EPIC Program Annual Report 2009-2010 Appendix: Tables IV-A and IV-B

Table IV-A
Claims, Expenditures and Revenue by Program Year*
DescriptionCategoryTwenty-first
(2007-2008)
Twenty-second
(2008-2009)
Twenty-third
(2009-2010)
Net State Cost=
(Expenditures+Premiums-Revenue)
$190,861,688$187,283,107$120,576,619
Number of ClaimsCo-payment9,192,9288,541,2838,070,456
Deductible1,477,9511,587,7041,607,887
Total Claims10,670,87910,128,9879,678,343
ExpendituresTotal Cost of Drugs$1,090,587,079$956,536,482$930,616,380
less Third Party Payments**$518,118,379$468,037,216$496,553,983
less Participant Co-payments$77,150,989$64,758,593$58,652,524
less Deductible Payments$44,412,254$43,836,044$41,851,962
Total EPIC
Expenditures
$450,905,457$379,904,629$333,557,911
Plus PremiumPayments***$25,924,547$27,466,913$26,976,400
Less RevenueManufacturers' Rebates$226,262,168$169,494,340$209,301,480
plus Participant Fees$18,746,354$17,117,037$17,563,017
plus Benefit Recovery****$40,959,794$33,477,058$13,093,195
Total Revenue$285,968,316$220,088,435$239,957,682

* Table IV-A represents Claims, Expenditures and Revenue by Program Year up to October 2009-September 2010.
** Estimated Third Party Payments from Medicare Part D coverage and other insurers.
*** Premium Payments reflects a 1.1% Federal Medical Assistance Percentage reduction for August and September 2010.
**** Retroactive Third Party Benefit recoveries from Medicare and other insurers as well as plan recoveries.


Table IV-B
Payment and Utilization by Program Year*
Paid ClaimsTwenty-first
(2007-2008)
Twenty-second
(2008-2009)
Twenty-third
(2009-2010)
Average EPIC Payment per Claim$42.26$37.51$34.46
Average Deductible Payment per Deductible Claim$30.05$27.61$26.03
Average Participant Co-payment per Co-payment Claim$8.39$7.58$7.27
Average Third Party Payment** per Claim$48.55$46.21$51.31
Average Total Cost per Claim$102.20$94.44$96.15
Number of Participants Reaching Deductible67,30167,16270,596
Number of Participants Reaching Copay limit12,1896,0914,218

* Table IV-B represents Payment and Utilization by program year up to October 2009-September 2010.
** Estimated Third Party Payments from Medicare Part D coverage and other insurers.