98 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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3.2 Pharmacy Economics
Growth from previous period through current period in pharmacy expenses can be attributed to changes in Member
Months and pharmacy PMPM cost , as shown in chart 2.2.1 .
Increase or decrease of pharmacy PMPM is caused by changes in the number of prescriptions written per Member
Month and changes in the cost per prescription.
Figure 3.2.1 Pharmacy Expenses
(Refer to Figure 2.2.1)
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Changes in scripts per
member
reflect overall
intensity of care and
member compliance.
Overall trends in volume
are less important than
the change on the ratios
between branded and
generic drugs.
Changes in cost/script
reflect overall
pharmaceutical industry
pricing trends. This cost
driver is best controlled
through strong PBM
contracting and tight
formulary control.
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Note:
Pharmacy PMPM totals reflect branded, generic and non-drug costs. Non-drug costs include items like diabetic supplies and syringes
which typically have low PMPM costs. Within the Medical Intelligence application, non-drug charges are located within the non-generic
category.
Source: Medical Intelligence : Claims Module / Pharmacy / Plan Type