EPIC Program Annual Data Tables 2003-2004: Tables IV-A and IV-B

Table IV-A
Claims, Expenditures and Revenue by Program Year*
DescriptionCategoryFifthteenth
(2001-2002)
Sixteenth
(2002-2003)
Seventeenth
(2003-2004)
Net State Cost=
(Expenditures-Revenue)
$325,049,682$398,450,931$486,550,971
Number of ClaimsCo-payment7,920,3999,131,7979,919,891
Deductible638,208810,150854,094
Total Claims8,558,6079,941,94710,773,985
ExpendituresTotal Cost of Drugs$588,817,853$734,758,484$892,398,354
less Third Party Payments**$0$0$28,001,001
less Participant Co-payments$93,838,144$110,315,610$119,881,862
less Deductible Payments$34,575,600$44,520,955$49,573,370
Total EPIC Expenditures$460,404,109$579,921,919$694,942,121
Less RevenueManufacturers' Rebates***$116,396,192$159,650,887$184,095,071
plus Participant Fees$18,958,235$21,820,101$22,117,521
plus Claim Recovery****$0$0$2,178,558
Total Revenue$135,354,427$181,470,988$208,391,150

* Table IV-A represents Claims, Expenditures and Revenue by Program Year up to October 2003-September 2004.

** Total Third Party Payments from Medicare drug discount cards and other insurers.

*** Manufacturers' rebates were calculated on an accrual basis from April 1991-September 2003 and on a cash basis from October 2003-present.

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



Table IV-B
Payment and Utilization by Program Year*
Paid ClaimsFifthteenth
(2001-2002)
Sixteenth
(2002-2003)
Seventeenth
(2003-2004)
Average EPIC Payment per Claim$53.79$58.33$64.50
Average Deductible Payment per Claim$54.18$54.95$58.04
Average Participant Co-payment per Claim$11.85$12.08$12.09
Average Third Party Payment** per Claim$0$0$2.60
Average Total Cost per Claim$68.80$73.90$82.83
Number of Participants Reaching Deductible$33,03847,52859,981
Number of Participants Reaching Copay limit$26,78830,56637,813

* Table IV-B represents Payment and Utilization by program year up to October 2003-September 2004.

** Total Third Party Payments from Medicare drug discount cards and other insurers.