119 / 208
Top 20 NDC by Plan Paid
TOP CONDITION
# OF CLAIMANTS
MEMBER PAID
% PLAN PAID
OF TOTAL
PLAN PAID
PLAN PAID
NDC DESCRIPTION (DRUG
NAME)
Psych & schizo disorder,
w comp, w comorb
2
$1,025.00
1.57 %
$26,603.94
Latuda
Diabetes, wo comp, w
comorb, wo surg
10
$1,845.00
1.30 %
$21,905.47
Levemir
Oth hematologic dis, wo
surg
1
$0.00
1.22 %
$20,579.18
JAKAFI
Diabetes, wo comp, w
comorb, wo surg
10
$1,024.00
1.20 %
$20,299.20
NovoLog
Diabetes, wo comp, w
comorb, wo surg
10
$3,145.00
1.20 %
$20,281.18
Lantus Solostar
Inflam esophagus, wo
comp, w comorb, wo surg
14
$650.00
1.12 %
$18,865.96
NEXIUM
AIDS, w comp, w comorb,
wo surg
1
$1,020.00
1.05 %
$17,740.45
Stribild
Exposure to infectious
disease
4
$990.00
0.97 %
$16,331.76
Truvada
Male sex gland disorder,
wo surg
5
$1,495.00
0.89 %
$15,054.30
Androgel
AIDS, w comp, w comorb,
wo surg
1
$1,020.00
0.81 %
$13,743.91
Triumeq
Diabetes, wo comp, wo
comorb, wo surg
8
$2,110.00
0.79 %
$13,368.41
INVOKANA
10,365
$234,853.84
52.34 %
$884,675.69
Remaining NDC Codes
Page 18 of 41
Incurred: 2/1/2016 to 1/31/2017
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