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Employer Group ABC

Incurred:

Apr 2014 thru Dec 2015

Paid:

Apr 2014 thru Mar 2016

30

|

Page

Drug

Current

PMPM

Change in

PMPM

Change in

# Scripts

Change in

Unit Pricing

Norm value

of PMPM

Percent

Rank (Norm

value =

50%)

Treatment

PHARMACY (ALSO SEE

063X, AN EXTENSION

OF 025X) - IV

SOLUTIONS

$1.17

29.8%

-23.6%

76.0%

$0.70

-

Injection, Ixabepilone,

1 Mg

$0.39

382.5%

1,500.0%

-68.7%

$0.03

-

Trastuzumab

$0.34

0.7%

-28.6%

46.1%

$0.69

-

Gemcitabine Hcl

$0.33

7.6%

23.1%

-9.4%

$0.10

-

Doxorubicin Hcl

Liposome Inj

$0.32

779.3%

200.0%

203.8%

$0.01

-