprotein metabolism and other lipidaemias | Disorders of lipid metabolism | Factors Influencing Health Status and Contact with Health Services | 3 | 56 | 102 | COSENTYX PEN INJ 300DOSE | |||
| Female 40-49 | Subscriber | No | PPO ACTIVE | 54,844.97 | 11,951.23 | 0.00 | 8,848.87 | 3,102.36 | 2,340.83 | 42,893.74 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus with complication | Endocrine, Nutritional and Metabolic Diseases | 16 | 2 | 53 | 52 | MOUNJARO INJ 10MG/0.5 | ||
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 51,593.66 | 4,721.55 | 0.00 | 1,620.69 | 3,100.86 | 0.00 | 46,872.11 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus with complication | Endocrine, Nutritional and Metabolic Diseases | 9 | 27 | 52 | XULTOPHY INJ 100/3.6 | |||
| Male 50-59 | Subscriber | Yes | HMO ACTIVE | 113,511.19 | 76,671.78 | 33,432.05 | 24,081.07 | 19,158.66 | 5,218.18 | 36,839.41 | N20 - Calculus of kidney and ureter | Calculus of urinary tract | Diseases of the Genitourinary System | 3 | 7 | 15 | 2 | 121 | 152 | OZEMPIC INJ 8MG/3ML |
| Male 65+ | Subscriber | Yes | PPO ACTIVE | 304,735.55 | 267,549.98 | 107,303.85 | 114,731.84 | 45,514.29 | 4,640.00 | 37,185.57 | I25 - Chronic ischaemic heart disease | Myocarditis and cardiomyopathy | Diseases of the Circulatory System | 5 | 25 | 52 | 3 | 245 | 147 | ENTRESTO TAB 24-26MG |
| Female 30-39 | Subscriber | Yes | PPO ACTIVE | 103,242.36 | 38,245.14 | 0.00 | 21,765.87 | 16,479.27 | 6,192.39 | 64,997.22 | E04 - Other nontoxic goitre | Thyroid disorders | Endocrine, Nutritional and Metabolic Diseases | 30 | 4 | 212 | 178 | TRULICITY INJ 3/0.5 | ||
| Female 30-39 | Subscriber | No | PPO ACTIVE | 211,385.10 | 211,361.93 | 158,881.67 | 4,292.21 | 48,188.05 | 3,973.90 | 23.17 | C78 - Secondary malignant neoplasm of respiratory and digestive organs | Secondary malignancies | Neoplasms | 1 | 27 | 3 | 2 | 167 | 7 | MORPHINE SUL TAB 15MG |
| Female 40-49 | Spouse | Yes | PPO ACTIVE | 199,197.55 | 198,948.13 | 0.00 | 163,643.75 | 35,304.38 | 3,280.00 | 249.42 | C50 - Malignant neoplasm of breast | Breast cancer - all other types | Neoplasms | 53 | 1 | 62 | 20 | TAMOXIFEN TAB 20MG | ||
| Male 60-64 | Subscriber | No | HMO ACTIVE | 242,203.64 | 240,787.54 | 175,078.37 | 25,463.45 | 40,245.72 | 6,596.42 | 1,416.10 | G00 - Bacterial meningitis, not elsewhere classified | Bacterial infections | Certain Infectious and Parasitic Diseases | 4 | 29 | 14 | 3 | 208 | 60 | NITROFURANTN CAP 100MG |
| Female 40-49 | Spouse | Yes | HMO ACTIVE | 52,061.46 | 51,903.95 | 8,107.08 | 27,758.58 | 16,038.29 | 26,717.89 | 157.51 | R56 - Convulsions, not elsewhere classified | Epilepsy; convulsions | Diseases of the Respiratory System | 1 | 2 | 14 | 12 | 52 | 36 | ALBUTEROL NEB 1.25MG/3 |
| Female 50-59 | Subscriber | Yes | PPO ACTIVE | 166,133.50 | 154,131.79 | 32,359.95 | 66,130.89 | 55,640.95 | 23,079.42 | 12,001.71 | A41 - Other septicaemia | Septicemia | Diseases of the Circulatory System | 2 | 13 | 113 | 11 | 314 | 117 | XIGDUO XR TAB 5-1000MG |
| Male 40-49 | Subscriber | Yes | PPO ACTIVE | 417,220.45 | 382,418.04 | 295,906.67 | 47,785.89 | 38,725.48 | 5,780.00 | 34,802.41 | C83 - Diffuse non-Hodgkin's lymphoma | Non-Hodgkin lymphoma | Neoplasms | 8 | 52 | 18 | 2 | 195 | 121 | MOUNJARO INJ 7.5/0.5 |
| Female 30-39 | Spouse | Yes | PPO ACTIVE | 61,445.28 | 61,144.18 | 7,931.92 | 40,230.62 | 12,981.64 | 8,221.71 | 301.10 | S83 - Dislocation, sprain and strain of joints and ligaments of knee | Sprains and strains, initial encounter | Injury, Poisoning and Certain Other Consequences of External Causes | 1 | 4 | 7 | 2 | 84 | 30 | ESTRAD VAL INJ 20MG/ML |
| Male <1-19 | Dependent Child | Yes | PPO ACTIVE | 143,482.14 | 115,694.09 | 0.00 | 104,915.06 | 10,779.03 | 0.00 | 27,788.05 | D84 - Other immunodeficiencies | Immunity disorders | Factors Influencing Health Status and Contact with Health Services | 36 | 55 | 95 | SIROLIMUS TAB 1MG | |||
| Female 60-64 | Subscriber | Yes | HMO ACTIVE | 114,794.15 | 89,048.81 | 39,512.46 | 24,927.42 | 24,608.93 | 16,911.83 | 25,745.34 | N39 - Other disorders of urinary system | Urinary tract infections | Diseases of the Genitourinary System | 4 | 16 | 33 | 8 | 194 | 235 | OZEMPIC INJ 2MG/3ML |
| Male 60-64 | Subscriber | No | PPO ACTIVE | 84,508.47 | 82,974.80 | 61,466.75 | 9,296.87 | 12,211.18 | 4,183.16 | 1,533.67 | K81 - Cholecystitis | Biliary tract disease | Diseases of the Digestive System | 2 | 13 | 15 | 1 | 84 | 59 | TRESIBA FLEX INJ 100UNIT |
| Male 65+ | Subscriber | Yes | PPO ACTIVE | 85,442.54 | 72,034.66 | 37,564.69 | 25,874.55 | 8,595.42 | 22,287.78 | 13,407.88 | I25 - Chronic ischaemic heart disease | Coronary atherosclerosis and other heart disease | Diseases of the Circulatory System | 1 | 3 | 19 | 10 | 77 | 81 | JARDIANCE TAB 10MG |
| Female 40-49 | Subscriber | Yes | PPO ACTIVE | 61,886.19 | 60,043.11 | 0.00 | 484.63 | 59,558.48 | 0.00 | 1,843.08 | I70 - Atherosclerosis | Peripheral and visceral vascular disease | Diseases of the Circulatory System | 1 | 53 | 53 | KRISTALOSE PAK 20GM | |||
| Female 40-49 | Subscriber | Yes | PPO ACTIVE | 53,298.80 | 51,616.38 | 0.00 | 44,475.77 | 7,140.61 | 3,831.42 | 1,682.42 | Q21 - Congenital malformations of cardiac septa | Cardiac and circulatory congenital anomalies | Congenital Malformations, Deformations and Chromosomal Abnormalities | 9 | 1 | 47 | 44 | LARIN 24 TAB FE 1/20 | ||
| Male 65+ | Subscriber | No | HMO ACTIVE | 312,177.72 | 311,141.66 | 255,108.66 | 44,635.47 | 11,397.53 | 0.00 | 1,036.06 | A41 - Other septicaemia | Septicemia | Certain Infectious and Parasitic Diseases | 1 | 44 | 3 | 148 | 11 | ENTRESTO TAB 24-26MG | |
| Male 40-49 | Subscriber | Yes | PPO RETIREE PRE 65 | 92,690.47 | 83,423.41 | 15,241.82 | 51,927.49 | 16,254.10 | 3,359.91 | 9,267.06 | I48 - Atrial fibrillation and flutter | Cardiac dysrhythmias | Diseases of the Circulatory System | 3 | 4 | 4 | 2 | 89 | 52 | ELIQUIS TAB 5MG |
| Female 50-59 | Spouse | Yes | PPO ACTIVE | 77,137.04 | 32,840.51 | 0.00 | 2,947.82 | 29,892.69 | 0.00 | 44,296.53 | E11 - Non-insulin-dependent diabetes mellitus | Diabetes mellitus with complication | Endocrine, Nutritional and Metabolic Diseases | 12 | 45 | 64 | OZEMPIC INJ 8MG/3ML | |||
| Male <1-19 | Dependent Child | Yes | PPO ACTIVE | 245,154.33 | 244,132.85 | 0.00 | 635.17 | 243,497.68 | 0.00 | 1,021.48 | F84 - Pervasive developmental disorders | Neurodevelopmental disorders | Mental, Behavioral and Neurodevelopmental Disorders | 1 | 735 | 59 | FINACEA AER 15% | |||
| Male <1-19 | Dependent Child | Yes | PPO ACTIVE | 63,547.98 | 63,450.94 | 56,831.95 | 910.00 | 5,708.99 | 910.00 | 97.04 | A40 - Streptococcal septicaemia | Septicemia | Certain Infectious and Parasitic Diseases | 2 | 14 | 1 | 1 | 50 | 27 | OSELTAMIVIR SUS 6MG/ML |
| Male <1-19 | Dependent Child | No | PPO ACTIVE | 151,384.23 | 151,384.23 | 149,393.24 | 0.00 | 1,990.99 | 0.00 | 0.00 | P07 - Disorders related to short gestation and low birth weight, not elsewhere classified | Short gestation; low birth weight; and fetal growth retardation | Certain Conditions Originating in the Perinatal Period | 1 | 13 | 16 | ||||
| 11,494,950.99 | 8,158,526.02 | 3,223,095.67 | 3,021,855.81 | 1,913,574.54 | 266,304.82 | 3,336,424.97 | 90 | 578 | 1,518 | 112 | 8,236 | 6,012 | ||||||||
| 11,494,950.99 | 8,158,526.02 | 3,223,095.67 | 3,021,855.81 | 1,913,574.54 | 266,304.82 | 3,336,424.97 | 90 | 578 | 1,518 | 112 | 8,236 | 6,012 |
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File details come from the government source that posted it. Updated .