EPIC Program Annual Data Tables 2006-2007: Tables IV-A and IV-B
| Description | Category | Eighteenth (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 Claims | Co-payment | 10,184,193 | 10,410,256 | 9,869,298 |
| Deductible | 932,354 | 1,107,765 | 1,371,050 | |
| Total Claims | 11,116,547 | 11,518,021 | 11,240,348 | |
| Expenditures | Total 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 Premium | Payments | $0 | $0 | $5,131,049 |
| Less Revenue | Manufacturers' 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.
| Paid Claims | Eighteenth (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 Deductible | 58,569 | 62,511 | 63,043 |
| Number of Participants Reaching Copay limit | 30,060 | 50,900 | 31,508 |
* 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.
