13 - NM Human Services
NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1200 Top Pharmacies Ranked by Amount Paid
|Report ID: M1200 |
|Title: Top Pharmacies Ranked by Amount Paid |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Pharmacies by “Amount Paid”. It includes line item information for the following metrics: Pharmacy ID, Pharmacy Name, # of |
|Utilizers, # of Claims, Avg # Claims/Utilizer, Ingr Amount Submitted, Ingr Amount Allowed, Amount Paid, Avg Amount Paid/Claim, and Avg Amount Paid/Utilizer. The summary at the bottom of the |
|report shows Subtotals, Percents and Averages of the Top Pharmacies compared to All Pharmacies for each metric. The summary also shows Totals and Averages for All Pharmacies for each metric. |
|Statistics from this report may be used to develop possible Program changes or cost avoidance measures. |
|Metrics: Rank - Ranking of Provider Pharmacies by Amount Paid |
|Pharmacy ID - Provider Pharmacy ID - from drug claim in NCPDP format |
|Pharmacy Name - Provider Pharmacy Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Pharmacy |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Pharmacy |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by # of Unique Utilizers per Provider Pharmacy |
|Ingr Submitted Amount - Sum of the Submitted Ingr Costs from the Pharmacies per Provider Pharmacy |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Pharmacy |
|Amount Paid - Sum of Amount Paid by the Client per Provider Pharmacy |
|Avg Amount Paid/Claim - Amount Paid divided by # of Claims per Provider Pharmacy |
|Avg Amount Paid/Utilizer - Amount Paid divided by # of Utilizers per Provider Pharmacy |
|Summaries: |
|Pharmacy ID: |
|Totals - Count of Unique Pharmacy ID Numbers for Top Pharmacies |
|Percents - Count of Unique Pharmacy IDs for Top Pharmacies divided by the Count of Unique Pharmacy IDs for All Pharmacies |
|Totals For All - Count of Unique Pharmacy IDs for All Pharmacies |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Pharmacies |
|Percents - Count of Unique Utilizer IDs for Top Pharmacies divided by the Count of Unique Utilizer IDs for All Pharmacies |
|Averages - Count of Unique Utilizer IDs for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Count of Unique Utilizer IDs for All Pharmacies |
|Averages for All - Count of Unique Utilizer IDs for All Pharmacies divided by the # of All Pharmacies |
|# of Claims: |
|Totals - Count of Claims for Top Pharmacies |
|Percents - Sum of the # of Claims for Top Pharmacies divided by the Sum of the # of Claims for All Pharmacies |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Claims for All Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of All Pharmacies |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of Unique Utilizers for All Pharmacies |
|Ingr Amount Submitted: |
|Totals - Sum of Ingr Amount Submitted for Top Pharmacies |
|Percents - Sum of Ingr Amount Submitted for Top Pharmacies divided by Sum of Ingr Amount Submitted for All Pharmacies |
|Averages - Sum of Ingr Amount Submitted for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Submitted for All Pharmacies |
|Averages for All - Sum of Ingr Amount Submitted for All Pharmacies divided by the # of All Pharmacies |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Pharmacies |
|Percents - Sum of Ingr Amount Allowed for Top Pharmacies divided by Sum of Ingr Amount Allowed for All Pharmacies |
|Averages - Sum of Ingr Amount Allowed for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Allowed for All Pharmacies |
|Averages for All - Sum of Ingr Amount Allowed for All Pharmacies divided by the # of All Pharmacies |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Pharmacies |
|Percents - Sum of Amount Paid for Top Pharmacies divided by Sum of Amount Paid for All Pharmacies |
|Averages - Sum of Amount Paid for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Amount Paid for All Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by the # of All Pharmacies |
|Avg Amount Paid/Claim: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by # of Claims for Top Pharmacies |
|Averages for All - Sum of Amount Paid for Top Pharmacies divided by # of Claims for All Pharmacies |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by # of Unique Utilizers for All Pharmacies |
|Sort Sequence(s): Top Pharmacies by Amount Paid |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1210 Top Pharmacies Ranked by Number of Prescriptions
|Report ID: M1210 |
|Title: Top Pharmacies Ranked by Number of Prescriptions |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Pharmacies by “Number of Prescriptions”. It includes line item information for the following metrics: Pharmacy ID, Pharmacy |
|Name, # of Utilizers, # of Claims, Avg # Claims/Utilizer, Ingr Amount Submitted, Ingr Amount Allowed, Amount Paid, Avg Amount Paid/Claim, and Avg Amount Paid/Utilizer. The summary at the bottom |
|of the report shows Subtotals, Percents and Averages of the Top Pharmacies compared to All Pharmacies for each metric. The summary also shows Totals and Averages for All Pharmacies for each |
|metric. Statistics from this report may be used to develop possible program changes or cost avoidance measures. |
|Metrics: Rank - Ranking of Provider Pharmacies by Number of Prescriptions |
|Pharmacy ID - Provider Pharmacy ID - from drug claim in NCPDP format |
|Pharmacy Name - Provider Pharmacy Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Pharmacy |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Pharmacy |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by # of Unique Utilizers per Provider Pharmacy |
|Ingr Submitted Amount - Sum of the Submitted Ingr Costs from the Pharmacies per Provider Pharmacy |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider |
|Amount Paid - Sum of Amount Paid by the Client per Provider Pharmacy |
|Avg Amount Paid/Claim - Amount Paid divided by # of Claims per Provider Pharmacy |
|Avg Amount Paid/Utilizer - Amount Paid divided by # of Utilizers per Provider Pharmacy |
|Summaries: |
|Pharmacy ID: |
|Totals - Count of Unique Pharmacy ID Numbers for Top Pharmacies |
|Percents - Count of Unique Pharmacy IDs for Top Pharmacies divided by the Count of Unique Pharmacy IDs for All Pharmacies |
|Totals For All - Count of Unique Pharmacy IDs for All Pharmacies |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Pharmacies |
|Percents - Count of Unique Utilizer IDs for Top Pharmacies divided by the Count of Unique Utilizer IDs for All Pharmacies |
|Averages - Count of Unique Utilizer IDs for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Count of Unique Utilizer IDs for All Pharmacies |
|Averages for All - Count of Unique Utilizer IDs for All Pharmacies divided by the # of All Pharmacies |
|# of Claims: |
|Totals - Count of Claims for Top Pharmacies |
|Percents - Sum of the # of Claims for Top Pharmacies divided by the Sum of the # of Claims for All Pharmacies |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Claims for All Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of All Pharmacies |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of Unique Utilizers for All Pharmacies |
|Ingr Amount Submitted: |
|Totals - Sum of Ingr Amount Submitted for Top Pharmacies |
|Percents - Sum of Ingr Amount Submitted for Top Pharmacies divided by Sum of Ingr Amount Submitted for All Pharmacies |
|Averages - Sum of Ingr Amount Submitted for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Submitted for All Pharmacies |
|Averages for All - Sum of Ingr Amount Submitted for All Pharmacies divided by the # of All Pharmacies |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Pharmacies |
|Percents - Sum of Ingr Amount Allowed for Top Pharmacies divided by Sum of Ingr Amount Allowed for All Pharmacies |
|Averages - Sum of Ingr Amount Allowed for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Allowed for All Pharmacies |
|Averages for All - Sum of Ingr Amount Allowed for All Pharmacies divided by the # of All Pharmacies |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Pharmacies |
|Percents - Sum of Amount Paid for Top Pharmacies divided by Sum of Amount Paid for All Pharmacies |
|Averages - Sum of Amount Paid for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Amount Paid for All Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by the # of All Pharmacies |
|Avg Amount Paid/Claim: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by # of Claims for Top Pharmacies |
|Averages for All - Sum of Amount Paid for Top Pharmacies divided by # of Claims for All Pharmacies |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by # of Unique Utilizers for All Pharmacies |
|Sort Sequence(s): Top Pharmacies by Number of Prescriptions |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1260 Top Pharmacies Ranked by Average Amount Paid per Prescription
|Report ID: M1260 |
|Title: Top Pharmacies Ranked by Average Amount Paid per Prescription |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Pharmacies by “Average Amount Paid per Prescription”. It includes line item information for the following metrics: Pharmacy ID,|
|Pharmacy Name, # of Utilizers, # of Claims, Avg # Claims/Utilizer, Ingr Amount Submitted, Ingr Amount Allowed, Amount Paid, Avg Amount Paid/Claim, and Avg Amount Paid/Utilizer. The summary at |
|the bottom of the report shows Subtotals, Percents and Averages of the Top Pharmacies compared to All Pharmacies for each metric. The summary also shows Totals and Averages for All Pharmacies |
|for each metric. Statistics from this report may be used to target possible outlier Pharmacies dispensing expensive medications. |
|Metrics: Rank - Ranking of Provider Pharmacies by Number of Prescriptions |
|Pharmacy ID - Provider Pharmacy ID - from drug claim in NCPDP format |
|Pharmacy Name - Provider Pharmacy Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Pharmacy |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Pharmacy |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by # of Unique Utilizers per Provider Pharmacy |
|Ingr Submitted Amount - Sum of the Submitted Ingr Costs from the Pharmacies per Provider Pharmacy |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Pharmacy |
|Amount Paid - Sum of Amount Paid by the Client per Provider Pharmacy |
|Avg Amount Paid/Claim - Sum of Amount Paid divided by the Sum of the # of Claims per Provider Pharmacy |
|Avg Amount Paid/Utilizer - Sum of Amount Paid divided by the Sum of the # of Utilizers per Provider Pharmacy |
|Summaries: |
|Pharmacy ID: |
|Totals - Count of Unique Pharmacy ID Numbers for Top Pharmacies |
|Percents - Count of Unique Pharmacy IDs for Top Pharmacies divided by the Count of Unique Pharmacy IDs for All Pharmacies |
|Totals For All - Count of Unique Pharmacy IDs for All Pharmacies |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Pharmacies |
|Percents - Count of Unique Utilizer IDs for Top Pharmacies divided by the Count of Unique Utilizer IDs for All Pharmacies |
|Averages - Count of Unique Utilizer IDs for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Count of Unique Utilizer IDs for All Pharmacies |
|Averages for All - Count of Unique Utilizer IDs for All Pharmacies divided by the # of All Pharmacies |
|# of Claims: |
|Totals - Count of Claims for Top Pharmacies |
|Percents - Sum of the # of Claims for Top Pharmacies divided by the Sum of the # of Claims for All Pharmacies |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Claims for All Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of All Pharmacies |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of Unique Utilizers for All Pharmacies |
|Ingr Amount Submitted: |
|Totals - Sum of Ingr Amount Submitted for Top Pharmacies |
|Percents - Sum of Ingr Amount Submitted for Top Pharmacies divided by Sum of Ingr Amount Submitted for All Pharmacies |
|Averages - Sum of Ingr Amount Submitted for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Submitted for All Pharmacies |
|Averages for All - Sum of Ingr Amount Submitted for All Pharmacies divided by the # of All Pharmacies |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Pharmacies |
|Percents - Sum of Ingr Amount Allowed for Top Pharmacies divided by Sum of Ingr Amount Allowed for All Pharmacies |
|Averages - Sum of Ingr Amount Allowed for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Allowed for All Pharmacies |
|Averages for All - Sum of Ingr Amount Allowed for All Pharmacies divided by the # of All Pharmacies |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Pharmacies |
|Percents - Sum of Amount Paid for Top Pharmacies divided by Sum of Amount Paid for All Pharmacies |
|Averages - Sum of Amount Paid for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Amount Paid for All Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by the # of All Pharmacies |
|Avg Amount Paid/Claim: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by Sum of the # of Claims for Top Pharmacies |
|Averages for All - Sum of Amount Paid for Top Pharmacies divided by Sum of the # of Claims for All Pharmacies |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by # of Unique Utilizers for All Pharmacies |
|Sort Sequence(s): Top Pharmacies by Avg Amount Paid per Prescriptions |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1280 Top Pharmacies with Top Therapeutic Class Ranked by Amount Paid
|Report ID: M1280 |
|Title: Top Pharmacies with Top Therapeutic Class Ranked by Amount Paid |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Pharmacies and reports metrics on the Top Therapeutic Classes by “Amount Paid per Prescription”. It includes line item |
|information for the following metrics: Therapeutic Class Code Description, Therapeutic Class Code, # of Utilizers, # of Claims, Avg # Claims/Utilizer, Ingr Amount Submitted, Ingr Amount Allowed,|
|Amount Paid, Avg Amount Paid/Claim, and Avg Amount Paid/Utilizer. The summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Pharmacies compared to All Pharmacies |
|for each metric. The summary also shows Totals and Averages for All Pharmacies for each metric. Statistics from this report may be used to target possible Pharmacy outliers which may represent |
|over utilization of state resources. This report shows the Top 25 Therapeutic Classes across All Pharmacies by “Amount Paid” and targets the Top 25 Pharmacies, displaying the activity within |
|those classes. |
|Metrics: Rank - Ranking of Top 25 Pharmacies by Total Amount Paid for All Claims (Ranked by Amount Paid for Claims in the Top 25 Therapeutic Classes |
|Pharmacy Name - Provider Pharmacy Name |
|Pharmacy ID - Provider Pharmacy ID - from drug claim in NCPDP format |
|Amount Paid per Pharmacy - Amount Paid for claims in the Top 25 Therapeutic Classes (Ranked by Amount Paid) |
|Therapeutic Class Description - Description of each Therapeutic Class Code |
|Therapeutic Class Code - Therapeutic Class Code groups drugs according to their most common intended use |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Pharmacy |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Pharmacy |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by # of Unique Utilizers per Provider Pharmacy |
|Submitted Ingr Amount - Sum of the Submitted Ingr Costs from the Pharmacies per Provider Pharmacy |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Pharmacy |
|Amount Paid/Therapeutic Class - Sum of Amount Paid for each of the “Top 25 Therapeutic Classes” per Provider Pharmacy |
|Avg Amount Paid/Claim - Sum of Amount Paid divided by the Sum of the # of Claims per Provider Pharmacy |
|Avg Amount Paid/Utilizer - Sum of Amount Paid divided by the Sum of the # of Utilizers per Provider Pharmacy |
|Summaries: |
|Pharmacy ID: |
|Totals - Count of Unique Pharmacy ID Numbers for Top Pharmacies |
|Percents - Count of Unique Pharmacy IDs for Top Pharmacies divided by the Count of Unique Pharmacy IDs for All Pharmacies |
|Totals For All - Count of Unique Pharmacy IDs for All Pharmacies |
|# of Therapeutic Classes: |
|Totals - Count of Therapeutic Class in the “Top 25” with Claims |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Pharmacies |
|Percents - Count of Unique Utilizer IDs for Top Pharmacies divided by the Count of Unique Utilizer IDs for All Pharmacies |
|Averages - Count of Unique Utilizer IDs for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Count of Unique Utilizer IDs for All Pharmacies |
|Averages for All - Count of Unique Utilizer IDs for All Pharmacies divided by the # of All Pharmacies |
|# of Claims: |
|Totals - Count of Claims for Top Pharmacies |
|Percents - Sum of the # of Claims for Top Pharmacies divided by the Sum of the # of Claims for All Pharmacies |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Claims for All Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of All Pharmacies |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of Unique Utilizers for All Pharmacies |
|Ingr Amount Submitted: |
|Totals - Sum of Ingr Amount Submitted for Top Pharmacies |
|Percents - Sum of Ingr Amount Submitted for Top Pharmacies divided by Sum of Ingr Amount Submitted for All Pharmacies |
|Averages - Sum of Ingr Amount Submitted for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Submitted for All Pharmacies |
|Averages for All - Sum of Ingr Amount Submitted for All Pharmacies divided by the # of All Pharmacies |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Pharmacies |
|Percents - Sum of Ingr Amount Allowed for Top Pharmacies divided by Sum of Ingr Amount Allowed for All Pharmacies |
|Averages - Sum of Ingr Amount Allowed for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Allowed for All Pharmacies |
|Averages for All - Sum of Ingr Amount Allowed for All Pharmacies divided by the # of All Pharmacies |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Pharmacies |
|Percents - Sum of Amount Paid for Top Pharmacies divided by Sum of Amount Paid for All Pharmacies |
|Averages - Sum of Amount Paid for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Amount Paid for All Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by the # of All Pharmacies |
|Avg Amount Paid/Claim: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by the Sum of the # of Claims for Top Pharmacies |
|Averages for All - Sum of Amount Paid for Top Pharmacies divided by the Sum of the # of Claims for All Pharmacies |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Pharmacies divided by # of Unique Utilizers for Top Pharmacies |
|Averages for All - Sum of Amount Paid for All Pharmacies divided by # of Unique Utilizers for All Pharmacies |
|Sort Sequence(s): Top 25 Pharmacies by Total Amount Paid / Top 25 Therapeutic Classes by Total Amount Paid |
|Control Breaks: Rank Top 25 |
|Filters: N/A |
|Notes: Only metrics for claims in Top 25 Therapeutic Classes are shown for each of the Top 25 Pharmacies. Note that not all |
|Pharmacies have claims in all 25 Therapeutic Classes. |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1290 Top Pharmacies Ranked by Percentage of Brand Utilization
|Report ID: M1290 |
|Title: Top Pharmacies Ranked by Percentage of Brand Utilization |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Pharmacies by “Percentage of Brand Utilization”. It includes line item information for the following metrics: Pharmacy ID, |
|Pharmacy Name, # of Utilizers, # of Claims, Ingr Amount Allowed, # of Brand, % of Brand Claims, # of Brand with Generic Available Claims, % of Brand with Generic Available Claims, # Generic |
|Claims, % Generic Claims. The summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Pharmacies compared to All Pharmacies for each metric. The summary also shows|
|Totals and Averages for All Pharmacies for each metric. This report includes only the drugs what were priced by AWP pricing programs to eliminate brand drugs that were paid by generic pricing |
|algorithms. This report helps identify Pharmacy outliers of excessive brand utilization. |
|Metrics: Rank - Ranking of Provider Pharmacies by Percentage of Brand Utilization |
|Pharmacy ID - Provider Pharmacy ID - from drug claim in NCPDP format |
|Pharmacy Name - Provider Pharmacy Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Pharmacy |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Pharmacy |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Pharmacy |
|# of Brand Claims - Unique Count of Brand Transaction Control Numbers per Provider Pharmacy |
|% of Brand Claims - # of Brand Claims divided by the # of Claims |
|# of Brand with Generic Available Claims - Count of Brand with Generic Available Transaction Control Numbers per Provider Pharmacy |
|% of Brand with Generic Available Claims - # of Brand with Generic Available Claims divided by the # of Claims |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers |
|% Generic Claims - # of Generic Claims divided by the # of Claims per Provider Pharmacy |
|Summaries: |
|Pharmacy ID: |
|Totals - Count of Unique Pharmacy ID Numbers for Top Pharmacies |
|Percents - Count of Unique Pharmacy IDs for Top Pharmacies divided by the Count of Unique Pharmacy IDs for All Pharmacies |
|Totals For All - Count of Unique Pharmacy IDs for All Pharmacies |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Pharmacies |
|Percents - Count of Unique Utilizer IDs for Top Pharmacies divided by the Count of Unique Utilizer IDs for All Pharmacies |
|Averages - Count of Unique Utilizer IDs for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Count of Unique Utilizer IDs for All Pharmacies |
|Averages for All - Count of Unique Utilizer IDs for All Pharmacies divided by the # of All Pharmacies |
|# of Claims: |
|Totals - Count of Claims for Top Pharmacies |
|Percents - Sum of the # of Claims for Top Pharmacies divided by the Sum of the # of Claims for All Pharmacies |
|Averages - Sum of the # of Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Claims for All Pharmacies |
|Averages for All - Sum of the # of Claims for All Pharmacies divided by the # of All Pharmacies |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Pharmacies |
|Percents - Sum of Ingr Amount Allowed for Top Pharmacies divided by Sum of Ingr Amount Allowed for All Pharmacies |
|Averages - Sum of Ingr Amount Allowed for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of Ingr Amount Allowed for All Pharmacies |
|Averages for All - Sum of Ingr Amount Allowed for All Pharmacies divided by the # of All Pharmacies |
|# of Brand Claims: |
|Totals - Count of Brand Claims for Top Pharmacies |
|Percents - Sum of the # of Brand Claims for Top Pharmacies divided by the Sum of the # of Brand Claims for All |
|Pharmacies |
|Averages - Sum of the # of Brand Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Brand Claims for All Pharmacies |
|Averages for All - Sum of the # of Brand Claims for All Pharmacies divided by the # of All Pharmacies |
|% Brand Claims: |
|Averages - Sum of the # of Brand Claims of Top Pharmacies divided by the Sum of the # of Claims for Top Pharmacies |
|Averages for All - Sum of the # of Brand Claims of All Pharmacies divided by the Sum of the # of Claims for All |
|Pharmacies |
|# of Brand with Generic Available Claims: |
|Totals - Count of Brand with Generic Available Claims for Top Pharmacies |
|Percents - Sum of the # of Brand with Generic Available Claims for Top Pharmacies divided by the Sum of the # of Brand |
|with Generic Available Claims for All Pharmacies |
|Averages - Sum of the # of Brand with Generic Available Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Brand with Generic Available Claims for All Pharmacies |
|Averages for All - Sum of the # of Brand with Generic Available Claims for All Pharmacies divided by the # of All |
|Pharmacies |
|% Brand with Generic Available Claims: |
|Averages - Sum of the # of Brand with Generic Available Claims of Top Pharmacies divided by the Sum of the # of Claims |
|for Top Pharmacies |
|Averages for All - Sum of the # of Brand with Generic Available Claims of All Pharmacies divided by the Sum of the # of |
|Claims for All Pharmacies |
|# of Generic Claims: |
|Totals - Count of Generic Claims for Top Pharmacies |
|Percents - Sum of the # of Generic Claims for Top Pharmacies divided by the Sum of the # of Generic Claims for All |
|Pharmacies |
|Averages - Sum of the # of Generic Claims for Top Pharmacies divided by the # of Top Pharmacies |
|Totals For All - Sum of the # of Generic Claims for All Pharmacies |
|Averages for All - Sum of the # of Generic Claims for All Pharmacies divided by the # of All Pharmacies |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Pharmacies divided by the Sum of the # of Claims for Top Pharmacies |
|Averages for All - Sum of the # of Generic Claims of All Pharmacies divided by the Sum of the # of Claims for All |
|Pharmacies |
|Sort Sequence(s): Top Pharmacies by Percentage of Brand Utilization |
|Control Breaks: Rank Top 100 |
|Filters: Brand Drugs priced at AWP - % |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1300 Top Prescribers Ranked by Amount Paid
|Report ID: M1300 |
|Title: Top Prescribers Ranked by Amount Paid |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Prescribers by “Amount Paid”. It includes line item information for the following metrics: Prescriber ID, Prescriber Name, |
|Prescriber Alt ID Type Code, # of Utilizers, # of Claims, Avg # Claims/Utilizer, # of Generic Claims, % Generic Claims, # of Brand Claims, Total Ingr Amount Allowed, Avg Ingr Amount |
|Allowed/Claim, Avg Ingr Amount Allowed/Utilizer, Total Amount Paid, and Avg Amount Paid/Utilizer. |
|NOTE: If a prescriber does not exist in the PDCS database, the Prescriber ID is provided in rank order, but the Prescriber Name does not appear on the report (see rank #28 in the example). |
|Metrics: Rank - Ranking of Provider Prescribers by Amount Paid |
|Prescriber ID - Provider Prescriber ID |
|Prescriber Name - Provider Prescriber Name |
|Prescriber Alt ID Type Code – Source of the Prescriber Alternate ID (only “NM MCD” is accepted). |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Prescriber |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Prescriber |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by # of Unique Utilizers per Provider Prescriber |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers per Provider Prescriber |
|% Generic Claims - # of Generic Claims divided by All Generic Claims per Provider Prescriber |
|# of Brand Claims - Count of Brand Transaction Control Numbers per Provider Prescriber |
|Total Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Prescriber |
|Avg Ingr Amt Allowed/Claim - Sum of Ingr Amt Allowed divided by # of Claims per Provider Prescriber |
|Avg Ingr Amount Allowed/Utilizer - Sum of Ingr Amt Allowed divided by # of Utilizers per Provider Prescriber |
|Total Amount Paid - Amount Paid for the Claim per Provider Prescriber |
|Avg Amount Paid/Utilizer - Amount Paid divided by # of Utilizers per Provider Prescriber |
|Sort Sequence(s): Top Prescribers by Amount Paid |
|Control Breaks: N/A |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1310 Top Prescribers Ranked by Number of Prescriptions
|Report ID: M1310 |
|Title: Top Prescribers Ranked by Number of Prescriptions |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Prescribers by “Number of Prescriptions”. It includes line item information for the following metrics: Prescriber ID, |
|Prescriber Name, # of Utilizers, # of Claims, Avg # Claims/Utilizer, # of Generic Claims, % Generic Claims, # of Brand Claims, Ingr Amount Allowed, Avg Ingr Amount Allowed/Claim, Avg Ingr Amount |
|Allowed/Utilizer, Amount Paid, Avg Amount Paid/Utilizer. The summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Prescribers compared to All Prescribers for |
|each metric. The summary also shows Totals and Averages for All Prescribers for each metric. Statistics from this report may be used to target and monitor prescribing habits to assist with the |
|development of educational initiatives and prescribing behavior modifications programs. |
|Metrics: Rank - Ranking of Provider Prescribers by Number of Prescriptions |
|Prescriber ID - Provider Prescriber ID |
|Prescriber Name - Provider Prescriber Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Prescriber |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Prescriber |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by # of Unique Utilizers per Provider Prescriber |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers per Provider Prescriber |
|% Generic Claims - # of Generic Claims divided by All Generic Claims per Provider Prescriber |
|# of Brand Claims - Count of Brand Transaction Control Numbers per Provider Prescriber |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Prescriber |
|Avg Ingr Amt Allowed/Claim - Sum of Ingr Amt Allowed divided by # of Claims per Provider Prescriber |
|Avg Ingr Amount Allowed/Utilizer - Sum of Ingr Amt Allowed divided by # of Utilizers per Provider Prescriber |
|Amount Paid - Amount Paid for the Claim per Provider Prescriber |
|Avg Amount Paid/Utilizer - Amount Paid divided by # of Utilizers per Provider Prescriber |
|Summaries: |
|Prescriber ID: |
|Totals - Count of Unique Prescriber ID Numbers for Top Prescribers |
|Percents - Count of Unique Prescriber IDs for Top Prescribers divided by the Count of Unique Prescriber IDs for All Prescribers |
|Totals For All - Count of Unique Prescriber IDs for All Prescribers |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Prescribers |
|Percents - Count of Unique Utilizer IDs for Top Prescribers divided by the Count of Unique Utilizer IDs for All Prescribers |
|Averages - Count of Unique Utilizer IDs for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Count of Unique Utilizer IDs for All Prescribers |
|Averages for All - Count of Unique Utilizer IDs for All Prescribers divided by the # of All Prescribers |
|# of Claims: |
|Totals - Count of Claims for Top Prescribers |
|Percents - Sum of the # of Claims for Top Prescribers divided by the Sum of the # of Claims for All Prescribers |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Claims for All Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of All Prescribers |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of Unique Utilizers for All Prescribers |
|# of Generic Claims: |
|Totals - Count of Generic Claims for Top Prescribers |
|Percents - Sum of the # of Generic Claims for Top Prescribers divided by the Sum of the # of Generic Claims for All |
|Prescribers |
|Averages - Sum of the # of Generic Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Generic Claims for All Prescribers |
|Averages for All - Sum of the # of Generic Claims for All Prescribers divided by the # of All Prescribers |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Prescribers divided by the Sum of the # of Claims for Top Prescribers |
|Averages for All - Sum of the # of Generic Claims of All Prescribers divided by the Sum of the # of Claims for All |
|Prescribers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Prescribers |
|Percents - Sum of Ingr Amount Allowed for Top Prescribers divided by Sum of Ingr Amount Allowed for All Prescribers |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Ingr Amount Allowed for All Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by the # of All Prescribers |
|Avg Ingr Amount Allowed/Claim: |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by # of Claims for Top Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by # of Claims for All Prescribers |
|Avg Ingr Amount Allowed/Utilizer: |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by # of Utilizers for Top Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by # of Utilizers for All Prescribers |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Prescribers |
|Percents - Sum of Amount Paid for Top Prescribers divided by Sum of Amount Paid for All Prescribers |
|Averages - Sum of Amount Paid for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Amount Paid for All Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by the # of All Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by # of All Prescribers |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Prescribers divided by # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by # of Unique Utilizers for All Prescribers |
|Sort Sequence(s): Top Prescribers by Number of Prescriptions |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1350 Top Prescribers Ranked by Ingredient Amount Allowed
|Report ID: M1350 |
|Title: Top Prescribers Ranked by Ingredient Amount Allowed |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Prescribers by “Ingredient Amount Allowed”. It includes line item information for the following metrics: Prescriber ID, |
|Prescriber Name, # of Utilizers, # of Claims, # of Generic Claims, # of Brand Claims, Avg Ingr Amount Allowed/Claim, Ingr Amount Allowed, % Generic Claims, Avg # Claims/Utilizer, Avg Ingr Amount |
|Allowed/Utilizer. The summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Prescribers compared to All Prescribers for each metric. The summary also shows |
|Totals and Averages for All Prescribers for each metric. Statistics from this report may be used to target and monitor Prescriber education and prescribing behavior modification programs. |
|Metrics: Rank - Ranking of Provider Prescribers by Ingr Amount Allowed |
|Prescriber ID - Provider Prescriber ID |
|Prescriber Name - Provider Prescriber Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Prescriber |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Prescriber |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by # of Unique Utilizers per Provider Prescriber |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers per Provider Prescriber |
|% Generic Claims - # of Generic Claims divided by # of All Claims per Provider Prescriber |
|# of Brand Claims – Unique Count of Brand Transaction Control Numbers per Provider Prescriber |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Prescriber |
|Avg Ingr Amount Allowed/Claim - Sum of Ingr Amount Allowed divided by # of Claims per Provider Prescriber |
|Avg Ingr Amount Allowed/Utilizer - Sum of Ingr Amount Allowed divided by # of Utilizers per Provider Prescriber |
|Amount Paid - Sum of Amount Paid per Provider Prescriber |
|Avg Amount Paid/Utilizer - Sum of Amount Paid divided by # of Utilizers per Provider Prescriber |
|Summaries: |
|Prescriber ID: |
|Totals - Count of Unique Prescriber ID Numbers for Top Prescribers |
|Percents - Count of Unique Prescriber IDs for Top Prescribers divided by the Count of Unique Prescriber IDs for All Prescribers |
|Totals For All - Count of Unique Prescriber IDs for All Prescribers |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Prescribers |
|Percents - Count of Unique Utilizer IDs for Top Prescribers divided by the Count of Unique Utilizer IDs for All Prescribers |
|Averages - Count of Unique Utilizer IDs for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Count of Unique Utilizer IDs for All Prescribers |
|Averages for All - Count of Unique Utilizer IDs for All Prescribers divided by the # of All Prescribers |
|# of Claims: |
|Totals - Count of Claims for Top Prescribers |
|Percents - Sum of the # of Claims for Top Prescribers divided by the Sum of the # of Claims for All Prescribers |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Claims for All Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of All Prescribers |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of Unique Utilizers for All Prescribers |
|# of Generic Claims: |
|Totals - Count of Generic Claims for Top Prescribers |
|Percents - Sum of the # of Generic Claims for Top Prescribers divided by the Sum of the # of Generic Claims for All |
|Prescribers |
|Averages - Sum of the # of Generic Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Generic Claims for All Prescribers |
|Averages for All - Sum of the # of Generic Claims for All Prescribers divided by the # of All Prescribers |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Prescribers divided by the Sum of the # of Claims for Top Prescribers |
|Averages for All - Sum of the # of Generic Claims of All Prescribers divided by the Sum of the # of Claims for All |
|Prescribers |
|# of Brand Claims: |
|Totals - Count of Brand Transaction Control Number for Top Prescribers |
|Percents - Sum of the # of Brand Claims for Top Prescribers divided by Sum of the # of Brand Claims for All Prescribers |
| |
|Averages - Sum of the # of Brand Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Brand Claims for All Prescribers |
|Averages for All - Sum of the # of Brand Claims for All Prescribers divided by the # of All Prescribers Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Prescribers |
|Percents - Sum of Ingr Amount Allowed for Top Prescribers divided by Sum of Ingr Amount Allowed for All Prescribers |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Ingr Amount Allowed for All Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by the # of All Prescribers |
|Avg Ingr Amount Allowed/Claim: |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by the # of Claims for Top Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by the # of Claims for All Prescribers |
|Avg Ingr Amount Allowed/Utilizer: |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by the # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by the # of Unique Utilizers for All Prescribers |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Prescribers |
|Percents - Sum of Amount Paid for Top Prescribers divided by the Sum of Amount Paid for All Prescribers |
|Averages - Sum of Amount Paid for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Amount Paid for All Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by the # of All Prescribers |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Prescribers divided by the # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by the # of Unique Utilizers for All Prescribers |
|Sort Sequence(s): Top Prescribers Ranked by Ingr Amount Allowed |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1360 Top Prescribers Ranked by Average Amount Paid per Prescription
|Report ID: M1360 |
|Title: Top Prescribers Ranked by Average Amount Paid per Prescription |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Prescribers by “Average Amount Paid per Prescription”. It includes line item information for the following metrics: Prescriber |
|ID, Prescriber Name, # of Utilizers, # of Claims, Avg # Claims/Utilizer, Ingr Amount Submitted, Amount Paid, Avg Amount Paid/Claim, Avg Amount Paid/Utilizer. The summary at the bottom of the |
|report shows Subtotals, Percents and Averages of the Top Prescribers compared to All Prescribers for each metric. The summary also shows Totals and Averages for All Prescribers for each metric. |
|Statistics from this report may be used to target and monitor Prescriber education and prescribing behavior modifications. |
|Metrics: Rank - Ranking of Provider Prescribers Average Amount Paid per Prescription |
|Prescriber ID - Provider Prescriber ID |
|Prescriber Name - Provider Prescriber Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Prescriber |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Prescriber |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by the # of Unique Utilizers per Provider Prescriber |
|Submitted Ingr Amount - Sum of the Submitted Ingr Costs from the Pharmacies per Provider Prescriber |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Prescriber |
|Amount Paid - Sum of Amount Paid by the Client per Provider Prescriber |
|Avg Amount Paid/Claim - Sum of Amount Paid divided by the Sum of the # of Claims per Provider Prescriber |
|Avg Amount Paid/Utilizer – Sum of Amount Paid divided by # of Unique Utilizers per Provider Prescriber |
|Summaries: |
|Prescriber ID: |
|Totals - Count of Unique Prescriber ID Numbers for Top Prescribers |
|Percents - Count of Unique Prescriber IDs for Top Prescribers divided by the Count of Unique Prescriber IDs for All Prescribers |
|Totals For All - Count of Unique Prescriber IDs for All Prescribers |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Prescribers |
|Percents - Count of Unique Utilizer IDs for Top Prescribers divided by the Count of Unique Utilizer IDs for All Prescribers |
|Averages - Count of Unique Utilizer IDs for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Count of Unique Utilizer IDs for All Prescribers |
|Averages for All - Count of Unique Utilizer IDs for All Prescribers divided by the # of All Prescribers |
|# of Claims: |
|Totals - Count of Claims for Top Prescribers |
|Percents - Sum of the # of Claims for Top Prescribers divided by the Sum of the # of Claims for All Prescribers |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Claims for All Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of All Prescribers |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of Unique Utilizers for All Prescribers |
|Ingr Amount Submitted: |
|Totals - Sum of Ingr Amount Submitted for Top Prescribers |
|Percents - Sum of Ingr Amount Submitted for Top Prescribers divided by Sum of Ingr Amount Submitted for All Prescribers |
|Averages - Sum of Ingr Amount Submitted for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Ingr Amount Submitted for All Prescribers |
|Averages for All - Sum of Ingr Amount Submitted for All Prescribers divided by the # of All Prescribers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Prescribers |
|Percents - Sum of Ingr Amount Allowed for Top Prescribers divided by Sum of Ingr Amount Allowed for All Prescribers |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Ingr Amount Allowed for All Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by the # of All Prescribers |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Prescribers |
|Percents - Sum of Amount Paid for Top Prescribers divided by Sum of Amount Paid for All Prescribers |
|Averages - Sum of Amount Paid for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Amount Paid for All Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by the # of All Prescribers |
|Avg Amount Paid/Claim: |
|Averages - Sum of Amount Paid for Top Prescribers divided by Sum of the # of Claims for Top Prescribers |
|Averages for All - Sum of Amount Paid for Top Prescribers divided by Sum of the # of Claims for All Prescribers |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Prescribers divided by # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by # of Unique Utilizers for All Prescribers |
|Sort Sequence(s): Top Prescribers Ranked by Average Amount Paid per Prescription |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1380 Top Prescribers with Top Therapeutic Class Ranked by Amount Paid
|Report ID: M1380 |
|Title: Top Prescribers with Top Therapeutic Class Ranked by Amount Paid |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Prescribers and reports metrics on the Top Therapeutic Classes by “Amount Paid per Prescription”. It includes line item |
|information for the following metrics: Therapeutic Class Code Description, Therapeutic Class Code, # of Utilizers, # of Claims, Avg # Claims/Utilizer, Ingr Amount Submitted, Ingr Amount Allowed,|
|Amount Paid, Avg Amount Paid/Claim, and Avg Amount Paid/Utilizer. The summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Prescribers compared to All |
|Prescribers for each metric. The summary also shows Totals and Averages for All Prescribers for each metric. Statistics from this report may be used to target possible Prescriber outliers which|
|may represent over utilization of state resources. This report shows the Top 25 Therapeutic Classes across All Prescribers by “Amount Paid” and targets the Top 25 Prescribers, displaying the |
|activity within those classes. |
|Metrics: Rank - Ranking of Top 25 Prescribers by Total Amount Paid for All Claims (Ranked by Amount Paid for Claims in the Top 25 Therapeutic Classes |
|Prescriber Name - Provider Prescriber Name |
|Prescriber ID - Provider Prescriber ID - from drug claim in NCPDP format |
|Amount Paid per Prescriber - Amount Paid for claims in the Top 25 Therapeutic Classes (Ranked by Amount Paid) |
|Therapeutic Class Description - Description of each Therapeutic Class Code |
|Therapeutic Class Code - Therapeutic Class Code groups drugs according to their most common intended use |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Prescriber |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Prescriber |
|Avg # Claims/Utilizer - Sum of the # of Claims divided by the # of Unique Utilizers per Provider Prescriber |
|Submitted Ingr Amount - Sum of the Submitted Ingr Costs from the Pharmacies per Provider Prescriber |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Prescriber |
|Amount Paid/Therapeutic Class - Sum of Amount Paid for each of the “Top 25 Therapeutic Classes” per Provider Prescriber |
|Avg Amount Paid/Claim – Sum of Amount Paid divided by # of Claims per Provider Prescriber |
|Avg Amount Paid/Utilizer - Sum of Amount Paid divided by # of Utilizers per Provider Prescriber |
|Summaries: |
|Prescriber ID: |
|Totals - Count of Unique Prescriber ID Numbers for Top Prescribers |
|Percents - Count of Unique Prescriber IDs for Top Prescribers divided by the Count of Unique Prescriber IDs for All Prescribers |
|Totals For All - Count of Unique Prescriber IDs for All Prescribers |
|# of Therapeutic Classes: |
|Totals - Count of Therapeutic Class in the “Top 25” with Claims |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Prescribers |
|Percents - Count of Unique Utilizer IDs for Top Prescribers divided by the Count of Unique Utilizer IDs for All Prescribers |
|Averages - Count of Unique Utilizer IDs for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Count of Unique Utilizer IDs for All Prescribers |
|Averages for All - Count of Unique Utilizer IDs for All Prescribers divided by the # of All Prescribers |
|# of Claims: |
|Totals - Count of Claims for Top Prescribers |
|Percents - Sum of the # of Claims for Top Prescribers divided by the Sum of the # of Claims for All Prescribers |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Claims for All Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of All Prescribers |
|Avg # Claims/Utilizer: |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of Unique Utilizers for All Prescribers |
|Ingr Amount Submitted: |
|Totals - Sum of Ingr Amount Submitted for Top Prescribers |
|Percents - Sum of Ingr Amount Submitted for Top Prescribers divided by Sum of Ingr Amount Submitted for All Prescribers |
|Averages - Sum of Ingr Amount Submitted for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Ingr Amount Submitted for All Prescribers |
|Averages for All - Sum of Ingr Amount Submitted for All Prescribers divided by the # of All Prescribers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Prescribers |
|Percents - Sum of Ingr Amount Allowed for Top Prescribers divided by Sum of Ingr Amount Allowed for All Prescribers |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Ingr Amount Allowed for All Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by the # of All Prescribers |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Prescribers |
|Percents - Sum of Amount Paid for Top Prescribers divided by Sum of Amount Paid for All Prescribers |
|Averages - Sum of Amount Paid for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Amount Paid for All Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by the # of All Prescribers |
|Avg Amount Paid/Claim: |
|Averages - Sum of Amount Paid for Top Prescribers divided by # of Claims for Top Prescribers |
|Averages for All - Sum of Amount Paid for Top Prescribers divided by # of Claims for All Prescribers |
|Avg Amount Paid/Utilizer: |
|Averages - Sum of Amount Paid for Top Prescribers divided by # of Unique Utilizers for Top Prescribers |
|Averages for All - Sum of Amount Paid for All Prescribers divided by # of Unique Utilizers for All Prescribers |
|Sort Sequence(s): Top 25 Prescribers by Total Amount Paid / Top 25 Therapeutic Classes by Total Amount Paid |
|Control Breaks: Rank Top 25 |
|Filters: N/A |
|Notes: Only metrics for claims in Top 25 Therapeutic Classes are shown for each of the Top 25 Prescribers. Note that not all |
|Prescribers have claims in all 25 Therapeutic Classes. |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1390 Top Prescribers Ranked by Percentage of Brand Utilization
|Report ID: M1390 |
|Title: Top Prescribers Ranked by Percentage of Brand Utilization |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Prescribers by “Percentage of Brand Utilization”. It includes line item information for the following metrics: Prescriber ID, |
|Prescriber Name, # of Utilizers, # of Claims, Ingr Amount Allowed, # of Brand Claims, % of Brand Claims, # of Brand with Generic Available Claims, % of Brand with Generic Available Claims, # |
|Generic Claims, % Generic Claims. The summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Prescribers compared to All Prescribers for each metric. The summary |
|shows Totals and Averages for All Prescribers for each metric. This report includes only the drugs what were priced by AWP Pricing Programs to eliminate brand drugs that were paid by generic |
|pricing algorithms. This report helps identify Prescriber outliers of excessive brand utilization. |
|Metrics: Rank - Ranking of Provider Prescribers by Percentage of Brand Utilization |
|Prescriber ID - Provider Prescriber ID - from drug claim in NCPDP format |
|Prescriber Name - Provider Prescriber Name |
|# of Utilizers - Unique Count of Utilizer IDs per Provider Prescriber |
|# of Claims - Unique Count of Transaction Control Numbers per Provider Prescriber |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Provider Prescriber |
|# of Brand Claims - Unique Count of Brand Transaction Control Numbers per Provider Prescriber |
|% of Brand Claims - # of Brand Claims divided by the # of Claims |
|# of Brand with Generic Available Claims - Count of Brand with Generic Available Transaction Control Numbers per Provider Prescriber |
|% of Brand with Generic Available Claims - # of Brand with Generic Available Claims divided by the # of Claims |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers |
|% Generic Claims - # of Generic Claims divided by the # of Claims per Provider Prescriber |
|Summaries: |
|Prescriber ID: |
|Totals - Count of Unique Prescriber ID Numbers for Top Prescribers |
|Percents - Count of Unique Prescriber IDs for Top Prescribers divided by the Count of Unique Prescriber IDs for All Prescribers |
|Totals For All - Count of Unique Prescriber IDs for All Prescribers |
|# of Utilizers: |
|Totals - Count of Unique Utilizer IDs for Top Prescribers |
|Percents - Count of Unique Utilizer IDs for Top Prescribers divided by the Count of Unique Utilizer IDs for All Prescribers |
|Averages - Count of Unique Utilizer IDs for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Count of Unique Utilizer IDs for All Prescribers |
|Averages for All - Count of Unique Utilizer IDs for All Prescribers divided by the # of All Prescribers |
|# of Claims: |
|Totals - Count of Claims for Top Prescribers |
|Percents - Sum of the # of Claims for Top Prescribers divided by the Sum of the # of Claims for All Prescribers |
|Averages - Sum of the # of Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Claims for All Prescribers |
|Averages for All - Sum of the # of Claims for All Prescribers divided by the # of All Prescribers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Prescribers |
|Percents - Sum of Ingr Amount Allowed for Top Prescribers divided by Sum of Ingr Amount Allowed for All Prescribers |
|Averages - Sum of Ingr Amount Allowed for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of Ingr Amount Allowed for All Prescribers |
|Averages for All - Sum of Ingr Amount Allowed for All Prescribers divided by the # of All Prescribers |
|# of Brand Claims: |
|Totals - Count of Brand Claims for Top Prescribers |
|Percents - Sum of the # of Brand Claims for Top Prescribers divided by the Sum of the # of Brand Claims for All |
|Prescribers |
|Averages - Sum of the # of Brand Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Brand Claims for All Prescribers |
|Averages for All - Sum of the # of Brand Claims for All Prescribers divided by the # of All Prescribers |
|% Brand Claims: |
|Averages - Sum of the # of Brand Claims of Top Prescribers divided by the Sum of the # of Claims for Top Prescribers |
|Averages for All - Sum of the # of Brand Claims of All Prescribers divided by the Sum of the # of Claims for All |
|Prescribers |
|# of Brand with Generic Available Claims: |
|Totals - Count of Brand with Generic Available Claims for Top Prescribers |
|Percents - Sum of the # of Brand with Generic Available Claims for Top Prescribers divided by the Sum of the # of Brand |
|with Generic Available Claims for All Prescribers |
|Averages - Sum of the # of Brand with Generic Available Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Brand with Generic Available Claims for All Prescribers |
|Averages for All - Sum of the # of Brand with Generic Available Claims for All Prescribers divided by the # of All |
|Prescribers |
|% Brand with Generic Available Claims: |
|Averages - Sum of the # of Brand with Generic Available Claims of Top Prescribers divided by the Sum of the # of Claims |
|for Top Prescribers |
|Averages for All - Sum of the # of Brand with Generic Available Claims of All Prescribers divided by the Sum of the # of |
|Claims for All Prescribers |
|# of Generic Claims: |
|Totals - Count of Generic Claims for Top Prescribers |
|Percents - Sum of the # of Generic Claims for Top Prescribers divided by the Sum of the # of Generic Claims for All |
|Prescribers |
|Averages - Sum of the # of Generic Claims for Top Prescribers divided by the # of Top Prescribers |
|Totals For All - Sum of the # of Generic Claims for All Prescribers |
|Averages for All - Sum of the # of Generic Claims for All Prescribers divided by the # of All Prescribers |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Prescribers divided by the Sum of the # of Claims for Top Prescribers |
|Averages for All - Sum of the # of Generic Claims of All Prescribers divided by the Sum of the # of Claims for All |
|Prescribers |
|Sort Sequence(s): Top Prescribers by Percentage of Brand Utilization |
|Control Breaks: Rank Top 100 |
|Filters: Brand Drugs priced at AWP - % |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1400 Top Utilizers Ranked by Amount Paid
|Report ID: M1400 |
|Title: Top Utilizers Ranked by Amount Paid |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Utilizers by “Amount Paid”. It includes line item information for the following metrics: Utilizer ID, Utilizer Name, and # of |
|Claims, # of Brand Claims, # of Generic Claims, % Generic Claims, Avg Ingr Amount Allowed/Claim, Ingr Amount Allowed, and Amount Paid. The summary at the bottom of the report shows Subtotals, |
|Percents and Averages of the Top Utilizers compared to All Utilizers for each metric. The summary also shows Totals and Averages for All Utilizers for each metric. This report can be used to |
|identify and target outlier Utilizers for cost avoidance initiatives or clinical interventions. |
|Metrics: Rank - Ranking of Utilizers by Amount Paid |
|Utilizer ID - Utilizer ID |
|Utilizer Name - Utilizer First and Last Name |
|# of Claims - Unique Count of Transaction Control Numbers per Utilizer |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers per Utilizer |
|% Generic Claims - Sum of the # of Generic Claims divided by the Sum of the # of Claims per Utilizer |
|# of Brand Claims - Unique Count of Brand Transaction Control Numbers per Utilizer |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Utilizer |
|Avg Ingr Amount Allowed/Claim - Sum of Ingr Amount Allowed divided by the Sum of the # of Claims per Utilizer |
|Amount Paid - Sum of Amount Paid by the Client per Utilizer |
|Summaries: |
|Utilizer ID: |
|Totals - Count of Unique Utilizer ID Numbers for Top Utilizers |
|Percents - Count of Unique Utilizer IDs for Top Utilizers divided by the Count of Unique Utilizer IDs for All Utilizers |
|Totals For All - Count of Unique Utilizer IDs for All Utilizers |
|# of Claims: |
|Totals - Count of Claims for Top Utilizers |
|Percents - Sum of the # of Claims for Top Utilizers divided by the Sum of the # of Claims for All Utilizers |
|Averages - Sum of the # of Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Claims for All Utilizers |
|Averages for All - Sum of the # of Claims for All Utilizers divided by the Unique # of All Utilizers |
|# of Generic Claims: |
|Totals - Count # of Generic Claims for Top Utilizers |
|Percents - Sum of the # of Generic Claims for Top Utilizers divided by the Sum of the # of Generic Claims for All Utilizers |
|Averages - Sum of the # of Generic Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Generic Claims for All Utilizers |
|Averages for All - Sum of the # of Generic Claims for All Utilizers divided by the Unique # of All Utilizers |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Utilizers divided by the Sum of the # of Claims for Top Utilizers |
|Averages for All - Sum of the # of Generic Claims for All Utilizers divided by the Sum of the # of Claims for All Utilizers |
|# of Brand Claims: |
|Totals - Count # of Brand Claims for Top Utilizers |
|Percents - Sum of the # of Brand Claims for Top Utilizers divided by the Sum of the # of Brand Claims for All Utilizers |
|Averages - Sum of the # of Brand Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Brand Claims for All Utilizers |
|Averages for All - Sum of the # of Brand Claims for All Utilizers divided by the Unique # of All Utilizers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Utilizers |
|Percents - Sum of Ingr Amount Allowed for Top Utilizers divided by Sum of Ingr Amount Allowed for All Utilizers |
|Averages - Sum of Ingr Amount Allowed for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of Ingr Amount Allowed for All Utilizers |
|Averages for All - Sum of Ingr Amount Allowed for All Utilizers divided by the Unique # of All Utilizers |
|Avg Ingr Amount Allowed/Claim: |
|Averages - Sum of Ingr Amount Allowed for Top Utilizers divided by # of Claims for Top Utilizers |
|Averages for All - Sum of Ingr Amount Allowed for All Utilizers divided by # of Claims for All Utilizers |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Utilizers |
|Percents - Sum of Amount Paid for Top Utilizers divided by Sum of Amount Paid for All Utilizers |
|Averages - Sum of Amount Paid for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of Amount Paid for All Utilizers |
|Averages for All - Sum of Amount Paid for All Utilizers divided by the Unique # of All Utilizers |
|Sort Sequence(s): Top Utilizers Ranked by Amount Paid |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1410 Top Utilizers Ranked by Number of Prescriptions
|Report ID: M1410 |
|Title: Top Utilizers Ranked by Number of Prescriptions |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Utilizers by “Number of Prescriptions”. It includes line item information for the following metrics: Utilizer ID, Utilizer |
|Name, and # of Claims, # of Brand Claims, # of Generic Claims, % Generic Claims, Avg Ingr Amount Allowed/Claim, Ingr Amount Allowed, and Amount Paid. The summary at the bottom of the report |
|shows Subtotals, Percents and Averages of the Top Utilizers compared to All Utilizers for each metric. The summary also shows Totals and Averages for All Utilizers for each metric. This report |
|can be used to identify and target outlier Utilizers for cost avoidance initiatives or clinical interventions. |
|Metrics: Rank - Ranking of Utilizers by Number of Prescriptions |
|Utilizer ID - Utilizer ID |
|Utilizer Name - Utilizer First and Last Name |
|# of Claims - Unique Count of Transaction Control Numbers per Utilizer |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers per Utilizer |
|% Generic Claims - Sum of the # of Generic Claims divided by the Sum of the # of Claims per Utilizer |
|# of Brand Claims - Unique Count of Brand Transaction Control Numbers per Utilizer |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Utilizer |
|Avg Ingr Amount Allowed/Claim - Sum of Ingr Amount Allowed divided by the Sum of the # of Claims per Utilizer |
|Amount Paid - Sum of Amount Paid by the Client per Utilizer |
|Summaries: |
|Utilizer ID: |
|Totals - Count of Unique Utilizer ID Numbers for Top Utilizers |
|Percents - Count of Unique Utilizer IDs for Top Utilizers divided by the Count of Unique Utilizer IDs for All Utilizers |
|Totals For All - Count of Unique Utilizer IDs for All Utilizers |
|# of Claims: |
|Totals - Count of Claims for Top Utilizers |
|Percents - Sum of the # of Claims for Top Utilizers divided by the Sum of the # of Claims for All Utilizers |
|Averages - Sum of the # of Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Claims for All Utilizers |
|Averages for All - Sum of the # of Claims for All Utilizers divided by the Unique # of All Utilizers |
|# of Generic Claims: |
|Totals - Count # of Generic Claims for Top Utilizers |
|Percents - Sum of the # of Generic Claims for Top Utilizers divided by the Sum of the # of Generic Claims for All Utilizers |
|Averages - Sum of the # of Generic Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Generic Claims for All Utilizers |
|Averages for All - Sum of the # of Generic Claims for All Utilizers divided by the Unique # of All Utilizers |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Utilizers divided by the Sum of the # of Claims for Top Utilizers |
|Averages for All - Sum of the # of Generic Claims for All Utilizers divided by the Sum of the # of Claims for All Utilizers |
|# of Brand Claims: |
|Totals - Count # of Brand Claims for Top Utilizers |
|Percents - Sum of the # of Brand Claims for Top Utilizers divided by the Sum of the # of Brand Claims for All Utilizers |
|Averages - Sum of the # of Brand Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Brand Claims for All Utilizers |
|Averages for All - Sum of the # of Brand Claims for All Utilizers divided by the Unique # of All Utilizers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Utilizers |
|Percents - Sum of Ingr Amount Allowed for Top Utilizers divided by Sum of Ingr Amount Allowed for All Utilizers |
|Averages - Sum of Ingr Amount Allowed for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of Ingr Amount Allowed for All Utilizers |
|Averages for All - Sum of Ingr Amount Allowed for All Utilizers divided by the Unique # of All Utilizers |
|Avg Ingr Amount Allowed/Claim: |
|Averages - Sum of Ingr Amount Allowed for Top Utilizers divided by # of Claims for Top Utilizers |
|Averages for All - Sum of Ingr Amount Allowed for All Utilizers divided by # of Claims for All Utilizers |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Utilizers |
|Percents - Sum of Amount Paid for Top Utilizers divided by Sum of Amount Paid for All Utilizers |
|Averages - Sum of Amount Paid for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of Amount Paid for All Utilizers |
|Averages for All - Sum of Amount Paid for All Utilizers divided by the Unique # of All Utilizers |
|Sort Sequence(s): Top Utilizers Ranked by Number of Prescriptions |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1460 Top Utilizers Ranked by Average Amount Paid per Prescription
|Report ID: M1460 |
|Title: Top Utilizers Ranked by Average Amount Paid per Prescription |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Utilizers by “Average Amount Paid per Prescription”. It includes line item information for the following metrics: Utilizer ID, |
|First Name, Last Name, and # of Claims, # of Brand Claims, # of Generic Claims, % Generic Claims, Avg Ingr Amount Allowed/Claim, Ingr Amount Allowed, Amount Paid, and Avg Amount Paid/Claim. The |
|summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Utilizers compared to All Utilizers for each metric. The summary also shows Totals and Averages for All |
|Utilizers for each metric. |
|Metrics: Rank - Ranking of Utilizers by Average Amount Paid per Prescription |
|Utilizer ID - Utilizer ID |
|Utilizer Name - Utilizer First and Last Name |
|# of Claims - Unique Count of Transaction Control Numbers |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers |
|% Generic Claims - # of Generic Claims divided by the # of All Generic Claims |
|# of Brand Claims - Unique Count of Brand Transaction Control Numbers |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) |
|Avg Ingr Amount Allowed/Claim - Sum of Ingr Amount Allowed divided by # of Claims |
|Amount Paid - Sum of Amount Paid for the Claim |
|Avg Amount Paid/Claim - Sum of Amount Paid divided by # of Claims |
|Summaries: |
|Utilizer ID: |
|Totals - Count of Unique Utilizer ID Numbers for Top Utilizers |
|Percents - Count of Unique Utilizer IDs for Top Utilizers divided by the Count of Unique Utilizer IDs for All Utilizers |
|Totals For All - Count of Unique Utilizer IDs for All Utilizers |
|# of Claims: |
|Totals - Count of Claims for Top Utilizers |
|Percents - Sum of the # of Claims for Top Utilizers divided by the Sum of the # of Claims for All Utilizers |
|Averages - Sum of the # of Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Claims for All Utilizers |
|Averages for All - Sum of the # of Claims for All Utilizers divided by the Unique # of All Utilizers |
|# of Generic Claims: |
|Totals - Count # of Generic Claims for Top Utilizers |
|Percents - Sum of the # of Generic Claims for Top Utilizers divided by the Sum of the # of Generic Claims for All Utilizers |
|Averages - Sum of the # of Generic Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Generic Claims for All Utilizers |
|Averages for All - Sum of the # of Generic Claims for All Utilizers divided by the Unique # of All Utilizers |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Utilizers divided by the Sum of the # of Claims for Top Utilizers |
|Averages for All - Sum of the # of Generic Claims for All Utilizers divided by the Sum of the # of Claims for All Utilizers |
|# of Brand Claims: |
|Totals - Count # of Brand Claims for Top Utilizers |
|Percents - Sum of the # of Brand Claims for Top Utilizers divided by the Sum of the # of Brand Claims for All Utilizers |
|Averages - Sum of the # of Brand Claims for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of the # of Brand Claims for All Utilizers |
|Averages for All - Sum of the # of Brand Claims for All Utilizers divided by the Unique # of All Utilizers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Utilizers |
|Percents - Sum of Ingr Amount Allowed for Top Utilizers divided by Sum of Ingr Amount Allowed for All Utilizers |
|Averages - Sum of Ingr Amount Allowed for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of Ingr Amount Allowed for All Utilizers |
|Averages for All - Sum of Ingr Amount Allowed for All Utilizers divided by the Unique # of All Utilizers |
|Avg Ingr Amount Allowed/Claim: |
|Averages - Sum of Ingr Amount Allowed for Top Utilizers divided by # of Claims for Top Utilizers |
|Averages for All - Sum of Ingr Amount Allowed for All Utilizers divided by # of Claims for All Utilizers |
|Amount Paid: |
|Totals - Sum of Amount Paid for Top Utilizers |
|Percents - Sum of Amount Paid for Top Utilizers divided by Sum of Amount Paid for All Utilizers |
|Averages - Sum of Amount Paid for Top Utilizers divided by the Unique # of Top Utilizers |
|Totals For All - Sum of Amount Paid for All Utilizers |
|Averages for All - Sum of Amount Paid for All Utilizers divided by the Unique # of All Utilizers |
|Avg Amount Paid/Claim: |
|Averages - Sum of Amount Paid for Top Utilizers divided by Sum of the # of Claims for Top Utilizers |
|Averages for All - Sum of Amount Paid for Top Utilizers divided by Sum of the # of Claims for All Utilizers |
|Sort Sequence(s): Top Utilizers Ranked by Average Amount Paid per Prescription |
|Control Breaks: Rank Top 100 |
|Filters: N/A |
|Notes: N/A |
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NEW MEXICO PRESCRIPTION DRUG CLAIM SYSTEM
REPORT SPECIFICATION
M1490 Top Utilizers Ranked by Percentage of Brand Utilization
|Report ID: M1490 |
|Title: Top Utilizers Ranked by Percentage of Brand Utilization |
|Frequency: Monthly |
|Source: OS PLUS Oracle DSS Warehouse; report generated via Business Objects |
|Description: This report provides a ranking of the Top Utilizers by “Percentage of Brand Utilization”. It includes line item information for the following metrics: Utilizer ID, Last |
|Name, First Name, # of Utilizers, # of Utilizers, # of Claims, Ingr Amount Allowed, # of Brand Claims, % Brand Claims, # of Brand with Generic Available Claims, % of Brand with Generic Available |
|Claims, # of Generic Claims, % Generic Claims. The summary at the bottom of the report shows Subtotals, Percents and Averages of the Top Utilizers compared to All Utilizers for each metric. The|
|summary also shows Totals and Averages for All Utilizers for each metric. |
|Metrics: Utilizer ID - Utilizer ID |
|Utilizer Name - Utilizer First and Last Name |
|# of Claims - Unique Count of Transaction Control Numbers per Utilizer |
|Ingr Amount Allowed - Sum of Allowed Ingr Amount (Lesser of Submitted Ingr Amount or Calculated Ingr Amount Allowed by Pricing Program) per Utilizer |
|# of Brand Claims - Unique Count of Brand Transaction Control Numbers per Utilizer |
|% of Brand Claims - # of Brand Claims divided by the # of Claims per Utilizer |
|# of Brand with Generic Available Claims - Count of Brand with Generic Available Transaction Control Numbers / Utilizer |
|% of Brand with Generic Available Claims - # of Brand with Generic Available Claims divided by the # of Claims / Utilizer |
|# of Generic Claims - Unique Count of Generic Transaction Control Numbers per Utilizer |
|% Generic Claims - # of Generic Claims divided by the # of Claims per Utilizer |
|Summaries: |
|Utilizer ID: |
|Totals - Count of Unique Utilizer ID Numbers for Top Utilizers |
|Percents - Count of Unique Utilizer IDs for Top Utilizers divided by the Count of Unique Utilizer IDs for All Utilizers |
|Totals For All - Count of Unique Utilizer IDs for All Utilizers |
|# of Claims: |
|Totals - Count of Claims for Top Utilizers |
|Percents - Sum of the # of Claims for Top Utilizers divided by the Sum of the # of Claims for All Utilizers |
|Averages - Sum of the # of Claims for Top Utilizers divided by the # of Top Utilizers |
|Totals For All - Sum of the # of Claims for All Utilizers |
|Averages for All - Sum of the # of Claims for All Utilizers divided by the # of All Utilizers |
|Ingr Amount Allowed: |
|Totals - Sum of Ingr Amount Allowed for Top Utilizers |
|Percents - Sum of Ingr Amount Allowed for Top Utilizers divided by Sum of Ingr Amount Allowed for All Utilizers |
|Averages - Sum of Ingr Amount Allowed for Top Utilizers divided by the # of Top Utilizers |
|Totals For All - Sum of Ingr Amount Allowed for All Utilizers |
|Averages for All - Sum of Ingr Amount Allowed for All Utilizers divided by the # of All Utilizers |
|# of Brand Claims: |
|Totals - Count of Brand Claims for Top Utilizers |
|Percents - Sum of the # of Brand Claims for Top Utilizers divided by the Sum of the # of Brand Claims for All Utilizers |
|Averages - Sum of the # of Brand Claims for Top Utilizers divided by the # of Top Utilizers |
|Totals For All - Sum of the # of Brand Claims for All Utilizers |
|Averages for All - Sum of the # of Brand Claims for All Utilizers divided by the # of All Utilizers |
|% Brand Claims: |
|Averages - Sum of the # of Brand Claims of Top Utilizers divided by the Sum of the # of Claims for Top Utilizers |
|Averages for All - Sum of the # of Brand Claims of All Utilizers divided by the Sum of the # of Claims for All Utilizers |
|# of Brand with Generic Available Claims: |
|Totals - Count of Brand with Generic Available Claims for Top Utilizers |
|Percents - Sum of the # of Brand with Generic Available Claims for Top Utilizers divided by the Sum of the # of Brand |
|with Generic Available Claims for All Utilizers |
|Averages - Sum of the # of Brand with Generic Available Claims for Top Utilizers divided by the # of Top Utilizers |
|Totals For All - Sum of the # of Brand with Generic Available Claims for All Utilizers |
|Averages for All - Sum of the # of Brand with Generic Available Claims for All Utilizers divided by the # of All Utilizers |
|% Brand with Generic Available Claims: |
|Averages - Sum of the # of Brand with Generic Available Claims of Top Utilizers divided by the Sum of the # of Claims |
|for Top Utilizers |
|Averages for All - Sum of the # of Brand with Generic Available Claims of All Utilizers divided by the Sum of the # of |
|Claims for All Utilizers |
|# of Generic Claims: |
|Totals - Count of Generic Claims for Top Utilizers |
|Percents - Sum of the # of Generic Claims for Top Utilizers divided by the Sum of the # of Generic Claims for All Utilizers |
|Averages - Sum of the # of Generic Claims for Top Utilizers divided by the # of Top Utilizers |
|Totals For All - Sum of the # of Generic Claims for All Utilizers |
|Averages for All - Sum of the # of Generic Claims for All Utilizers divided by the # of All Utilizers |
|% Generic Claims: |
|Averages - Sum of the # of Generic Claims of Top Utilizers divided by the Sum of the # of Claims for Top Utilizers |
|Averages for All - Sum of the # of Generic Claims of All Utilizers divided by the Sum of the # of Claims for All Utilizers |
|Sort Sequence(s): Top Utilizers Ranked by Percentage of Brand Utilization |
|Control Breaks: Rank Top 100 |
|Filters: Brand Drugs priced at AWP - % |
|Notes: N/A |
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