128 / 208
Top 20 Drug Classes
305
327
835
485
577
520
456
515
440
296
522
518
12
323
346
483
499
504
176
639
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
# OF
CLAIMANTS
TOTAL PAID
(RETAIL)
TOTAL PAID (MAIL
ORDER)
MEMBER PAID
PLAN PAID
THERAPEUTIC CLASS
10
$43,221.33
$325,975.53
$14,099.24
$355,097.62
Immunologics, immunomodulator
2
$0.00
$127,329.84
$1,500.00
$125,829.84
Kinase inhibitors,
chemotherapeutic
39
$126,460.95
$3,097.30
$12,261.38
$117,296.87
Insulin
1
$73,240.12
$0.00
$600.00
$72,640.12
Adrenal steroid inhibitors
186
$58,078.58
$108.91
$301.58
$57,885.91
Contraceptive hormones
1
$0.00
$44,944.79
$660.00
$44,284.79
Neurodegenerative disorders drug
therapy
27
$46,768.79
$0.00
$2,886.96
$43,881.83
Antipsychotics
6
$33,272.61
$12,654.78
$2,430.00
$43,497.39
HIV antiviral combinations, or
systemic exposure boosters
Page 27 of 41
Incurred: 2/1/2016 to 1/31/2017
Episode Treatment Groups, third party software included in Design180 ™, is the proprietary and copyrighted
intellectual property of Symmetry ™. Copyright © 2015, NavigatorMD, Inc.
Sample Company