Requerimiento de Información Sobre Costo y Utilización de Medicamentos de Receta.

GOBIERNO DE PUERTO RICO OFICINA DEL COMISIONADO DE SEGUROS 21 de agosto de 2017 CARTA CIRCULAR NÚM.: CC-2017-1906-D A TODAS LAS ORGANIZACIONES DE SEGUROS DE SALUD Y ASEGURADORES QUE OFRECEN CUBIERTA DE FARMACIA EN PLANES MÉDICOS. RE: REQUERIMIENTO DE INFORMACIÓN SOBRE COSTO Y UTILIZACIÓN DE MEDICAMENTOS DE RECETA. El Departamento de Asuntos del Consumidor (DACO) se encuentra en proceso de revisar y actualizar la regulación de precio de venta de productos medicinales, conforme a los poderes le fueron concedidos bajo las Leyes Núm. 5 del 23 de abril de 1973 y Núm. 228 del 12 de mayo de 1942, según enmendadas. Para estos efectos, el DACO ha solicitado la colaboración de nuestra agencia para recopilar de las organizaciones de seguros de salud y aseguradores, que ofrecen cubierta de farmacia en el sector de planes médicos privados, información sobre el costo y utilización de los primeros diez (10) medicamentos de marca y genéricos de mayor costo y utilización bajo la cubierta de farmacia durante el año 2016. En vista de lo anterior, se requiere a todas las organizaciones de seguros de salud y aseguradores que ofrecen cubierta de farmacia en el sector de planes médicos privados, presentar la información requerida en la tabla anejada a esta Carta Circular a la siguiente dirección de correo electrónico apoyo@ocs.pr.gov, en o antes de lunes, 11 de septiembre de 2017. De tener alguna duda sobre la información aquí requerida, se pueden comunicar con nuestra Oficina al 787-304-8686, extensiones 1000 o 1301. Se requiere estricto cumplimiento con lo dispuesto en esta Carta Circular. Cordialmente, Sr. Javier Rivera Ríos, LUTCF Sr. Javier Rivera Ríos, LUTCF Comisionado de Seguros de Puerto Rico Anejo B5 Calle Tabonuco Suite 216 • PMB 356 • Guaynabo, PR 00968-3029 • Tel: (787) 304-8686 • Fax: (787) 273-6082 www.ocs.gobierno.pr Aneja Carta Circular CC-1017-1906-B del 21 de agosto de 2017 Name of Agency/Insurance Period: 01/1/2016-12/31/2016 # TOP 10 Generics Sort by Cost | Brand Generic Indicator | Description | Rank based on Utilization (1 to 10) | Rank based on Cost (1 to 10) | Claims | Drug Cost / Claim | Drug Cost / Unit | Member Cost Share | Member Paid/ Claim | AWP / Unit | WAC / Unit | AWP Extended | WAC Extended | Plan Paid | Total Drug Cost | Patient Paid | Quantity Dispersed | MRC - MaxIndPrice | MRC - MinIndPrice | MRC - AvgIndPrice | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | Name of Agency/Insurance Period: 01/1/2016-12/31/2016 # TOP 10 Generics Sort by Utilization | Brand Generic Indicator | Description | Rank based on Utilization (1 to 10) | Rank based on Cost (1 to 10) | Claims | Drug Cost / Claim | Drug Cost / Unit | Member Cost Share | Member Paid/ Claim | AWP / Unit | WAC / Unit | AWP Extended | WAC Extended | Plan Paid | Total Drug Cost | Patient Paid | Quantity Dispersed | MRC - MaxIndPrice | MRC - MinIndPrice | MRC - AvgIndPrice | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | | Generic | | | | | | | | | | | | | | | | | | | | Name of Agency/Insurance Period: 01/1/2016-12/31/2016 # TOP 10 Brand Sort by Cost | Brand Generic Indicator | Description | Rank based on Utilization (1 to 10) | Rank based on Cost (1 to 10) | Claims | Drug Cost / Claim | Drug Cost / Unit | Member Cost Share | Member Paid/ Claim | AWP / Unit | WAC / Unit | AWP Extended | WAC Extended | Plan Paid | Total Drug Cost | Patient Paid | Quantity Dispersed | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | Name of Agency/Insurance Period: 01/1/2016-12/31/2016 # TOP 10 Brand Sort by Utilization | Brand Generic Indicator | Description | Rank based on Utilization (1 to 10) | Rank based on Cost | Claims | Drug Cost / Claim | Drug Cost / Unit | Member Cost Share | Member Paid/ Claim | AWP / Unit | WAC / Unit | AWP Extended | WAC Extended | Plan Paid | Total Drug Cost | Patient Paid | Quantity Dispersed | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | | Brand | | | | | | | | | | | | | | | | | AWP Extended: means total AWP for the info dispersed Drug cost/ claim: includes what the plan and the member paid for the claims processed MRC: Maximum Allowable Cost or the maximum the plan will use for a multi WAC Extended: means total WAC for info dispersed Drug cost/Unit: includes what the plan and the member paid for all units dispersed