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OPTUM RX - Adopting the Premium Formulary
1. Excluded Drugs, UM Edits, and Tier Change
Information
TOP 20 DRUGS BY IMPACTED MEMBERS
Number of excluded drugs (on PDL) 75 PDL Members
Number of drugs requiring a UM Edit 0 Excluded Drug Condition Change Impacted
Number of Uptiers 14 1 Viagra Erectile Disfunction Exclusion 6
Number of Downtiers 1 2 QVAR Asthma Exclusion 3
3 Testosterone 1% Gel Low Testosterone Exclusion 2
Drug Spend $11,610 4 Tanzeum Diabetes Exclusion 2
Plan Paid $6,476 5
Strips: Abbott (FreeStyle,
Precision), Bayer (Breeze,
Contour), Nipro
(TRUEtest, TRUEtrack),
Roche (Accu-Chek) Diabetes Exclusion 2
Member Paid $5,134 6 NovoLog Diabetes Exclusion 1
7 Levemir Diabetes Exclusion 1
2. Impact Analysis 8 Farxiga Diabetes Exclusion 1
Members Impacted 20 9 Proventil HFA Asthma Exclusion 1
Annual Plan Paid Savings - Exclusions -$4,211 10 Zorvolex Arthritis/Pain Exclusion 1
Annual Plan Paid Savings - UM Edits $0 11 Kitabis Pak Cystic Fibrosis Exclusion 0
Annual Plan Paid Savings - Tier Changes $0 12 TOBI Nebulizer Cystic Fibrosis Exclusion 0
Annual Plan Paid Savings - Rebates $75,442 13 TOBI Podhaler Cystic Fibrosis Exclusion 0
Annual Plan Paid Savings - Total $71,231 14 Axiron Low Testosterone Exclusion 0
Plan Savings PMPM, Total $11.57 15 Fortesta Low Testosterone Exclusion 0
16 Testim Low Testosterone Exclusion 0
Annual Member Savings $1,832 17 Vogelxo Low Testosterone Exclusion 0
Member Savings PMPM $0.30 18 Androgel 1% Low Testosterone Exclusion 0
3. Total Information * 19 Apidra Diabetes Exclusion 0
Average Members 513 20 Novolin Diabetes Exclusion 0
Total Plan Paid PMPM $89.61
Total Drug Spend $775,939
Total Drug Spend PMPM $215.99
*Includes costs for all medication (i.e. both Excluded and covered medication)
1. Savings amounts are annualized
2. Plan Paid Savings estimates are net of rebates
3. Members impacted includes utilizing members for excluded and UM Edit drugs; and members negatively impacted by a tier change
4. Annual Plan Paid Savings – Exclusions’ including savings from both excluded drugs and non-excluded drugs 17