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40113 ChoiceRx ePub long (1)

Run: 02/13/2011 CLAIMS AUDIT & REVIEW Page 1 CLMTOT PASS THROUGH REPRICING SUMMARY REPORT SUMMARY-PT.PDF Date Range: 01/01/2010 to 03/31/2010 Client: CLIENT NAME Scenario: CLIENT - #1 P-T Retail: Pricing Used in This Scenario: PASS THROUGH Total Number of Months Calculated (Base Claims): 3.00 Mail: Pricing Used in This Scenario: Brand: AWP - 22.00% + $0.00 Generic: AWP - 68.00% + $0.00 GENERAL COMMENTS: U&C: THE INPUT FILE DID NOT CONTAIN U&C PRICING SO LOWER FINAL PRICE OF CALCULATED AND U&C COULD NOT BE DETERMINED DAW: DAW CODE NOT PROVIDED SO MULTI-SOURCE BRANDS, EVEN IF DOCTOR APPROVED, WERE MARKED DOWN USING MAC PROCESSING: Note-1: NO DAW, NO U&C TO EVALUATE, INTEGER QTY SUBMITTED (FIXQTY) Note-2: FINANCIAL AMT IN CLAIMS DID NOT BALANCE Note-3: PASS-THROUGH ONLY Note-4: GENERAL CLAIM REPRICING RECAP: Total Records Net RXs Brand Generic Retail Rx Mail Rx 90 Day Prior Auths Reversals Total: 4,892 4,892 1,864 3,028 4,623 267 2 0 0 Percent of Total: 100.00% 38.10% 61.90% 94.50% 5.46% 0.04% 0.00% 0.00% FINANCIAL RECAP TOTALS: Ingredient Cost Dispensing Fee Sales Tax Claim Total Member Copay Total Billed Potential Savings Previous Vendor: $397,837 $7,238 $1,260 $406,336 $57,271 $349,065 PROCARE: $348,158 $8,383 $630 $357,171 $54,641 $302,530 $46,535 TEQ Program: $357,171 $117,843 $239,328 $109,737 *PRx Savings: $49,679 ($1,145) $631 $49,165 $2,630 $46,535 Estimated Annualized Savings: $196,661 Est. Savings / Rx: $10.05 {Estimated Annualized Savings is based on TOTAL BILLED shown at right} Note: All numbers in the findings below are rounded so Estimated Annualized Savings may vary ** "Blended" rates are average discounts and dispending fees across all pharmacies 0.00 E Run: 08/23/2012 CLAIMS AUDIT & REVIEW Page 1 CLMPFILE REPRICING SUMMARY - PASS THROUGH COSTGRID-PT.PDF Date Range: 06/01/2011 to 05/31/2012 Client: <Sample Report - CLIENT NAME HERE> Incumbent Our Repricing (Same Day, Same Pharmacy) TOTAL BRD RETL GEN RETL BRD-MAIL GEN-MAIL TOTAL BRD RETL GEN RETL BRD-MAIL GEN-MAIL Rx Count: 9,491 1,540 5,727 610 1,614 9,491 1,540 5,727 610 1,614 Tier 2: 1,372 964 0 408 0 1,372 964 0 408 0 Rebatable: 1,026 689 0 337 0 1,026 689 0 337 0 AWP: $1,696,326.62 $466,710.25 $484,851.63 $359,926.62 $384,838.12 $1,696,326.62 $466,710.25 $484,851.63 $359,926.62 $384,838.12 Ingr Cost: $0.00 $0.00 $0.00 $0.00 $0.00 $868,153.82 $388,874.26 $128,187.94 $277,980.32 $73,111.30 Disp Fee: $0.00 $0.00 $0.00 $0.00 $0.00 $11,055.30 $2,409.55 $8,579.75 $49.50 $16.50 Tax: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Tot Price: $0.00 $0.00 $0.00 $0.00 $0.00 $879,209.12 $391,283.81 $136,767.69 $278,029.82 $73,127.80 Copay: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Plan Cost: $0.00 $0.00 $0.00 $0.00 $0.00 $879,209.12 $391,283.81 $136,767.69 $278,029.82 $73,127.80 SAVINGS: Only Totals Provided! REBATES: $28,735.08 $12,760.23 $0.00 $15,974.85 $0.00 Totals May Not Balance DO NOT SUBMIT DATA BELOW THE LINE: BRD RETL GEN RETL BRD-MAIL GEN-MAIL Dispensing Rate - Total: 16.23% 60.34% 6.43% 17.01% Dispensing Rate - By Source: 21.19% 78.81% 27.43% 72.57% Note: Totals shown above may be slightly off due to rounding 14


40113 ChoiceRx ePub long (1)
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