POAH 2017 APR Final_opt 2

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Top 25 NDC by Plan Paid
59310057922
00310614530
00597002402
00469260230
54092047612
00006057561
00003089421
00310621030
53885024510
00310620530
50458057930
49502050002
15455950401
45861006301
63402030830
00002143480
00023916360
00078035752
00088222033
00002751001
00002879959
65976010001
00088221905
00006307402
$0 $7,000 $14,000 $21,000 $28,000 $35,000 $42,000 $49,000 $56,000
TOP CONDITION # OF CLAIMANTS MEMBER PAID
% PLAN PAID
OF TOTAL
PLAN PAID
PLAN PAID NDC DESCRIPTION (DRUG
NAME)
Infectious hepatitis, wo
comp, wo comorb 1 $165.00 17.10 % $53,561.40 ZEPATIER
Diabetes, wo comp, wo
comorb, wo surg 6 $910.00 3.66 % $11,470.16 Lantus Solostar
unavailable 1 $55.00 3.47 % $10,859.88 Arestin
Diabetes, wo comp, w
comorb, wo surg 3 $455.00 3.19 % $10,002.23 Humalog
Diabetes, wo comp, w
comorb, wo surg 4 $487.32 2.81 % $8,797.21 Humalog
Diabetes, wo comp, w
comorb, wo surg 3 $735.00 2.46 % $7,698.26 Lantus
Other psych/behavior
disorder 1 $165.00 2.32 % $7,268.91 Trileptal
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