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Forms.purchasing.wayne.edu
WAYNE STATE UNIVERSITY LOSS EXPERIENCE Claims Paid as of 12/31/2011 2008/2009 Policy Year Ultimate with Claims Paid Ultimate Loss Ratio Domestic International 2009/2010 Policy Year Ultimate with Claims Paid Ultimate Loss Ratio Domestic International 2010/2011 Policy Year Ultimate with Claims Paid Ultimate Loss Ratio Domestic International WAYNE STATE UNIVERSITY POINT IN TIME LOSS EXPERIENCE 2010/2011 2011/2012 Based on Claims Paid as of Based on Claims Paid as of 12/31/10 12/31/11 DOMESTIC $125,184 INTERNATIONAL $225,939 Grand Total $290,043 $165,093 Aetna Student Health Wayne State University
Plan Management/Utilization Report Package
Data as of Medical: December 31, 2011 Rx: November 30, 2011
*This document contains proprietary and/or confidential health information. Disclosure is strictly prohibited except as permitted or required by applicable law. Important: Aetna Student Health makes no representation or warranty of any kind, whether express or implied, with respect to the information in this report, and cannot guarantee its accuracy or completeness. Accordingly, Aetna Student Health shall not be liable for any act or omissions of third parties made in reliance on the information.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Report Package Parameters Plan Effective Date: August 1, 2011 Plan End Date: July 31, 2012 Plan(s): Policy 0474901 Plan 0000103 Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Table of Contents Report Title Page Number
Reconcilation of Medical Charges and Cost Sharing Analysis
High Dollar Claimant(s) Detail - 2011-2012
High Dollar Claimant(s) Detail - 2010-2011
High Dollar Claimant(s) Detail - 2009-2010
Key Statistics by Generic, Brand Single-Source & Brand Multi-Source (APM)
Top 25 GPI Classifications By Number of Claims (APM) - 2011-2012
Top 25 GPI Classifications By Number of Claims (APM) - 2010-2011
Top 25 GPI Classifications By Number of Claims (APM) - 2009-2010
Top 25 GPI Classifications By Paid Amount (APM) - 2011-2012
Top 25 GPI Classifications By Paid Amount (APM) - 2010-2011
Top 25 GPI Classifications By Paid Amount (APM) - 2009-2010
Top 25 Drugs Prescribed by Paid Amount (APM) - 2011-2012
Top 25 Drugs Prescribed by Paid Amount (APM) - 2010-2011
Top 25 Drugs Prescribed by Paid Amount (APM) - 2009-2010
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Key Statistics 2009-2010 2010-2011 2011-2012 Demographics Summary for Medical* Plan Year Plan Year Plan Year Medical Paid Amount per Member Key Statistics
Total Medical and Pharmacy Paid Amount***
Comparison of Medical Paid Amount Per Member
Total Medical Paid (Claims and Health Center)
Medical Paid per Member (Claims and Health Center
*Enrollment statistics reflect headcount. A member enrolled for a full or partial plan year is considered one member. **If gender is not provided during enrollment process, gender is defaulted to female. ***Medical Paid Amounts include behavioral health. ****Aetna Pharmacy Management (APM) claims only. Pharmacy claims not run through APM are represented in Medical Paid Amount.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Demographics for Medical Membership Member Age/Gender Comparison Member Current Plan Year, Percent of Membership, Claimants, and Plan Paid Comparison Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Provider Network Experience - Medical 2009-2010 2010-2011 2011-2012 Discount In Network Experience Plan Year Plan Year Plan Year Savings % Network Discount Savings Network Discount Savings % % In Network Utilization Results Note: Report does not include health center reimbursements, tax payments, access fees, or APM pharmacy claims.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Reconciliation of Medical Charges and Cost Sharing Analysis* In-Network Out of Network 2009-2010 2010-2011 2011-2012 2009-2010 2010-2011 2011-2012 2009-2010 2010-2011 2011-2012 Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Cost Sharing % of Allowed Amount Cost Sharing % of Allowed Amount Cost Sharing % of Allowed Amount 2009-2010 Plan Year 2010-2011 Plan Year 2011-2012 Plan Year
*Note: Report does not include health center reimbursements, tax payments, access fees, or APM pharmacy claims
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Paid Amount by Medical Cost Category Amount Paid Amount Paid per Member 2009-2010 2010-2011 2011-2012 2009-2010 2010-2011 2011-2012 2009-2010 2010-2011 2011-2012 Aetna Student Health Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Inpatient: Subtotal Inpatient: $277,503 Outpatient: Subtotal Outpatient: $138,243 $158,728 Behavioral Health: Subtotal Mental Health Subtotal Substance Abuse Subtotal Behavioral Health Health Center Reimbursements: Miscellaneous Medical: Pharmacy: Subtotal Pharmacy: Total Medical and Pharmacy Paid Amount $194,972 $452,366 *Aetna Student Health book of business (BOB) ranges represent benchmarks derived from plan utilization for the overall Aetna student health segment. **Includes medical costs for well newborns while the mother and baby are both in the hospital. Sick babies (i.e. Preemies) are covered separately. ***Surgical Facility costs are always coded as outpatient. ****Includes Physical Therapy, Chiropractic Care, and Occupational Therapy.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Analysis by Medical Cost Category Percentage of Total Medical Paid Amount by Medical Cost Category Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
ICD-9 Code Range Analysis 2009-2010 Plan Year 2010-2011 Plan Year 2011-2012 Plan Year Inpatient Paid Outpatient Paid Inpatient Paid Outpatient Paid Inpatient Paid Outpatient Paid Paid Amount Paid Amount Paid Amount ICD-9 Code Range
Infectious and Parasitic Diseases (001-139.9)
Endocrine, Nutritional, and Metabilic Diseases, and Immunity Disorders (240-279.9)
Diseases of the Blood and Blood-Forming Organs (280-289.9)
Diseases of the Nervous System and Sense Organs (320-389.9)
Diseases of the Circulatory System (390-459.9)
Diseases of the Respiratory System (460-519.9)
Diseases of the Digestive System (520-579.9)
Diseases of the Genitourinary System (580-629.9)
Complications of Pregnancy, Childbirth, and the Puerperium (630-677.9)
Diseases of the Skin and Subcutaneous Tissue (680-709.9)
Diseases of the Musculoskeletal System and Connective Tissue (710-739.9)
Certain Conditions Originating in the Perinatal Period (760-779.9)
Symptoms, Signs, and Ill-defined Conditions (780-799.9)
$186,221 $141,632 $444,506 $281,003 $163,503 Note: Report does not include Health Center Reimbursements, Tax Payments, Access Fees, or APM Pharmacy Claims.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top Provider Report* - 2011-2012 Inpatient as Outpatient as City State Total Medical Inpatient % of Total Outpatient % of Total Provider Name*** In Network Zip Code**** of Claimants Paid Amount Paid Amount Paid Amount Paid Amount Paid Amount *Includes top 25 providers year to date by total medical paid amount. **Multiple providers with the same Tax ID are considered the same provider for purposes of this report. Provider Name represents the name with the largest dollar amount under a Tax ID. ***In and Out of Network providers with the same Tax ID will appear as separate providers on this report. ****City, State and Zip Code may reflect the billing address of the provider and not geographic location.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top Provider Report* - 2010-2011 Inpatient as Outpatient as City State Total Medical Inpatient % of Total Outpatient % of Total Provider Name*** In Network Zip Code**** of Claimants Paid Amount Paid Amount Paid Amount Paid Amount Paid Amount
DR. L. REYNOLDS & AS SOCIATES, P.C. $410,150 $271,267 $138,883 *Includes top 25 providers year to date by total medical paid amount. **Multiple providers with the same Tax ID are considered the same provider for purposes of this report. Provider Name represents the name with the largest dollar amount under a Tax ID. ***In and Out of Network providers with the same Tax ID will appear as separate providers on this report. ****City, State and Zip Code may reflect the billing address of the provider and not geographic location.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top Provider Report* - 2009-2010 Inpatient as Outpatient as City State Total Medical Inpatient % of Total Outpatient % of Total Provider Name*** In Network Zip Code**** of Claimants Paid Amount Paid Amount Paid Amount Paid Amount Paid Amount
DR. L. REYNOLDS & AS SOCIATES, P.C. $166,228 $122,182 *Includes top 25 providers year to date by total medical paid amount. **Multiple providers with the same Tax ID are considered the same provider for purposes of this report. Provider Name represents the name with the largest dollar amount under a Tax ID. ***In and Out of Network providers with the same Tax ID will appear as separate providers on this report. ****City, State and Zip Code may reflect the billing address of the provider and not geographic location.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Impact of High Dollar Claimant(s) High Dollar Claimant Threshold: $25,000 All Claimants Claimants Above Threshold* 2009-2010 2010-2011 2011-2012 2009-2010 2010-2011 2011-2012 Plan Year Plan Year Plan Year Plan Year Plan Year Plan Year Net of High Dollar Claimants Paid Amount per Member With & Without High Dollar Claimants Note: Report does not include Health Center Reimbursements, Tax Payments, Access Fees, or APM Pharmacy Claims. *See Medical High Dollar Claimant Detail Reports for detail on claimants above the threshold for current and prior periods.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
High Dollar Claimant(s) Detail - 2011-2012 Claimants Exceeding $25,000 Relationship Total Medical Inpatient Outpatient Claimant Paid Amount Paid Amount Paid Amount ICD-9 Description Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
High Dollar Claimant(s) Detail - 2010-2011 Claimants Exceeding $25,000 Relationship Total Medical Inpatient Outpatient Claimant Paid Amount Paid Amount Paid Amount ICD-9 Description $251,394 $179,789
1707 MALIGNANT NEOPLASM OF LONG BONES OF LOWER LIMB
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
High Dollar Claimant(s) Detail - 2009-2010 Claimants Exceeding $25,000 Relationship Total Medical Inpatient Outpatient Claimant Paid Amount Paid Amount Paid Amount ICD-9 Description
1707 MALIGNANT NEOPLASM OF LONG BONES OF LOWER LIMB
5409 ACUTE APPENDICITIS W\O MENTION OF PERITONITIS
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Claimant Distribution - by Paid Amount - 2011-2012 Medical Claimant Distribution Dependent Claimant Distribution *Eligible members who have submitted a claim with no benefit payment (i.e. copays, deductibles).Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Claimant Distribution - by Paid Amount - 2010-2011 Medical Claimant Distribution Dependent Claimant Distribution *Eligible members who have submitted a claim with no benefit payment (i.e. copays, deductibles).Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Claimant Distribution - by Paid Amount - 2009-2010 Medical Claimant Distribution Dependent Claimant Distribution *Eligible members who have submitted a claim with no benefit payment (i.e. copays, deductibles).Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Key Statistics - Pharmacy (APM) 2009-2010 2010-2011 2011-2012 Demographics Summary* Plan Year Plan Year Plan Year Pharmacy Paid Amount per Eligible Member Number of Pharmacy Claims Per Eligible Key Statistics
Pharmacy Paid Amount per Utilizing Member
Number of Pharmacy Claims per Eligible Member
Number of Pharmacy Claims per Utilizing Member
Average Out of Pocket and Average Paid Amount Per Claim *Enrollment statistics reflect headcount on plans with APM coverage. A member enrolled for a full or partial plan year is considered one member. **Includes all Rx expenses paid by the member including copays, deductibles, co-insurance, and any submitted amounts over the plan maximums.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Key Statistics By Generic, Brand Single-Source, & Brand Multi-Source (APM) 2009-2010 2010-2011 2011-2012 Average Amount Paid Per Claim Plan Year Plan Year Plan Year
Generic Pharmacy Paid Amount per Eligible Member
Generic Pharmacy Paid Amount per Utilizing Member
Number of Generic Pharmacy Claims per Eligible Member
Brand Single-Source
Brand Single-Source Pharmacy Paid Amount per Eligible Member
Brand Single-Source Pharmacy Paid Amount per Utilizing Member
Utilization by Generic, Brand Single-Source, and Brand Multi-
Number of Brand Single-Source Pharmacy Claims per Eligible Member
Brand Multi-Source
Brand Multi-Source Pharmacy Paid Amount per Eligible Member
Brand Multi-Source Pharmacy Paid Amount per Utilizing Member
Number of Brand Multi-Source Pharmacy Claims per Eligible Member
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 GPI Classifications By Number of Claims (APM) - 2011-2012 Number of Calculated Average Paid Paid Amount Utilizing Percent of Ingredient Per Utilizing GPI Classification of Claims Utilization Utilization All Claims Per Claim
Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 GPI Classifications By Number of Claims (APM) - 2010-2011 Number of Calculated Average Paid Paid Amount Utilizing Percent of Ingredient Per Utilizing GPI Classification of Claims Utilization Utilization All Claims Per Claim
Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 GPI Classifications By Number of Claims (APM) - 2009-2010 Number of Calculated Average Paid Paid Amount Utilizing Percent of Ingredient Per Utilizing GPI Classification of Claims Utilization Utilization All Claims Per Claim
Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 GPI Classifications By Paid Amount (APM) - 2011-2012 Number of Calculated Percent of Average Paid Paid Amount Utilizing Percent of Ingredient Per Utilizing GPI Classification of Claims All Claims Paid Amount Per Claim
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Angiotensin II Receptor Antag & Ca Channel Blocker C
Non-Benzodiazepine - GABA-Receptor Modulators
Selective Serotonin Reuptake Inhibitors (SSRIs)
Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 GPI Classifications By Paid Amount (APM) - 2010-2011 Number of Calculated Percent of Average Paid Paid Amount Utilizing Percent of Ingredient Per Utilizing GPI Classification of Claims All Claims Paid Amount Per Claim
Inosine Monophosphate Dehydrogenase Inhibitors
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Non-Benzodiazepine - GABA-Receptor Modulators
Selective Serotonin Reuptake Inhibitors (SSRIs)
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 GPI Classifications By Paid Amount (APM) - 2009-2010 Number of Calculated Percent of Average Paid Paid Amount Utilizing Percent of Ingredient Per Utilizing GPI Classification of Claims All Claims Paid Amount Per Claim
Antiretrovirals - RTI-Nucleotide Analogues
Selective Serotonin Reuptake Inhibitors (SSRIs)
Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 Drugs Prescribed by Paid Amount (APM) - 2011-2012 Number of Number of Drug Name GPI Classification Claimants Amount Paid
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Angiotensin II Receptor Antag & Ca Channel Blocker Comb
Non-Benzodiazepine - GABA-Receptor Modulators
Selective Serotonin Reuptake Inhibitors (SSRIs)
Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Note: Multiple dosages of the same drug are listed as one line for the purposes of this report.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 Drugs Prescribed by Paid Amount (APM) - 2010-2011 Number of Number of Drug Name GPI Classification Claimants Amount Paid
Inosine Monophosphate Dehydrogenase Inhibitors
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Non-Benzodiazepine - GABA-Receptor Modulators
Selective Serotonin Reuptake Inhibitors (SSRIs)
Note: Multiple dosages of the same drug are listed as one line for the purposes of this report.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Top 25 Drugs Prescribed by Paid Amount (APM) - 2009-2010 Number of Number of Drug Name GPI Classification Claimants Amount Paid
Antiretrovirals - RTI-Nucleotide Analogues
Selective Serotonin Reuptake Inhibitors (SSRIs)
Note: Multiple dosages of the same drug are listed as one line for the purposes of this report.Aetna Student Health Wayne State University
Data as of Medical: December 31, 2011 Rx: November 30, 2011
Financial Overview Total Health Center Pharmacy Number of Students Premium * Reimbursement Paid Amount Paid Amount 2009-2010 Plan Year: $194,972 2010-2011 Plan Year: $452,366 2011-2012 Plan Year: *Paid premium includes payments received and processed (YTD) from the Client School, as well as any Voluntary or Dependent premium received from individual students/dependents attending that Client School. These payments may be net of estimated administrative fees and/or Broker Fees, and would/can include premiums related to other products (I.e. Worldwide Assist (AD&D), Student Assistance Program (SAP), Vital Savings, etc.), which are included in the student and dependent's rate, but excluded from overall loss ratio calculations. **Refers to claims processed under programs beginning prior to the main program effective date.Glossary - Medical Admission
Confinement as inpatient in a hospital. (Includes partial hospitalizations as multiple admissions)
Admissions/1,000 Members
Total admissions divided by members per 1,000.
Allowed Amount
Total amount allowed under the medical plan including the enrollee's paid portion of deductibles, copays, coinsurance, the planpaid portion (paid amount) and COB. Allowed amount does not include plan and administrative exclusions such as duplicateclaims, ineligible claims, network discount savings and R&C savings. Ambulatory / Outpatient Care
Health services provided without the patient being admitted. APM Pharmacy Claims
The total RX amount paid by the insurance plan for claims under the Aetna Pharmacy Management plan. Average Age of Students
The sum of ages of all students divided by the number of students. Average Discount Savings
In-network financial savings expressed on a per admission basis. per Admission Average Length of Stay
Total inpatient days of care divided by total admissions. Average Paid Amount per Claimant
The total paid amount divided by the total number of claimants. Behavioral Health
An umbrella term that includes mental health, psychiatric, marriage and family counseling, and addictions treatment. Many stateshave "parity" laws that attempt to require that behavioral health insurance coverage be provided "on par" to physical healthcoverages. Behavioral Health Paid Amount Per Member
The total paid amount for behavioral health divided by the total numbers of members. Billed Network Charges (before discount)
The actual charge for a covered service by the provider that furnishes it. Aetna Student Health BOB
Benchmark ranges derived from Aetna Student Health Book-of-Business average experience. Claimant / Utilizing Member
A member who has submitted a claim under the medical or RX portion of the program. Coinsurance
The total amount of covered expenses payable by the member under the insurance plan.
The amount that must be paid by the covered person at the time services are rendered by a preferred provider. Copay amountsare the responsibility of the covered person. Deductible
A specific amount of covered expenses that must be incurred and paid for by the member before benefits are payable under theplan. Deductible amounts are the responsibility of the covered person. Dependent
Spouses or domestic partners and/or child or children covered under the medical plan. Disallowed
Amounts above reasonable charge and denied claims.
Supplemental classification of external causes of injury and poisoning. Eligible Charges
Generic Product Identifier. A general classification of drugs used to identify a group of drugs into like-therapeutic classes. Health Center Capitation per Member
The total amount of capitation payments expressed on a per member basis (applies to capitated medical arrangements only). Health Center Charges per Member
Charges for services rendered at the Student Health Center based on a fee schedule agreement divided by the number of members. Health Center Reimbursements
Health Center Capitation plus Health Center Charges
IDC-9 Code
Codes used to classify diseases, symptoms, and abnormal findings based on Incremental Classification of Diseases, 9th Revision. In-Network / Preferred Care
An affiliation of providers through formal and informal contracts and agreements. Inpatient Ancillary
Includes items such as laboratory, radiology, and physical therapy. Inpatient Facility
Facilities that provide care in an inpatient setting versus ambulatory (outpatient). Glossary - Medical Insurance Plan Percent Share Medical
The Insurance Plan paid portion divided by the Allowed Amount. Insurance Plan Paid Portion
The total medical paid amount by the insurance plan. Medical Paid Amount - Dependents
The amount paid by the insurance plan on dependent (spouse/domestic partner and child) claims. Medical Paid Amount - Students
The amount paid by the insurance plan on student claims.
A covered student or dependent who is enrolled under the insurance program. Member Percent Share Medical
Total member cost sharing divided by the Allowed Amount
Member Paid Portion per Member
The total of deductibles, copays and coinsurance paid by members expressed on a per member basis. Miscellaneous Medical
Includes items such as ambulance, dental injury, durable medical equipment, wisdom teeth removal, and home health care. Network Discount Savings
The total savings to the plan due to the application of negotiated discount arrangements with contracted providers. Number of Claimants
The total number of unique utilizing members. Number of Dependents
The number of dependents (spouses or domestic partners and/or child or children) covered under the medical plan. Number of Members
The number of students and dependents covered under the medical plan. Other Pharmacy Claims
The total amount paid by the insurance plan for pharmacy claims under the medical plan (not covered under Aetna PharmacyManagement). Out of Network / Non-Preferred Care
A health care service or supply furnished by a health care provider that is not In-Network.
Paid premium includes payments received and processed (YTD) from the Client School, as well as any Voluntary or Dependentpremium received from individual students/dependents attending that Client School. These payments may be net of estimatedadministrative fees and/or Broker Fees, and would/can include premiums related to other products (I.e. Worldwide Assist (AD&D),Student Assistance Program (SAP), Vital Savings, etc.), which are included in the student and dependent's rate, but excluded fromoverall loss ratio calculations.
Submitted Charges
Billed charges, excluding duplicates but including denied claims. Total Member Cost Sharing
Copay, deductible and coinsurance amounts paid by the member. Total Pharmacy Paid Amount
Calculated as Ingredient Cost + Dispensing Fee + Sales Tax - Copay Amount.
A Diagnosis which is not a sickness or injury, such as preventative care, immunizations, and maternity deliveries. Glossary- Pharmacy Average Age of Students
The sum of ages of all students divided by the number of students. Average Brand Multi-Source
The total brand multi-source pharmacy paid amount divided by the number of brand multi-source pharmacy claims. Paid Amount per Claim Average Brand Single-Source
The total brand single-source pharmacy paid amount divided by the number of brand single-source pharmacy claims. Paid Amount per Claim Average Generic Paid
The total generic pharmacy paid amount divided by the number of generic pharmacy claims. Amount per Claim Average Paid Amount per Claim
The total pharmacy paid amount divided by the total number of pharmacy claims. Brand Multi-Source Prescription Drug
Brand name drugs manufactured by multiple pharmaceutical companies. Brand multi-source prescription drugs also have a generic equivalent. Brand Multi-Source Utilization
The percent of total claims that were brand multi-source drugs. Brand Name Prescription Drug
A prescription drug which is protected by trademark registration. Brand Single-Source Prescription Drug
Brand name drugs manufactured by a single pharmaceutical company. Brand single-source prescription drugs do not have a generic equivalent. Brand Single-Source Utilization
The percent of total claims that were brand single-source drugs. Brand Utilization
The percentage of total prescriptions that were dispensed as brand drugs. Calculated Ingredient Cost
The Calculated Ingredient Cost is the lesser of: a) The Average Wholesale Price (AWP) - Percentage Discount; (b) Maximum Allowable Cost (MAC); or (c) The Reasonable and Customary Cost. The Calculated Ingredient Cost does not include the dispensing fee or the copay. Claimant / Utilizing Member
A member who has submitted a claim under the medical or RX portion of the program. Dependent
Spouses or domestic partners and/or child or children covered under the medical plan. Formulary Prescription Drug
An approved list of prescription drugs as determined by APM. This list is subject to change every calendar year. Formulary Utilization
The percentage of total prescriptions that were dispensed on the Formulary list. Generic Prescription Drug
A prescription drug which is not protected by trademark registration, but is produced and sold under the chemical formulation name. Generic Substitution
The process of substituting a lower cost generic version of a brand-name drug, when available.
Generic Utilization
The percentage of total prescriptions dispensed as generic drugs. The generic utilization rate is highly dependent on benefit plan design (i.e., the presence or absence of a differential copay between brand and generic drugs). Mail-Order Prescription Drug
An establishment where prescription drugs are legally dispensed by mail. Mail-Order Utilization
Percent of mail order drugs divided by the prescription drug total.
A covered student or dependent who is enrolled under the insurance program. Number of Dependents
The number of dependents (spouses or domestic partners and/or child or children) covered under the medical plan. Number of Members
The number of students and dependents covered under the medical plan. Total Member Out of Pocket Amount (Rx)
Copay, deductible and coinsurance amounts paid by the member.
Dr. Ike Okorie Inland Family Practice Center LLC118 s. 10th ave Hattiesburg, MS 39401 Phone: 6015447012 Patient Education PHENTERMINE - ORAL IMPORTANT NOTE: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your health care professional. Always seek the advice of your healt
JOURNAL OF DENTAL SCIENCES Volume 2 Issue 1 PRESCRIBING ANTIBIOTICS AND ANALGESICS IN CHILDREN Dr. Jyoti Mathur Dr. Amish Diwanji Abstract For the purpose of having a standardized prescription practice, it is very necessary for the operators involved in dispensing treatment in a large set up, to have a quick reference system which would minimize chances of errors due to variation