EPIC Program Annual Data Tables 2008-2009
EPIC Program Annual Report 2008-2009 Appendix:
Tables IV-A and IV-B
| Description | Category | Twentieth (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 Claims | Co-payment | 9,869,298 | 9,192,928 | 8,541,283 |
| Deductible | 1,371,050 | 1,477,951 | 1,587,704 | |
| Total Claims | 11,240,348 | 10,670,879 | 10,128,987 | |
| Expenditures | Total 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 Premium | Payments | $5,131,049 | $25,924,547 | $27,466,913 |
| Less Revenue | Manufacturers' 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.
| Paid Claims | Twentieth (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 Deductible | 63,043 | 67,301 | 67,162 |
| Number of Participants Reaching Copay limit | 31,508 | 12,189 | 6,091 |
* 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.
