EPIC Program Annual Data Tables 2008-2009

EPIC Program Annual Report 2008-2009 Appendix:
Tables IV-A and IV-B

Table IV-A
Claims, Expenditures and Revenue by Program Year*
DescriptionCategoryTwentieth
(2006-2007)
Twenty-first
(2007-2008)
Twenty‑second
(2008-2009)
Net State Cost= (Expenditures+Premiums-Revenue)$377,303,406$190,861,688$187,283,107
Number of ClaimsCo-payment9,869,2989,192,9288,541,283
Deductible1,371,0501,477,9511,587,704
Total Claims11,240,34810,670,87910,128,987
ExpendituresTotal Cost of Drugs$1,125,400,862$1,090,587,079$956,536,482
less Third Party Payments**$297,696,081$518,118,379$468,037,216
less Participant Co-payments$101,573,094$77,150,989$64,758,593
less Deductible Payments$55,386,837$44,412,254$43,836,044
Total EPIC Expenditures$670,744,850$450,905,457$379,904,629
Plus PremiumPayments$5,131,049$25,924,547$27,466,913
Less RevenueManufacturers' Rebates$263,864,871$226,262,168$169,494,340
plus Participant Fees$20,636,889$18,746,354$17,117,037
plus Claim Recovery***$14,070,733$40,959,794$33,477,058
Total Revenue$298,572,493$285,968,316$220,088,435

* Table IV-A represents Claims, Expenditures and Revenue by Program Year up to October 2008-September 2009.

** 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 ClaimsTwentieth
(2006-2007)
Twenty-first
(2007-2008)
Twenty-second
(2008-2009)
Average EPIC Payment per Claim$59.67$42.26$37.51
Average Deductible Payment per Claim$40.40$30.05$27.61
Average Participant Co-payment per Claim$10.29$8.39$7.58
Average Third Party Payment** per Claim$26.48$48.55$46.21
Average Total Cost per Claim$100.12$102.20$94.44
Number of Participants Reaching Deductible63,04367,30167,162
Number of Participants Reaching Copay limit31,50812,1896,091

* Table IV-B represents Payment and Utilization by program year up to October 2008-September 2009.

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