RFP CDR083126 UCONN Pharmacy Claims 2025-26.xlsx

This document is a pharmacy claims data file for the University of Connecticut (UCONN) Student Health Insurance Plan for the 2025-2026 academic year, displaying detailed pharmaceutical utilization and cost information for the period starting August 1, 2026. The file contains comprehensive claims data for 788 distinct medications and medical supplies across multiple therapeutic categories, including specialty pharmaceuticals, biologicals, vaccines, contraceptives, and various over-the-counter items. The data reflects actual plan spending and utilization patterns, with individual line items showing plan spend, ingredient costs, member cost-sharing (copays and coinsurance), units dispensed, and mail versus retail pharmacy distribution percentages. Top-cost medications include TRIKAFTA ($472,111 total plan spend), ERLEADA ($202,532), STELARA ($188,076), and LUMRYZ ($150,436), indicating significant utilization of specialty drugs for cystic fibrosis, cancer, immunosuppression, and sleep disorders. The claims represent actual historical data that will inform the forthcoming 2027-28 student health insurance plan procurement.

The data demonstrates significant pharmaceutical cost concentration, with approximately 15 medications accounting for over $2.3 million in plan spending. Member cost-sharing arrangements include both copay and coinsurance structures, with notable variation across drug categories—specialty drugs typically feature lower member copays relative to total plan spend, while generic and over-the-counter items show higher member cost participation percentages. Mail order pharmacy utilization varies considerably by medication type, ranging from 0% to 100% for different drugs, reflecting varying patient preferences and clinical appropriateness. The dataset encompasses approximately 1.2 million total units dispensed across all medications, distributed among numerous individual members with varying utilization patterns. This claims history provides critical baseline information for evaluating vendor proposals in the upcoming 2027-28 student health insurance plan request for proposals, enabling potential bidders to understand current pharmaceutical spending patterns, cost drivers, and the scope of pharmacy benefits required under the UCONN student health program.