EPIC Program Annual Data Tables 2006-2007: Tables IV-A and IV-B

Table IV-A
Claims, Expenditures and Revenue by Program Year*
DescriptionCategoryEighteenth
(2004-2005)
Nineteenth
(2005-2006)
Twentieth
(2006-2007)
Net State Cost=
(Expenditures+Premiums-Revenue)
$477,556,474$486,122,557$377,303,406
Number of ClaimsCo-payment10,184,19310,410,2569,869,298
Deductible932,3541,107,7651,371,050
Total Claims11,116,54711,518,02111,240,348
ExpendituresTotal Cost of Drugs$994,273,017$1,089,577,439$1,125,400,862
less Third Party Payments**$74,640,427$101,141,903$297,696,081
less Participant Co-payments$119,958,485$121,075,046$101,573,094
less Deductible Payments$52,089,489$54,171,014$55,386,837
Total EPIC Expenditures$747,584,616$813,189,476$670,744,850
Plus PremiumPayments$0$0$5,131,049
Less RevenueManufacturers' Rebates$246,214,041$295,721,272$263,864,871
plus Participant Fees$18,772,759$21,192,305$20,636,889
plus Claim Recovery***$5,041,342$10,153,342$14,070,733
Total Revenue$270,028,142$327,066,919$298,572,493

* Table IV-A represents Claims, Expenditures and Revenue by Program Year up to October 2006-September 2007.

** Estimated Third Party Payments from Medicare Part D coverage and other insurers.

*** Retroactive Third Party Claim recoveries from Medicare and other insurers.



Table IV-B
Payment and Utilization by Program Year*
Paid ClaimsEighteenth
(2004-2005)
Nineteenth
(2005-2006)
Twentieth
(2006-2007)
Average EPIC Payment per Claim$67.25$70.60$59.67
Average Deductible Payment per Claim$55.87$48.90$40.40
Average Participant Co-payment per Claim$11.77$11.63$10.29
Average Third Party Payment** per Claim$6.71$8.78$26.48
Average Total Cost per Claim$89.44$94.60$100.12
Number of Participants Reaching Deductible58,56962,51163,043
Number of Participants Reaching Copay limit30,06050,90031,508

* Table IV-B represents Payment and Utilization by program year up to October 2006-September 2007.

** Estimated Third Party Payments from Medicare Part D coverage and other insurers.