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40113 ChoiceRx ePub long (1)

Run: 08/22/2012 CLAIMS AUDIT & REVIEW Page: 1 Formulary Impact by Brand Name FRM_IMPACT+-.PDF Client: <Sample Report - CLIENT NAME HERE> Print Criteria: More than 5 prescriptions Tiers Drug Name Mnt Rx Ct OldNw Patent Therapeutic Class Formulary Alternatives (if noted) Negative Formulary Change - Member Copay Higher CYMBALTA YES 57 2 3 12/01/2013 Generic Soon SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) PREF: GENERICS ONLY CIALIS NO 36 2 3 11/21/2017 Generic Soon DRUGS TO TREAT ERECTILE DYSFUNCTION (ED) PREF: VIAGRA, LEVITRA LIPITOR YES 32 2 3 11/28/2011 Now Generic ANTIHYPERLIPIDEMIC - HMG COA REDUCTASE INHIBITORS PREF: GENERICS, CRESTOR PLAVIX YES 30 2 3 05/21/2012 Now Generic PLATELET AGGREGATION INHIBITORS PREF: GENERICS, AGGRENOX SUBOXONE NO 29 2 3 NARCOTIC WITHDRAWAL THERAPY AGENTS NON-PREFERRED VYTORIN YES 23 2 3 04/01/2017 Generic Soon ANTIHYPERLIP.HMG COA REDUCT INHIB&CHOLEST.AB.INHIB PREF: GENERICS, CRESTOR PHENOBARBITAL YES 17 1 3 BARBITURATES NUVARING YES 14 2 3 CONTRACEPTIVES, INTRAVAGINAL, SYSTEMIC NON-PREFERRED EFFIENT YES 13 2 3 PLATELET AGGREGATION INHIBITORS PREF: GENERICS, AGGRENOX ENBREL YES 13 2 3 ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR PREF: HUMIRA FIRST PROGRAM - P/A CHANTIX NO 12 2 3 SMOKING DETERRENT-NICOTINIC RECEPT.PARTIAL AGONIST NON-PREFERRED PRISTIQ ER YES 12 2 3 SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) PREF: GENERICS ONLY ANTARA YES 11 2 3 LIPOTROPICS PREF: GEN,NIASPAN,TRICOR,ZETIA,LOVAZA COLCRYS YES 11 2 3 COLCHICINE PREF: GENERICS, ULORIC STRATTERA YES 11 2 3 11/26/2016 Generic Soon TX FOR ATTENTION DEFICIT-HYPERACT.(ADHD), NRI-TYPE P= GEN, ADD XR,DAYTRANA,VYVANSE,INTUNIV ONE TOUCH ULTRA TEST STRIPS YES 10 2 X BLOOD SUGAR DIAGNOSTICS PREF: ROCHE/BAYER PRODUCTS BYSTOLIC YES 9 2 3 BETA-ADRENERGIC BLOCKING AGENTS PREF: GENERICS PREDNISONE NO 9 1 3 GLUCOCORTICOIDS PREMPRO YES 9 2 3 ESTROGENIC AGENTS PREF: GENERICS, ENJUVIA, MENEST LUVOX CR YES 8 2 3 SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS) PREF: GENERICS ONLY MONONESSA YES 8 2 3 03/29/2009 Use Generic OC CONTRACEPTIVES,ORAL PREF: GEN, YAZ/BEYAZ, NATAZIA, SAFYRAL NYSTATIN-TRIAMCINOLONE NO 8 1 3 TOPICAL ANTIFUNGALS TRILIPIX YES 8 2 3 LIPOTROPICS PREF: GEN,NIASPAN,TRICOR,ZETIA,LOVAZA TRINESSA YES 8 2 3 03/29/2009 Use Generic OC CONTRACEPTIVES,ORAL PREF: GEN, YAZ/BEYAZ, NATAZIA, SAFYRAL ANDRODERM YES 7 2 3 ANDROGENIC AGENTS PREF: GENERICS, ANDROGEL KLOR-CON 10 YES 7 2 3 03/29/2009 Now Generic POTASSIUM REPLACEMENT PREF: GENERICS ONLY LOESTRIN 24 FE YES 7 2 3 Use Generic OC CONTRACEPTIVES,ORAL PREF: GEN, YAZ/BEYAZ, NATAZIA, SAFYRAL SIMCOR YES 7 2 3 ANTIHYPERLIPIDEMIC-HMG COA REDUCTASE INHIB.&NIACIN NON-PREF: USE NIASPAN & SIMVASTATIN ZIAGEN YES 7 2 3 06/25/2012 Now Generic ANTIVIRALS, HIV-SPECIFIC, NUCLEOSIDE ANALOG, RTI NON PREFERRED ZOVIRAX NO 7 2 3 TOPICAL ANTIVIRALS NON-PREFERRED BREEZE 2 YES 6 3 X BLOOD SUGAR DIAGNOSTICS NOT COVERED - PREF: ACCU-CHEK, TRUETRACK FREESTYLE LITE STRIPS YES 6 3 X BLOOD SUGAR DIAGNOSTICS PREF: ACCU-CHEK, TRUERESULT, STORE BRAND ROXICET NO 6 2 3 09/29/2008 Now Generic ANALGESICS, NARCOTICS P: GEN,AVINZA,KADIAN,OXYCONTIN,OPANA ER BUDESONIDE YES 5 1 3 GLUCOCORTICOIDS, ORALLY INHALED CHLORTHALIDONE YES 5 1 3 THIAZIDE AND RELATED DIURETICS MICARDIS YES 5 2 3 ANTIHYPERTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST PREF: GENERICS, BENICAR, DIOVAN NITROSTAT YES 5 2 3 VASODILATORS,CORONARY PREF: GENERICS, NITROLINGUAL XOPENEX YES 5 2 3 08/20/2012 Now Generic BETA-ADRENERGIC AGENTS PREF: GENERICS,PROVENTIL HFA,PROAIR HFA Total Claims: 9,491 636 % of Claims with NEGATIVE Change 6.70% Old = Submitted Formulary Tier New = New Formulary Tier Run: 08/22/2012 CLAIMS AUDIT & REVIEW Page: 1 Formulary Impact by Brand Name FRM_IMPACT+-.PDF Client: <Sample Report - CLIENT NAME HERE> Print Criteria: More than 5 prescriptions Tiers Drug Name Mnt Rx Ct OldNw Patent Therapeutic Class Formulary Alternatives (if noted) Positive Formulary Change - Member Copay Lower SYNTHROID YES 50 3 2 THYROID HORMONES PREFERRED LEVITRA NO 33 3 2 DRUGS TO TREAT ERECTILE DYSFUNCTION (ED) PREFERRED DEXILANT YES 12 3 2 PROTON-PUMP INHIBITORS PREFERRED ARMOUR THYROID YES 10 3 2 10/18/2010 Now Generic THYROID HORMONES PREFERRED PROVENTIL HFA YES 7 3 2 BETA-ADRENERGIC AGENTS PREFERRED LEVOTHROID YES 6 3 2 09/29/2008 Now Generic THYROID HORMONES PREFERRED Total Claims: 9,491 146 % of Claims with POSITIVE Change 1.54% Total # of Claims: 9,491 Total # of Claims Not Impacted: 8,709 Total # of Claims Impacted: 782 Maximum # of Members Impacted: 138 % of RXs Impacted: 8.24% Old = Submitted Formulary Tier New = New Formulary Tier 15


40113 ChoiceRx ePub long (1)
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