Description and Important Notes
The prescription utilization report shows prescription frequency and plan spending by drug. Each row summarizes all pharmacy claims for one drug across the group, so the report answers questions like "which drugs drive our pharmacy spend?" rather than showing individual prescriptions. The report is found on the "Reports" tab of the portal.
A few important notes:
The report includes approved adjudicated pharmacy claims. Pending claims are excluded.
Reversed prescriptions are excluded (once reversed), so reversed fills do not inflate the counts or totals.
The report covers the group's full pharmacy claims history. There is no date-range filter.
The report is a snapshot in time. Regenerate it on a regular basis to get up-to-date information.
Unlike the medical claims report, this report contains no member-level information. Figures are aggregated by drug.
If you are unable to download the report, try normal troubleshooting steps. If you're still unable to access, email partners@yuzu.health.
Interpretation Guide
1. Each row is one drug, not one prescription. All of the group's pharmacy claims are grouped by product name, and each distinct product name gets one row. claimCount tells you how many claims are behind the row.
2. Mind naming conventions. The report groups based on drugs’ exact brand name provided to us in the claim. This means that the same drug may appear in multiple rows if it’s name is formatted or spelled differently. Claims received without , it is grouped into a single row labeled "Unknown."
3. Know which claims are counted. The report includes pharmacy claims that finished adjudication, whether approved or denied, and excludes any claim whose most recent status is a reversal. Pending claims are not included, so very recent prescriptions may not appear until you regenerate the report later.
4. Follow the money. totalAllowedAmount is the allowed amount for the drug: the price the plan recognizes after discounts, summed across every claim for that drug. totalPlanPaid is the portion of that total the plan paid; the remainder is member responsibility. averageCostPerScript is simply totalAllowedAmount divided by claimCount.
5. The report is sorted by spend. Rows appear in descending order of totalAllowedAmount, so the highest-spend drugs are at the top. The .csv and .pdf downloads contain the same rows in the same order.
6. Update cell formats (if needed) for calculations. The dollar columns may render as text values with a dollar sign and thousands commas (e.g., "$6,712.32"), and the percentage carries a "%" suffix. You may need to reformat in order to complete calculations.
Data Definitions
This section explains each field, its format, any applicable calculations, and a basic definition.
Drug and Utilization
Column | Format | Calculation (if applicable) | What it means |
|---|---|---|---|
brand | String | The product name on the pharmacy claim; shows "Unknown" when no product name is available | The drug or product the row summarizes. This is the product name as billed, not necessarily a brand-versus-generic distinction. |
claimCount | Number | Count of approved, non-reversed pharmacy claims for the product | Number of pharmacy claims for that drug across the group. |
Dollar Amounts
All amounts below are totals across every claim for the drug, not per-prescription figures (except averageCostPerScript).
Column | Format | Calculation (if applicable) | What it means |
|---|---|---|---|
averageCostPerScript | Dollars | totalAllowedAmount ÷ claimCount | The average allowed cost per claim for that drug. |
totalAllowedAmount | Dollars | Sum of the allowed amount across all service lines of all claims for the drug | The total allowed amount for the drug: the price the plan recognizes after discounts. Rows are sorted by this value, highest first. |
totalPlanPaid | Dollars | Sum of the plan-paid amount across all service lines of all claims for the drug | The total amount the health plan paid for the drug. The difference between this and |
percentagePlanPaid | Percentage (String, "%"-suffixed, unrounded) | (totalPlanPaid ÷ totalAllowedAmount) × 100 | The plan's share of the total cost. Not rounded, so it may show many decimal places; 100% means the plan paid the full allowed amount. |