The use of high cost or Nonpreferred Brand drugs is contributing to higher overall costs for your group. Consider the following to reduce costs:

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1 April 22, 2014 Sandy Randall Dear Ms. Randall: Enclosed are 4 th Quarter 2013 reports that analyze the major parameters of drug utilization by Rocky Mountain Health Plans (RMHP) Members within the. Graphs The following page(s) contains a line graph that trends paid and allowed dollars PMPM and generic percentage. Only Members with a pharmacy benefit are included. The detached symbols within the graph on the right side (labeled Benchmark ) for each line of business compare your group s trends to the statewide goals. Green indicates your group s performance is better than the goal. Blue means the data is close to the goal. Red indicates your group s performance needs improvement to reach the goal. Top 30 list The use of high cost or Nonpreferred Brand drugs is contributing to higher overall costs for your group. Consider the following to reduce costs: High Cost or Nonpreferred Brands Celebrex (high cost) Advair Lyrica Lunesta Generic or Preferred Brand alternatives generic NSAIDS (e.g. naproxen, meloxicam): Gastroprotective effect of Celebrex unproven; no efficacy advantage. consider step down therapy with Asmanex (Tier 1) or another ICS; if not a candidate for step down therapy, consider use of lower cost brand ICS/LABA inhaler (e.g. Symbicort) generic gabapentin generic zolpidem We hope this information is beneficial to you. Please contact us if you have any comments or questions. Sincerely, Steve Nolan, Pharm D Heather Carwin, Pharm D Pharmacy Director Clinical Pharmacist ~ ext ~ ext 8743 steve.nolan@rmhp.org heather.carwin@rmhp.org Enclosures cc Kevin Fitzgerald, MD Plans underwritten by Rocky Mountain HMO or Rocky Mountain HealthCare Options PHP21R011312

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4 Utilization Analysis Drug Utilization by Paid Dollars 4 th Quarter 2013 Top 30 Drugs Prescribed, by Cost of Claims Table 1 Rank Drug Name Common Usage Claims Costs % $$ Cuml % 1 ABILIFY Antipsychotic 335 $ 254, % 3.5% 2 ADVAIR DISKUS Asthma/COPD 714 $ 189, % 6.1% 3 Duloxetine (Cymbalta) SNRIs (Anti-depressant) 403 $ 119, % 7.7% 4 COPAXONE Multiple Sclerosis 25 $ 116, % 9.3% 5 HUMIRA PEN Anti-TNF-alpha - Monoclonal Antibodies 41 $ 114, % 10.9% 6 LANTUS SOLOSTAR Insulin 392 $ 113, % 12.4% 7 STRATTERA ADHD 463 $ 107, % 13.9% 8 Methylphenidate HCl (Ritalin) Stimulants - Misc. 611 $ 103, % 15.3% 9 LYRICA Epilespsy, Neuropathic Pain 336 $ 94, % 16.6% 10 OXYCONTIN Opioid Analgesic 322 $ 88, % 17.8% 11 ZYTIGA Cancer 12 $ 83, % 19.0% 12 TECFIDERA Multiple Sclerosis 17 $ 80, % 20.1% 13 LANTUS Insulin 278 $ 80, % 21.2% 14 Ipratropium-Albuterol (DuoNeb) Asthma/COPD 263 $ 80, % 22.2% 15 HUMALOG Insulin 239 $ 78, % 23.3% 16 Amphet-Dextroamphet(Adderall) ADHD 620 $ 77, % 24.4% 17 SPIRIVA HANDIHALER Bronchodilators - Anticholinergics 244 $ 71, % 25.4% 18 ENBREL SURECLICK TNF Inhibitor 27 $ 66, % 26.3% 19 CELEBREX NSAIDs 269 $ 62, % 27.1% 20 ENBREL TNF Inhibitor 24 $ 62, % 28.0% 21 CIMZIA Inflammatory Bowel Agents 20 $ 61, % 28.8% 22 REVLIMID Cancer 7 $ 59, % 29.6% 23 VICTOZA Incretin Mimetic Agents 121 $ 53, % 30.3% 24 SYMBICORT Asthma/COPD 225 $ 50, % 31.0% 25 GENOTROPIN Growth Hormones 9 $ 49, % 31.7% 26 Hydrocod/Acet (Vicodin) Opioid Combinations 3,855 $ 49, % 32.4% 27 Metoprolol Succinate (Toprol XL) Beta Blockers (Blood Pressure) 1,970 $ 46, % 33.0% 28 Lidocaine (Xylocaine) Local Anesthetics - Topical 198 $ 46, % 33.7% 29 Oxycod/Acet (Percocet) Opioid Combinations 1,634 $ 46, % 34.3% 30 Levothyroxine (Levoxyl) Thyroid Hormones 6,065 $ 45, % 34.9% Black = Good use of generic drugs GREEN = Good use of preferred formulary drugs RED = Opportunities for Improvement (RMHP Nonpreferred) BLUE = High cost specialty drugs

5 Utilization Analysis Drug Utilization by Paid Dollars 4 th Quarter 2013 Top 30 Drugs Prescribed, by Number of Claims Table 2 Rank Drug Name Common Usage Claims Costs % Rx Cuml % 1 Levothyroxine (Levoxyl) Thyroid Hormones 6,065 $ 45, % 4.1% 2 Lisinopril (Prinivil & Zestril) ACE Inhibitors (Blood Pressure) 4,780 $ 17, % 7.3% 3 Simvastatin (Zocor) High Cholesterol 4,322 $ 14, % 10.2% 4 Hydrocod/Acet (Vicodin) Opioid Combinations 3,855 $ 49, % 12.8% 5 Hydrochlorothiazide (HydroDIURIL) Thiazides & Thiazide-Like Diuretics 3,170 $ 8, % 15.0% 6 Omeprazole (Prilosec) Proton Pump Inhibitors 3,152 $ 25, % 17.1% 7 Metformin (Glucophage) Biguanides - Diabetes 2,284 $ 9, % 18.6% 8 Amoxicillin (Amoxil) Antibiotic 2,221 $ 16, % 20.1% 9 Amlodopine (Norvasc) Calcium Channel Blockers (Blood Pressure) 2,220 $ 7, % 21.6% 10 Atorvastatin (Lipitor) High Cholesterol 2,121 $ 24, % 23.1% 11 Fluoxetine (Prozac) SSRIs (Anti-depressant) 2,116 $ 15, % 24.5% 12 Metoprolol Succinate (Toprol XL) Beta Blockers (Blood Pressure) 1,970 $ 46, % 25.8% 13 Metoprolol Tartrate (Lopressor) Beta Blockers (Blood Pressure) 1,909 $ 7, % 27.1% 14 Alprazolam (Xanax) Anxiety, Sleep, Muscle Relaxant 1,840 $ 10, % 28.3% 15 Sertraline (Zoloft) SSRIs (Anti-depressant) 1,744 $ 8, % 29.5% 16 Losartan Potassium (Cozaar) Angiotensin II Receptor Antagonists 1,694 $ 9, % 30.7% 17 Oxycod/Acet (Percocet) Opioid Combinations 1,634 $ 46, % 31.8% 18 Fluticasone Propionate (Flonase) Allergic Rhinitis 1,621 $ 30, % 32.9% 19 Warfarin (Coumadin) Anticoagulants 1,620 $ 9, % 33.9% 20 Pantoprazole Sodium (Protonix) Proton Pump Inhibitors 1,590 $ 11, % 35.0% 21 Gabapentin (Neurontin) Epilespsy, Neuropathic Pain 1,554 $ 26, % 36.1% 22 Citalopram (Celexa) SSRIs (Anti-depressant) 1,538 $ 6, % 37.1% 23 Atenolol (Tenormin) Beta Blockers (Blood Pressure) 1,533 $ 4, % 38.1% 24 Furosemide (Lasix) Loop Diuretics 1,530 $ 5, % 39.2% 25 Trazodone (Desyrel) Serotonin Modulators 1,495 $ 8, % 40.2% 26 Zolpidem (Ambien) Insomnia 1,470 $ 6, % 41.2% 27 Azithromycin (Zithromax) Antibiotic 1,389 $ 15, % 42.1% 28 Tramadol (Ultram) Opioid Analgesic 1,269 $ 6, % 43.0% 29 Lovastatin (Mevacor) High Cholesterol 1,043 $ 5, % 43.7% 30 Tamsulosin (Flomax) Prostatic Hypertrophy (BPH) 1,042 $ 10, % 44.4% Black = Good use of generic drugs GREEN = Good use of preferred formulary drugs RED = Opportunities for Improvement (RMHP Nonpreferred) BLUE = High cost specialty drugs