Medical Trust Actuarial Report
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5724237v1/00914.015 Rachel Calisi Senior Health Consultant T 602.381.4027 rcalisi@segalco.com 1501 West Fountainhead Parkway, Suite 370 Tempe, AZ 85282 segalco.com May 20, 2022 Ms. Rae Lynn Nielsen Human Resources Director City of Chandler PO Box 4008 Chandler, AZ 85244-4008 Re: City of Chandler Medical and Prescription Drug Plan Monthly Reporting January 1, 2022 through December 31, 2022 – Data through March 31, 2022 Dear Rae Lynn: Enclosed is the monthly experience reporting for the City’s medical and prescription drug plans. The report contains medical claims, prescription drug claims, enrollment, and expense information as furnished by Blue Cross Blue Shield of Arizona (Whyzen Analytics reporting tool) through March 31, 2022. For the month of March, Medical paid claims were approximately $1,650,000 while net Rx claims were about $288,000. For the 2022 plan year-to-date, claims and expenses (after stop- loss reimbursements and pharmacy rebates) exceeded contributions by approximately $101,000 or -1.8% of contributions. Based on paid claims and expenses, Actives and Retirees on the Red plan, as well as Retirees on the Blue Plan have experienced an operating deficit, as displayed on Page 8. There have been three claimants with paid claims in excess of $100,000 during the reporting period. There are no individuals in the current plan year who have exceeded the stop loss deductible of $350,000. Expenses included in this report are medical plan administration, stop-loss premium, capitation for behavioral health & chiropractic services, value based services, HSA administration, and fees associated with the Affordable Care Act. Also included is the amount of $92,562 per month from the 2022 Operating Budget. These expenses exclude those funded by Blue Cross Blue Shield of Arizona. These expenses include categories such as wellness incentives, wellness portal, personnel support, audit & financial services, promotional, operating supplies & equipment, bank charges, contractual services, IT reports, and health savings and flex account contributions. In March 2022, approximately 37.5% of all active employees and retirees were enrolled in the Red plan, with 4.8% enrolled in the Blue plan, and 57.7% enrolled in the White plan. At the end 5724237v1/00914.015 Ms. Rae Lynn Nielsen May 20, 2022 Page 2 of 2021, approximately 38.9% of enrollment was in the Red plan, 4.5% in the Blue plan and 56.6% in the White plan. The current average enrollment in 2022 is approximately 2.4% higher than the 2021 average enrollment. The Coronavirus (COVID-19) pandemic has impacted the US economy and health plan claim’s history and projections for most Health Plan Sponsors. Realized trends in the 2021 plan year could be significantly different in 2022 as the population is vaccinated and changes in the spread of the COVID-19 virus is altered. I look forward to discussing this report with you. Sincerely yours, Rachel Calisi Senior Health Consultant /as City of Chandler (Data Through March 2022) 5/20/2022 Presented by: Rachel Calisi © 2022 by The Segal Group Inc. Medical/Rx Monthly Reporting: January 2022 - December 2022 Mar'22 Jan'22-Mar'22 Jan'21-Dec'21 Mar'22 Jan'22-Mar'22 Jan'21-Dec'21 Contributions (PEPM) $1,063.35 $1,062.96 $1,071.86 Avg. # of Employees 1,747 1,754 1,713 Net Paid Medical Claims (PEPM) $876.97 $770.96 $861.61 Avg. # of Members 4,598 4,614 4,555 Net Paid Rx Claims (PEPM) $165.07 $161.57 $221.05 Ratio Members to EEs 2.63 2.63 2.66 Total Claims (PEPM) $1,042.04 $932.53 $1,082.66 Age/Gender Index 1 - 0.980 0.980 Stop Loss & Adm Expenses (PEPM) $150.38 $149.62 $164.05 Total Claims & Expenses (PEPM) $1,192.42 $1,082.14 $1,246.70 Surplus/Deficit (PEPM) -$129.07 -$19.18 -$174.84 Loss Ratio 112% 102% 116% PEPM % Change 10.2% -13.2% Jan'22-Mar'22 Jan'21-Mar'21 % Change # of Claimants 3 6 -50.0% $ of Medical/Rx Paid Claims $406,028 $831,705 -51.2% % of Medical/Rx Paid Claims 7.8% 4.0% 96.7% Jan'22-Mar'22 Jan'21-Dec'21 % Change Jan'22-Mar'22 Jan'21-Dec'21 % Change Bed Days/1,000 258.4 308.9 -16.4% Generic (PEPM) $28.02 $31.55 -11.2% Avg Length of Stay 5.7 6.5 -12.4% Brand Preferred (PEPM) $179.62 $222.65 -19.3% Brand Non-Preferred (PEPM) $10.80 $11.65 -7.3% Specialty (PEPM) $111.41 $135.37 -17.7% Total (PEPM) $329.86 $401.22 -17.8% Jan'22-Mar'22 Jan'21-Dec'21 % Change Jan'22-Mar'22 Jan'21-Dec'21 % Change In-Network Allowed % 98.6% 97.1% 1.5% Retail Scripts PMPY 3.58 13.99 -74.5% Discount from Billed5 65.7% 67.2% -2.3% Mail Order Scripts PMPY 0.02 0.14 -86.1% % Mail Order 0.5% 1.0% -45.3% Jan'22-Mar'22 Jan'21-Dec'21 % Change Generic Dispensing Rate 82.6% 81.1% 1.8% Jan'22-Mar'22 Jan'21-Dec'21 % Change Generic Plan Paid/Script $8.97 $10.18 -11.9% Member Cost Share % 18.9% 13.4% 41.5% Brand Plan Paid/Script $301.17 $341.02 -11.7% Plan Paid % 81.1% 86.6% -6.4% Specialty Plan Paid/Script $4,211.04 $4,062.97 3.6% Total Plan Paid/Script $87.18 $105.02 -17.0% 1 Pharmacy Spend 2 Medical In-Network Usage & Discounts Pharmacy Retail vs Mail Order Pharmacy Per Script Metrics2 Medical/Rx Plan - Member Cost Sharing 3 (1) BCBS factor for measuring the cost deviation of a population from that of a benchmark population based on age and gender attributes. (2) The amount that plan participants enrolled in the White plan pay for their prescription drugs is not included in the Pharmacy Spend and Pharmacy Per Script Metric sections of the Dashboard because the information is not available broken down by pharmacy category in the BCBSAZ Whyzen system. Differences in pharmacy spend may also be due to the reporting data source. (3) Cost share means the member's out-of-pocket expense compared to the sum of plan paid claims plus member out-of-pocket. Percentages do not reflect employee contributions. (4) Percentages are rounded to the first decimal. (5) Dashboard Large Claims data is taken from the BCBSAZ Whyzen reporting tool, which is a utilization "snapshot in time" possibly resulting in a difference between the dashboard and the monthly report. Inpatient Hospital City of Chandler HealthPlan Dashboard - Data thru March 2022 Income vs Paid Medical/Rx Claims + Expenses Demographics Large Claimants (> $100,000) 5718498 Financial Prescription Drugs (Rx) Enrollment Medical Utilization Medical Network Medical/Rx Plan Design Month Enrollment Contributions1 Medical Paid2,3 Stop Loss Refunds Rx Paid Net Claims Expenses4 Total Paid Claims and Expenses Surplus/ (Deficit) Total Loss Ratio Jan-21 1,708 $1,829,009 $1,661,205 ($71,830) $389,983 $1,979,358 $278,182 $2,257,540 ($428,532) 123.4% Feb-21 1,698 $1,819,359 $1,384,946 ($11,968) $375,656 $1,748,635 $280,266 $2,028,901 ($209,542) 111.5% Mar-21 1,704 $1,828,100 $1,739,289 ($20,983) $321,008 $2,039,314 $280,796 $2,320,110 ($492,010) 126.9% Apr-21 1,703 $1,828,978 $1,524,544 ($1,603) $388,568 $1,911,509 $280,675 $2,192,184 ($363,206) 119.9% May-21 1,703 $1,830,244 $1,714,029 ($83,558) $394,335 $2,024,807 $280,636 $2,305,443 ($475,200) 126.0% Jun-21 1,722 $1,847,707 $1,640,304 ($134,389) $374,365 $1,880,279 $282,462 $2,162,742 ($315,035) 117.1% Jul-21 1,717 $1,839,218 $1,349,631 ($104,469) $360,363 $1,605,525 $281,979 $1,887,503 ($48,286) 102.6% Aug-21 1,714 $1,840,013 $1,352,027 ($130,390) $379,275 $1,600,912 $281,650 $1,882,563 ($42,550) 102.3% Sep-21 1,717 $1,841,570 $1,332,072 ($131,720) $378,985 $1,579,337 $279,041 $1,858,377 ($16,807) 100.9% Oct-21 1,733 $1,858,733 $1,600,815 ($119,875) $423,006 $1,903,947 $286,019 $2,189,966 ($331,233) 117.8% Nov-21 1,735 $1,854,450 $1,666,669 ($184,296) $345,153 $1,827,526 $283,565 $2,111,091 ($256,641) 113.8% Dec-21 1,752 $1,869,360 $2,030,370 ($246,550) $424,269 $2,208,089 $285,066 $2,493,155 ($623,795) 133.4% 2021 Total 20,606 $22,086,738 $18,995,900 ($1,241,629) $4,554,966 $22,309,237 $3,380,337 $25,689,574 ($3,602,836) 116.3% 2021 Avg. 1,717 $1,840,562 $1,582,992 ($103,469) $379,580 $1,859,103 $281,695 $2,140,798 ($300,236) 116.3% Jan-22 1,760 $1,871,210 $1,507,401 ($191,783) $326,101 $1,641,719 $261,157 $1,902,876 ($31,666) 101.7% Feb-22 1,756 $1,865,487 $1,231,204 ($21,351) $235,866 $1,445,719 $263,559 $1,709,278 $156,210 91.6% Mar-22 1,747 $1,857,678 $1,649,945 ($117,877) $288,374 $1,820,442 $262,717 $2,083,159 ($225,481) 112.1% Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 2022 Total 5,263 $5,594,375 $4,388,550 ($331,011) $850,341 $4,907,880 $787,433 $5,695,312 ($100,937) 101.8% 2022 Avg. 1,754 $1,864,792 $1,462,850 ($110,337) $283,447 $1,635,960 $262,478 $1,898,437 ($33,646) 101.8% 2 City of Chandler 2021-2022 Medical/Rx Contributions and Expenses Year-to-date through March 2022 (1) Contributions for COBRA are assumed to be the same as the Actives. (2) Medical Paid claims include BCBSAZ AEA amounts, access fees, and capitation. (3) Medical Paid claims includes retroactive adjustments which causes discrepancies when comparing to BCBSAZ invoices. (4) Expenses include prorated monthly PCORI fees. $1,902,876 $3,612,154 $5,695,312 $2,257,540 $4,286,441 $6,606,551 $8,798,735 $11,104,179 $13,266,920 $15,154,423 $17,036,986 $18,895,363 $21,085,329 $23,196,420 $25,689,574 $- $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. 2022 vs 2021 Cumulative Paid Claims & Expenses 2022 Cumulative Claims & Expenses 2021 Cumulative Claims & Expenses 5718498 Red Blue White Total Red Blue White Total Red Blue White Total Jan-22 591 56 909 1,556 73 27 104 204 664 83 1,013 1,760 Feb-22 585 57 905 1,547 75 27 107 209 660 84 1,012 1,756 Mar-22 580 57 898 1,535 75 27 110 212 655 84 1,008 1,747 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 2022 Avg. 585 57 904 1,546 74 27 107 208 660 84 1,011 1,754 % of Total 33% 3% 52% 88% 4% 2% 6% 12% 38% 5% 58% 100% 2021 Avg. 600 50 874 1,524 68 28 98 193 667 78 972 1,717 % Change -2% 13% 3% 1% 10% -2% 9% 8% -1% 7% 4% 2.2% 3 City of Chandler 2022 Enrollment by Status and Plan Year-to-date through March 2022 TOTAL ACTIVE RETIREE 0 500 1,000 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Active Enrollment by Plan ACTIVE Red ACTIVE Blue ACTIVE White 0 20 40 60 80 100 120 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Retiree Enrollment by Plan RETIREE Red RETIREE Blue RETIREE White 5718498 Notes: Paid claims illustrated include capitation but are not reduced for stop loss reimbursements and prescription drug rebates. The claims information by Active and Retiree status is approximate based on the status information reported to Blue Cross Blue Shield as of the date the claim was adjudicated. 4 City of Chandler 2022 Medical/Rx Paid Claims by Plan and Status Year-to-date through March 2022 $1,571 $771 $659 $1,008 $1,177 $1,883 $458 $899 $1,526 $1,130 $638 $995 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 Red Blue White All Plans Claims per Employee per Month Medical/Rx YTD Claims Paid by Plan and Status -- 2022 Plan Year Actives '22 Retirees '22 All '22 $1,480 $1,708 $742 $1,064 $3,120 $1,105 $1,007 $1,761 $1,647 $1,495 $769 $1,143 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 Red Blue White All Plans Claims per Employee per Month Medical/Rx Claims Paid by Plan and Status -- 2021 Plan Year Actives '21 Retirees '21 All '21 5718498 Enrollment Contributions Claims & Expenses Active Loss Ratio Enrollment Contributions Claims & Expenses Retiree Loss Ratio Enrollment Contributions Total Claims & Expenses Total Loss Ratio All Plans 4,638 $5,049,156 $5,370,907 106% 625 $545,219 $655,416 120% 5,263 $5,594,375 $6,026,323 108% % of Total 88% 90% 89% 12% 10% 11% 100% 100% 100% Red Plan 1,756 $2,377,853 $3,020,912 127% 223 $236,908 $295,805 125% 1,979 $2,614,761 $3,316,717 127% % of Total 89% 91% 91% 11% 9% 9% 38% 47% 55% Blue Plan 170 $171,791 $156,414 91% 81 $69,919 $164,643 235% 251 $241,710 $321,057 133% % of Total 68% 71% 49% 32% 29% 51% 5% 4% 5% White Plan 2,712 $2,499,512 $2,193,580 88% 321 $238,393 $194,969 82% 3,033 $2,737,905 $2,388,549 87% % of Total 89% 91% 92% 11% 9% 8% 58% 49% 40% 4/10/2015 * 5 The claims information by Active and Retiree is approximate based on the status information reported to Blue Cross Blue Shield as of the date the claim was adjudicated. Notes: Paid claims include capitation but are unadjusted for stop loss reimbursements. City of Chandler 2022 Contributions and Paid Claims by Status and Plan Year-to-date through March 2022 ACTIVE RETIREE TOTAL Percent of Total rows sum Active and Retiree columns by plan and show each plan's percentage of the total in the Total columns. $- $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 $ Year-to-Date Active Contributions vs Claims and Expenses $- $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 $ Year-to-Date Retiree Contributions vs Claims and Expenses Contributions Claims & Expenses 5718498 Month EE EE+SP EE+Ch(rn) EE+Fam EE EE+SP EE+Ch(rn) EE+Fam EE EE+SP EE+Ch(rn) EE+Fam Jan-22 148 136 81 226 26 6 10 14 277 117 100 415 Feb-22 145 136 81 223 26 7 10 14 278 115 99 413 Mar-22 141 136 81 222 25 8 10 14 278 111 99 410 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 2022 Total 434 408 243 671 77 21 30 42 833 343 298 1,238 2022 Avg. 145 136 81 224 26 7 10 14 278 114 99 413 Month Retiree Ret+SP Ret+Ch(rn) Ret+Fam Retiree Ret+SP Ret+Ch(rn) Ret+Fam Retiree Ret+SP Ret+Ch(rn) Ret+Fam Jan-22 33 32 5 3 14 13 0 0 47 44 4 9 Feb-22 34 33 5 3 14 12 0 1 48 44 4 11 Mar-22 33 34 5 3 14 12 0 1 48 45 4 13 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 2022 Total 100 99 15 9 42 37 0 2 143 133 12 33 2022 Avg. 33 33 5 3 14 12 0 1 48 44 4 11 6 City of Chandler Enrollment by Tier Year-to-date through March 2022 Red Blue White Actives Retirees Red Blue White 5718498 Month EE EE+SP EE+Ch(rn) EE+Fam EE EE+SP EE+Ch(rn) EE+Fam EE EE+SP EE+Ch(rn) EE+Fam Jan-21 153 138 87 224 18 3 7 17 261 122 100 396 Feb-21 147 136 89 223 18 2 7 17 256 119 101 395 Mar-21 146 136 89 226 20 3 7 18 257 119 100 395 Apr-21 145 136 90 226 19 3 7 19 255 120 100 396 May-21 143 135 91 227 18 3 7 19 257 117 99 396 Jun-21 146 135 91 231 18 3 7 19 260 122 103 395 Jul-21 147 133 90 229 19 4 8 19 260 119 99 395 Aug-21 145 134 90 231 20 4 8 19 259 116 95 396 Sep-21 146 133 89 230 22 5 8 19 260 116 96 398 Oct-21 149 131 91 232 24 5 8 19 261 117 97 398 Nov-21 152 132 90 229 25 5 9 19 263 120 96 394 Dec-21 150 133 88 232 23 5 9 19 276 119 96 398 2021 Total 1,769 1,612 1,075 2,740 244 45 92 223 3,125 1,426 1,182 4,752 2021 Avg. 147 134 90 228 20 4 8 19 260 119 99 396 Month Retiree Ret+SP Ret+Ch(rn) Ret+Fam Retiree Ret+SP Ret+Ch(rn) Ret+Fam Retiree Ret+SP Ret+Ch(rn) Ret+Fam Jan-21 28 30 2 3 14 14 0 0 40 39 2 10 Feb-21 29 30 2 3 15 14 0 0 43 40 2 10 Mar-21 29 30 2 3 15 14 0 0 42 40 3 10 Apr-21 29 29 2 4 16 13 0 0 42 41 3 8 May-21 30 30 3 4 16 13 0 0 42 42 3 8 Jun-21 30 30 3 4 17 12 0 0 43 42 3 8 Jul-21 30 31 4 3 15 12 0 0 47 43 3 7 Aug-21 30 30 5 3 15 12 0 0 47 45 3 7 Sep-21 29 31 5 3 15 11 0 0 46 45 3 7 Oct-21 28 36 6 3 15 11 0 0 46 45 3 8 Nov-21 28 35 6 3 15 11 0 0 47 45 3 8 Dec-21 31 35 6 3 15 11 0 0 47 45 3 8 2021 Total 351 377 46 39 183 148 0 0 532 512 34 99 2021 Avg. 29 31 4 3 15 12 0 0 44 43 3 8 7 Actives Retirees Red Blue White City of Chandler Enrollment by Tier Plan Year 2021 Red Blue White 5718498 4/10/2015 * 8 City of Chandler 2022 Contributions and Expenses by Status and Plan Year-to-date through March 2022 Claims include capitation (allocated by claims paid year-to-date), but are unreduced for stop loss reimbursements. Expenses on these graphs are limited to self-insurance administrative fees, PCORI fees, and paid claims. The claims information by Active and Retiree status is approximate based on the status information reported to Blue Cross as of the date the claim was adjudicated. $1,354 $1,011 $922 $1,089 $1,720 $920 $809 $1,158 ($366) $90 $113 ($69) -$1,500 -$1,000 -$500 $0 $500 $1,000 $1,500 $2,000 $2,500 Red Blue White All Plans $ per Employee per Month Active Surplus/(Deficit) by Plan Contributions Claims+Expenses Surplus/(Deficit) $1,062 $863 $743 $872 $1,326 $2,033 $607 $1,049 ($264) ($1,169) $135 ($176) -$1,500 -$1,000 -$500 $0 $500 $1,000 $1,500 $2,000 $2,500 Red Blue White All Plans $ per Employee per Month Retiree Surplus/(Deficit) by Plan Contributions Claims+Expenses Surplus/(Deficit) 88% 12% Enrollment Active % Retiree % 90% 10% Contributions Active Retiree 89% 11% Claims and Expenses Active Retiree 5718498 Rank Plan Medical/Rx Paid YTD Medical/Rx Paid in Excess of $350K Stop Loss Deductible 1 White Plan $176,464 $0 2 Red Plan $122,514 $0 3 Red Plan $107,050 $0 $406,028 $0 7.8% City of Chandler 2022 Incurred Medical Claims Paid in Excess of $100,000 Year-to-date through March 2022 9 Total of three claimants Percentage of Total Medical/Rx Paid: 7.8% 92.2% Large Claims All Other Medical/Rx Claims 5718498 Twelve Month Period Ending (a) Enrollment (b) Medical Claims Paid (c) Stop Loss Reimbursements (d)=(b)+(c) Net Medical Claims (e) Rx Paid (f)=(d)+(e) Net Claims (d)/(a) Net Medical Claims PEPM (e)/(a) Rx Claims PEPM Mar-21 20,424 $17,173,727 ($1,055,678) $16,118,049 $4,434,789 $20,552,838 $789.17 $217.14 Apr-21 20,426 $17,645,904 ($828,614) $16,817,290 $4,484,949 $21,302,239 $823.33 $219.57 May-21 20,424 $18,286,370 ($837,797) $17,448,573 $4,623,656 $22,072,229 $854.32 $226.38 Jun-21 20,439 $18,881,903 ($922,629) $17,959,274 $4,658,039 $22,617,313 $878.68 $227.90 Jul-21 20,448 $19,023,093 ($919,883) $18,103,210 $4,639,035 $22,742,245 $885.33 $226.87 Aug-21 20,454 $18,794,607 ($982,693) $17,811,914 $4,586,043 $22,397,956 $870.83 $224.21 Sep-21 20,470 $18,594,973 ($991,646) $17,603,327 $4,594,938 $22,198,264 $859.96 $224.47 Oct-21 20,513 $18,688,733 ($1,043,316) $17,645,417 $4,631,827 $22,277,244 $860.21 $225.80 Nov-21 20,557 $18,834,622 ($1,091,323) $17,743,300 $4,573,876 $22,317,175 $863.13 $222.50 Dec-21 20,606 $18,995,900 ($1,241,629) $17,754,271 $4,554,966 $22,309,237 $861.61 $221.05 Jan-22 20,658 $18,842,097 ($1,361,582) $17,480,514 $4,491,084 $21,971,598 $846.19 $217.40 Feb-22 20,716 $18,688,354 ($1,370,965) $17,317,389 $4,351,293 $21,668,682 $835.94 $210.05 Mar-22 20,759 $18,599,010 ($1,467,858) $17,131,152 $4,318,659 $21,449,811 $825.24 $208.04 Notes: Medical Claims Paid includes capitation. 10 City of Chandler Thirteen Month Snapshot - Medical and Rx Plan Paid Claims Through March 2022 $789 $823 $854 $879 $885 $871 $860 $860 $863 $862 $846 $836 $825 $740 $760 $780 $800 $820 $840 $860 $880 $900 Claims per Employee per Month 12-Month Period Ending Rolling Twelve Month Net Medical Claims PEPM Net Medical Trend 4.6% $217 $220 $226 $228 $227 $224 $224 $226 $222 $221 $217 $210 $208 $160 $170 $180 $190 $200 $210 $220 $230 $240 $250 $260 Claims per Employee per Month 12-Month Period Ending Rolling Twelve Month Rx Claims PEPM Rx Trend -4.2% 5718498