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PLAN SPEND OVERVIEW
Live

$2,302,000

total plan spend

$3,420,000

traditional PBM estimate

$1,118,000

savings vs traditional

32.7%

cost reduction

Total Plan Spend
$2,302,000
14.2%vs prior year
Member Cost Share
$187,400
8.6%vs prior year
Total Claims
2,739
6.2%vs prior year
Avg Cost / Claim
$840.45
18.4%vs prior year
Generic Fill Rate
72.40%
4.8%vs prior year
PMPM Spend
$37.59
12.1%vs prior year
PBM Admin Fee (Flat)
$8.50
62%vs traditional PBM
Estimated Rebates YTD
$31,815
100%vs prior year

Spend Trend & Forecast

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Predictive Analytics

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GLP-1 / Weight Management Spotlight

Total GLP-1 Spend

$487,000

Members on GLP-1

142

Avg Cost/Member/Mo

$1,143

YoY Growth Rate

34.2%

Monthly GLP-1 Spend Trend

DrugClaimsSpendTrend
Ozempic 1mg34$196,000+28.0%
Wegovy 2.4mg18$124,000+52.0%
Mounjaro 15mg22$98,000+41.0%
Zepbound 15mg8$41,000+89.0%
Trulicity 1.5mg28$28,000-12.0%

Impact Alert: GLP-1 medications represent 25.0% of total pharmacy spend. Projected annual impact: $1,948,000

Cost Avoidance Waterfall

Top 10 Drugs by Spend

1

Humira

Specialty

$284K-$89K
2

Ozempic

Diabetes

$196K-$62K
3

Eliquis

Cardiovascular

$142K-$38K
4

Imatinib

Oncology

$5.0K-$191K
5

Jardiance

Diabetes

$98K-$31K
6

Atorvastatin

Cardiovascular

$12K-$8K
7

Metformin

Diabetes

$8.2K-$3K
8

Sertraline

Mental Health

$16K-$5K
9

Omeprazole

GI

$9.8K-$4K
10

Lisinopril

Cardiovascular

$6.2K-$3K

Brand vs Generic Mix

Generic72.4%
Brand18.8%
Specialty8.8%

Therapeutic Categories

Industry Benchmarks

PMPM Rx Spend-37.2%
Your Plan
$37.59
Industry
$59.82
Generic Fill Rate+18.3%
Your Plan
72.4%
Industry
61.2%
Specialty % of Spend-25.7%
Your Plan
38.2%
Industry
51.4%
Avg Cost/Claim-33.8%
Your Plan
$840.45
Industry
$1,268.90
Mail Order %+56.3%
Your Plan
28.6%
Industry
18.3%

Specialty Drug Tracker

Total Monthly Specialty Cost$78,667/mo

Humira

BIOSIMILARPAP

$23.7K/mo

12%

Stelara

PAP

$18.4K/mo

3%

Keytruda

$14.2K/mo

8%

Revlimid

BIOSIMILARPAP

$12.8K/mo

5%

Xarelto

$9.6K/mo

1%

Member Cost Distribution

Fiduciary & Transparency Scorecard

A+

Transparency Grade

7 of 7 metrics passing

Spread Pricing

$0.00✓

Rebate Passthrough

100%✓

Admin Fee PMPM

$8.50

vs industry $28.50

MetricRxDuneTraditional PBMStatus
Spread Pricing$0.00$4.50–$22 PMPM✓
Rebate Passthrough100%55–70%✓
Admin Fee (PMPM)$8.50$22–$45✓
AWP Discount TransparencyFull disclosureOpaque✓
MAC List AccessPublishedProprietary✓
Clinical Rebate SteeringNoneCommon✓
Audit RightsUnlimitedLimited / Annual✓

ERISA Compliance

100% pass-through model with complete audit trail available. All pricing and rebate data is transparent and fiduciary-aligned.

Audit-Ready — All pricing and rebate data available for fiduciary review

High-Cost Claimant Alerts

Members requiring intervention

MBR-4821

Keytruda

$14,200/mo

PAP Eligibility Review

MBR-7762

Humira

$8,900/mo

Biosimilar Switch — Hadlima

MBR-1093

Ozempic + Farxiga

$4,200/mo

Therapeutic Alternatives Review

Rebate Transparency

Estimated Rebates YTD

$31,815

Rebate Realization Rate

87.2%

RxDune Rebate Passthrough

100%

Industry avg: 55-70%

Rebate Estimates by Drug

100% passthrough
DrugTypeTotal SpendEst. Rebate/ClaimClaimsTotal Est. Rebate
HumiraSpecialty$284,000$65012$7,800
EliquisBrand$142,000$9578$7,410
KeytrudaSpecialty$242,000$6508$5,200
JardianceBrand$98,000$9545$4,275
RevlimidSpecialty$89,000$6506$3,900
OzempicBrand$196,000$9534$3,230

Plan Performance: RxDune vs Traditional

Key Financial Metrics

MetricRxDuneTraditionalVariance
PMPM Cost$37.59$59.82▼37.2%
Avg Cost/Brand Rx$237.86$412.50▼42.3%
Avg Cost/Generic Rx$6.26$8.42▼25.7%
Generic Dispensing Rate72.4%61.2%▲18.3%

Contract Benchmarking & Competitive Analysis

MetricRxDuneBig 3 PBMs (Avg)Independent PBMs (Avg)Your Current RFP
PMPM$37.59$59.82$47.14$54.08
Estimated Spread$0.00$4.50$2.20$3.80
Rebate Retention %0%35%22%30%
Admin Fee PMPM$8.50$28.50$18.00$22.00
Generic Discount (AWP-%)AWP-88%AWP-82%AWP-85%AWP-83%
Brand Discount (AWP-%)AWP-24%AWP-17%AWP-20%AWP-18%
Total Annual Savings vs.Baseline+$266.76/yr+$114.60/yr+$197.88/yr

Employer Group Segmentation

SegmentMembersSpendPMPMGeneric RateSpecialty %
Corporate HQ8,420$892,000$35.3076.2%6.4%
Manufacturing5,180$624,000$40.1568.4%12.1%
Distribution Centers3,640$412,000$37.7371.8%8.9%
Field Sales2,172$268,000$41.1269.1%11.2%
Remote / WFH1,000$106,000$35.3378.4%4.8%

Member Experience & Satisfaction

87/ 100

Overall Score

Formulary Disruption

4.2%

Lower is better

Network Access

94

Prior Auth Satisfaction

82

Copay Predictability

91

Score vs. Industry Benchmark

Rx Affordability89 / 72
Pharmacy Access94 / 88
Prior Auth Speed82 / 64
Formulary Coverage91 / 78
Digital Experience86 / 71
Overall Satisfaction87 / 74
Above benchmark Below benchmark Benchmark

Prior Auth Tracker

12

Pending

156

Approved

8

Denied

1.2 days

Avg TAT

Formulary Compliance

94.2%

Formulary Compliance Rate

2,580

On-Formulary

159

Off-Formulary

Renewal Projection & Scenario Modeling

Toggle scenarios to model projected plan year impact

Your Trend: +2.8% vs Industry: +8.4%

Current Annual

$2,302,000

Base Projected

$2,366,456

Adjusted Projected

$2,366,456

Savings vs Traditional

$128,912

What-If Scenarios

Adjudicated Claims Feed

Live
Member IDFill DateDrug NameBrand / GenericFill LocationChannelPlan PaidMember CopaySavings vs Traditional
MBR-21982026-03-25Imatinib Mesylate 400mgSpecialtyCostPlusDrugsCost Plus$1,656.00FREE↓$63,667
MBR-45212026-03-24Metformin 500mgGenericCVS PharmacyRetail$4.20$5.00↓$2.8
MBR-78342026-03-24Lisinopril 10mgGenericWalgreensRetail$3.80$5.00↓$3.2
MBR-31562026-03-23Humira 40mgSpecialtyAccredoSpecialty$2,847.00$150.00↓$4,123
MBR-68922026-03-23Atorvastatin 20mgGenericExpress Scripts MailMail Order$8.40$10.00↓$26.6
MBR-12472026-03-22Ozempic 1mgBrandCVS SpecialtySpecialty$892.00$75.00↓$433
MBR-56732026-03-22Amlodipine 5mgGenericRite AidRetail$4.50$5.00↓$5.5
MBR-82342026-03-21Eliquis 5mgBrandWalgreensRetail$285.00$45.00↓$190
MBR-40892026-03-21Omeprazole 20mgGenericAmazon PharmacyMail Order$6.20$5.00↓$13.8
MBR-91562026-03-20Jardiance 25mgBrandOptumRx MailMail Order$412.00$50.00↓$188
MBR-25672026-03-20Sertraline 50mgGenericCVS PharmacyRetail$5.80$5.00↓$9.2
MBR-74122026-03-19Keytruda 100mgSpecialtyBiologics by McKessonSpecialty$9,245.00$250.00↓$12,505
MBR-38902026-03-19Gabapentin 300mgGenericWalmart PharmacyRetail$7.20$5.00↓$7.8
MBR-61232026-03-18Trulicity 1.5mgBrandExpress Scripts MailMail Order$678.00$60.00↓$362
MBR-17892026-03-18Levothyroxine 50mcgGenericRite AidRetail$4.80$5.00↓$10.2
MBR-52342026-03-17Stelara 45mgSpecialtyCVS SpecialtySpecialty$6,892.00$200.00↓$8,908
MBR-89012026-03-17Metoprolol 25mgGenericCVS PharmacyRetail$4.00$5.00↓$6
MBR-23452026-03-16Xarelto 20mgBrandWalgreensRetail$312.00$45.00↓$193
MBR-67892026-03-16Losartan 50mgGenericAmazon PharmacyMail Order$5.60$5.00↓$9.4
MBR-45672026-03-15Revlimid 25mgSpecialtyAccredoSpecialty$18,456.00$300.00↓$6,244

Showing 20 of 2,739 claims