23 / 63
NDC DESCRIPTION (DRUG NAME)
PLAN PAID
% PLAN PAID OF
TOTAL PLAN PAID
MEMBER PAID
# OF CLAIMANTS
TOP CONDITION
EPIPEN
$8,930.20
6.61%
$440.00
6
Environmental trauma
Humira
$7,393.05
5.47%
$80.00
1
Inflam bowel disease, w comp, wo
comorb, wo surg
Multaq
$5,682.54
4.21%
$960.00
1
Oth conduction disorder, wo
comp, w comorb
Absorica
$5,344.23
3.95%
$2,102.26
1
Acne
Nuvigil
$5,264.20
3.90%
$800.00
1
unavailable
Dyrenium
$4,361.23
3.23%
$360.00
1
unavailable
ELIQUIS
$3,673.21
2.72%
$560.00
1
unavailable
Esomeprazole Magnesium
$3,421.47
2.53%
$280.00
1
Jt degen -back, wo comp, w
comorb, wo surg
Budesonide
$3,345.08
2.48%
$15.00
1
unavailable
ADVAIR
$2,749.08
2.03%
$1,018.18
3
unavailable
Lialda
$2,707.50
2.00%
$120.00
1
Inflam bowel disease, w comp, wo
comorb, wo surg
Aripiprazole
$2,474.12
1.83%
$180.00
2
Mood disorder, bipolar, wo comp,
wo comorb
XIFAXAN
$2,472.33
1.83%
$160.00
2
Oth infect disease intest/abd, wo
surg
Carac
$2,408.51
1.78%
$80.00
1
Non mal neo skin, w comp, wo
surg
Dextroamphetamine Saccharate,
Amphetamine Aspartate,
Dextroamphetamine Sulfate, and
Amphetamine Sulfate
$2,042.56
1.51%
$120.00
1
Attention deficit disorder, wo
comp
INVOKANA
$2,020.44
1.50%
$240.00
1
Diabetes, wo comp, wo comorb,
wo surg
Tribenzor
$1,994.55
1.48%
$880.00
1
unavailable
Minastrin 24 Fe
$1,942.15
1.44%
$0.00
1
unavailable
Spiriva Respimat
$1,802.52
1.33%
$920.84
1
unavailable
Vyvanse
$1,681.40
1.24%
$800.00
1
Attention deficit disorder, wo
comp
Retin-A MICRO
$1,657.08
1.23%
$160.00
1
Acne
Absorica
$1,622.23
1.20%
$478.36
1
Acne
FENTANYL
$1,564.68
1.16%
$150.00
1
Jt degen -neck, wo comp, wo
comorb, wo surg
Uceris
$1,526.96
1.13%
$80.00
1
Inflam bowel disease, w comp, wo
comorb, wo surg
PROAIR
$1,486.12
1.10%
$1,832.20
26
Asthma, w comp, wo comorb
Remaining NDC Codes
$55,562.29
41.12%
$94,701.82
1,514
Top 25 NDC by Plan Paid
23