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
$84.32
18.4%vs prior year
Generic Fill Rate
72.40%
4.8%vs prior year
PMPM Spend
$37.59
12.1%vs prior year
Spend Trend & Forecast
AI Insights
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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-37.3%
Your Plan
$37.59
Industry
$142.67
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-33.5%
Your Plan
$84.32
Industry
$126.89
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
High-Cost Claimant Alerts
Members requiring intervention
MBR-4821
Keytruda
$14,200/mo
PAP Eligibility ReviewMBR-7762
Humira
$8,900/mo
Biosimilar Switch — HadlimaMBR-1093
Ozempic + Farxiga
$4,200/mo
Therapeutic Alternatives ReviewAdjudicated Claims Feed
Live
Real-time desensitized claim data from adjudication platform
| Member ID | Fill Date | Drug Name | Brand / Generic | Fill Location | Channel | Plan Paid | Member Copay | Savings vs Traditional |
|---|---|---|---|---|---|---|---|---|
| MBR-2198 | 2026-03-22 | Imatinib 400mg | Generic | RxDune Intl. | Intl. Pharmacy | $34.50 | FREE | ↓$5,382★ 99% saved |
| MBR-4521 | 2026-03-22 | Atorvastatin 40mg | Generic | Cost Plus Pharmacy | Cost Plus | $4.20 | FREE | ↓$18.8 |
| MBR-3892 | 2026-03-21 | Humira 40mg | Specialty | Specialty Rx Hub | Biosimilar | $1,842.00 | $125.00 | ↓$892 |
| MBR-7123 | 2026-03-21 | Ozempic 1mg | Brand | CVS #4412 | Retail | $892.00 | $45.00 | ↓$312 |
| MBR-5567 | 2026-03-21 | Metformin 1000mg | Generic | Mail Order | Mail Order | $3.80 | FREE | ↓$12.2 |
| MBR-8834 | 2026-03-20 | Eliquis 5mg | Brand | Walgreens #2201 | Retail | $245.00 | $35.00 | ↓$89 |
| MBR-2901 | 2026-03-20 | Sertraline 100mg | Generic | Cost Plus Pharmacy | Cost Plus | $5.40 | FREE | ↓$22.6 |
| MBR-6643 | 2026-03-20 | Keytruda 200mg | Specialty | Specialty Rx Hub | Specialty | $14,200.00 | $250.00 | ↓$1,800 |
| MBR-1298 | 2026-03-19 | Lisinopril 20mg | Generic | CVS #4412 | Retail | $4.00 | $5.00 | ↓$8 |
| MBR-4455 | 2026-03-19 | Jardiance 25mg | Brand | Cost Plus Pharmacy | Cost Plus | $312.00 | $25.00 | ↓$178 |
| MBR-9021 | 2026-03-19 | Omeprazole 40mg | Generic | Mail Order | Mail Order | $6.20 | FREE | ↓$14.8 |
| MBR-3378 | 2026-03-18 | Amlodipine 10mg | Generic | Walgreens #2201 | Retail | $3.50 | $5.00 | ↓$9.5 |
| MBR-7789 | 2026-03-18 | Revlimid 25mg | Specialty | RxDune Intl. | Manufacturer DTC | $8,500.00 | $150.00 | ↓$4,300 |
| MBR-5512 | 2026-03-18 | Gabapentin 300mg | Generic | Cost Plus Pharmacy | Cost Plus | $4.80 | FREE | ↓$18.2 |
| MBR-8123 | 2026-03-17 | Escitalopram 20mg | Generic | Mail Order | Mail Order | $5.20 | FREE | ↓$16.8 |
Showing 15 of 2,739 claims