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CITY OF DECATUR
<br /> SUMMARY PRICING AND NETWORK IDENTIFICATION
<br /> BROKER Mercer Clemens Consociate Consociate Behnke Behnke
<br /> THIRD PARTYADMINISTRATOR Cypress Benefit Heaith Alliance Consociate Consociate Blue Cross Personai Care '
<br /> Rx BENEFIT MANAGER Partners Rx Medlmpact Script Care Ltd. Express Scripts Prime Therapeutics Medco Health
<br /> Claims Administration $94,464.00 $141,302.40 $74,784.00 $74,784.00 $363,214.08 $180,662.40 L
<br /> BrokerFee notresponsive(%ofcost) $19,680.00 N/C N/C $49,672.32 $23,616.00
<br /> PPO Access Fee $62,976.00 INC $35,424.00 535,424.00 $64,680.00 INC
<br /> Utilization Review $19,680.00 INC $11,020.80 $11,020.80 INC INC �
<br /> Repricing Fee $1,968.00 unknown(%of savings) INC INC INC INC
<br /> Health Information Line INC INC $8,659.20 $8,659.20 INC INC
<br /> Large Case Management unknown(per hour) INC unknown(per hour) unknown(per hour) INC INC
<br /> Disease Management based on need INC $17,712.00 $17,712.00 INC $4,880.64
<br /> Lifestyle Management based on need $6,927.36 unknown
<br /> (per participant) unknown(per participant) INC INC
<br /> Implementation Cost $0.00 $1,500.00 $5,000.00 $5,000.00 INC INC
<br /> Employee Materials at cost at cost at cost at cost INC INC
<br /> Fixed Medical Fees $179,088.00 $169,409.76 $152,600.00 $152,600.00 $477,566.40 $209,159.04
<br /> Rx Administration Fees $33,975.15 $56,57331 $32,945.60 $30,117.70 INC $36,491.40
<br /> Total Fees $213,063.15 $225,983.07 $185,545.60 $182,717.70 $477,566.40 $245,650.44
<br /> Rx Rebate -$57,856.90 -$118,849.30 -$74,555.00 -$106,784.50 -$95,644.80 INC
<br /> Net Proposed Fees $155,206.25 5107,133.77 $110,990.60 $75,933.20 $381,921.60 $245,650.44
<br /> Vendors Response From Claims Repricing
<br /> on S00 Medical Claims
<br /> Allowed Amount from Vendors Response $49,148.00 $60,378.61 $52,459.74 552,459.74 $39,312.10 $36,060.52
<br /> %Difference of Amount Allowed to Amount Billed 44.57% 31.91% 40.84% 40.84% 55.67% 59.33%
<br /> Annualized Allowed Amount Based on Actual Billed Claims
<br /> ($17,981,063) $9,g66,132 $12,243,452 $10,637,680 $10,637,680 $7,971,628 57,312,279
<br /> Vendors Response to 100 Claims in or Out of Network
<br /> Percent Claims In Network 78.10% 78.22% 91.43% 91.43% 99.05% 75.24%
<br /> Number of All Claims In Network(Total Claims 50,391) 39,355 39,416 46,072 46,072 49,912 37,914
<br /> Number All qaims Not in Network 11,036 10,975 4,319 4,319 479 12,477
<br /> Percent of Unique Providers In Network from Vendor 66.67% 5833% 81.25% 81.25% 97.92% 69.75%
<br /> Responses
<br /> Prestription Drug Ingredient Cost from Vendor Rsponses $7,212.10 $6,599.77 $6,767.75 $7,369.40 $6,553.04 $6,520.59
<br /> Summary Pricing Council document revised.xls Page 1 of 1
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