Payers & Copay
Channel mix with starts vs continuing, the Medicaid plan × week pivot, and the copay program
Escitalopram TRx by payer channel
The four windows the chat users asked about, side by side with one definition
5 rows
| Channel | TRx | Share | NRx | Starts (starter) | Continuing | Starter % |
|---|---|---|---|---|---|---|
| Commercial | 569 | 44.0% | 254 | 236 | 333 | 41% |
| Medicaid | 333 | 25.8% | 143 | 133 | 200 | 40% |
| Medicare | 282 | 21.8% | 119 | 111 | 171 | 39% |
| TriCare | 45 | 3.5% | 20 | 18 | 27 | 40% |
| Cash | 64 | 4.9% | 30 | 28 | 36 | 44% |
Medicaid & Managed Medicaid plans × week
Plans down, week-ending dates across, Escitalopram TRx in the cells
| Plan | MCO | ST | 06-12 | 06-19 | 06-26 | 07-03 | 07-10 | 07-17 | 07-24 | 07-31 | 08-07 | 08-14 | 08-21 | 08-28 | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NY Medicaid FFS | State FFS | NY | 8 | 7 | 4 | 4 | 5 | 5 | 2 | 5 | 5 | 4 | 6 | 7 | 62 |
| CVS Health (Aetna) TX Managed Medicaid | CVS Health (Aetna) | TX | 5 | 9 | 1 | 5 | 3 | 3 | 7 | 5 | 1 | 6 | 8 | 9 | 62 |
| Elevance NY Managed Medicaid | Elevance | NY | 2 | 3 | 6 | 3 | 7 | 2 | 4 | 6 | 3 | 5 | 7 | 7 | 55 |
| TX Medicaid FFS | State FFS | TX | 4 | 4 | 3 | 3 | 5 | 2 | 8 | 4 | 4 | 3 | 7 | 3 | 50 |
| PA Medicaid FFS | State FFS | PA | 1 | 5 | 3 | 8 | 5 | 6 | 5 | 3 | 4 | 4 | 44 | ||
| OH Medicaid FFS | State FFS | OH | 2 | 5 | 5 | 2 | 4 | 6 | 1 | 4 | 3 | 4 | 2 | 2 | 40 |
| FL Medicaid FFS | State FFS | FL | 3 | 1 | 4 | 3 | 4 | 6 | 4 | 3 | 1 | 3 | 3 | 4 | 39 |
| Centene NJ Managed Medicaid | Centene | NJ | 2 | 4 | 1 | 2 | 6 | 7 | 2 | 5 | 4 | 2 | 3 | 38 | |
| Centene CA Managed Medicaid | Centene | CA | 6 | 3 | 3 | 6 | 5 | 2 | 2 | 4 | 1 | 4 | 36 | ||
| CVS Health (Aetna) LA Managed Medicaid | CVS Health (Aetna) | LA | 4 | 3 | 2 | 3 | 2 | 4 | 2 | 6 | 3 | 4 | 3 | 36 | |
| UnitedHealth Group PA Managed Medicaid | UnitedHealth Group | PA | 2 | 1 | 1 | 2 | 3 | 5 | 4 | 3 | 4 | 2 | 8 | 35 | |
| NJ Medicaid FFS | State FFS | NJ | 3 | 2 | 3 | 2 | 4 | 2 | 3 | 5 | 4 | 3 | 2 | 33 | |
| CA Medicaid FFS | State FFS | CA | 4 | 1 | 4 | 2 | 2 | 3 | 3 | 3 | 1 | 5 | 2 | 2 | 32 |
| Elevance MI Managed Medicaid | Elevance | MI | 1 | 2 | 3 | 1 | 2 | 5 | 2 | 3 | 2 | 4 | 3 | 3 | 31 |
| Elevance NJ Managed Medicaid | Elevance | NJ | 2 | 4 | 5 | 4 | 2 | 5 | 1 | 5 | 3 | 31 | |||
| Centene FL Managed Medicaid | Centene | FL | 2 | 4 | 1 | 3 | 2 | 3 | 3 | 2 | 1 | 8 | 29 | ||
| LA Medicaid FFS | State FFS | LA | 3 | 2 | 2 | 4 | 1 | 5 | 1 | 3 | 1 | 2 | 5 | 29 | |
| Elevance FL Managed Medicaid | Elevance | FL | 3 | 4 | 2 | 2 | 3 | 4 | 2 | 3 | 2 | 2 | 1 | 28 | |
| UnitedHealth Group IL Managed Medicaid | UnitedHealth Group | IL | 1 | 1 | 1 | 2 | 2 | 2 | 2 | 4 | 2 | 5 | 2 | 4 | 28 |
| MI Medicaid FFS | State FFS | MI | 1 | 4 | 2 | 1 | 2 | 1 | 1 | 5 | 2 | 2 | 4 | 1 | 26 |
| IL Medicaid FFS | State FFS | IL | 2 | 2 | 2 | 3 | 3 | 1 | 3 | 2 | 2 | 3 | 2 | 1 | 26 |
| UnitedHealth Group OH Managed Medicaid | UnitedHealth Group | OH | 2 | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 4 | 3 | 3 | 24 | |
| Elevance IL Managed Medicaid | Elevance | IL | 2 | 3 | 3 | 3 | 3 | 1 | 2 | 4 | 1 | 2 | 24 | ||
| UnitedHealth Group MI Managed Medicaid | UnitedHealth Group | MI | 1 | 2 | 1 | 3 | 2 | 2 | 1 | 3 | 4 | 1 | 3 | 23 | |
| Elevance CA Managed Medicaid | Elevance | CA | 2 | 2 | 3 | 2 | 3 | 1 | 1 | 3 | 4 | 2 | 23 | ||
| Centene OH Managed Medicaid | Centene | OH | 2 | 4 | 2 | 1 | 1 | 2 | 2 | 3 | 1 | 1 | 1 | 1 | 21 |
Copay claims, net
2,311
119 reversals removed
Network pharmacy share
34%
is_network_pharmacy
Unique patients
1,912
350 with multiple fills
Starter packs
1,718
74% of net claims
Program spend
$671,142
$290 blended per claim
Avg patient OOP
$10
non-reversed claims
Pharmacies by claims
Blended copay rate = program $ / non-reversed transactions
9 rows
| Pharmacy | Network | Claims | Blended copay | Avg OOP | Spend |
|---|---|---|---|---|---|
| BlinkRx | Network | 272 | $220 | $0 | $59,906 |
| Tri Star Pharmacy | Network | 269 | $219 | $0 | $58,812 |
| Walmart Pharmacy | Retail | 262 | $324 | $14 | $84,847 |
| Kroger Pharmacy | Retail | 262 | $328 | $15 | $85,901 |
| Publix Pharmacy | Retail | 261 | $326 | $14 | $84,961 |
| CVS Pharmacy | Retail | 253 | $330 | $14 | $83,601 |
| Carepoint Specialty | Network | 246 | $222 | $0 | $54,719 |
| Meijer Pharmacy | Retail | 244 | $326 | $15 | $79,603 |
| Walgreens | Retail | 242 | $326 | $16 | $78,792 |
Weekly copay claims
Net claims and reversals by submission week
Every number on this site is generated from a seeded synthetic dataset. No real HCP, patient, rep or client data is present.