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CMS releases Medicare Part D data
The Centers for Medicare & Medicaid Services has released new data on Medicare Part D prescription drugs prescribed by physicians and other health care professionals in 2013. This data shows which prescription drugs were prescribed to Medicare Part D beneficiaries by which practitioners. The agency said they relased the data as part of the Obama Administration’s efforts to make the health care system "more transparent, affordable, and accountable."
The new data set contains information from more one million distinct health care providers who collectively prescribed approximately $103 billion in prescription drugs and supplies paid under the Part D program. The data characterizes the individual prescribing patterns of health providers that participate in Medicare Part D for mre than 3,000 distinct drug products. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost paid by beneficiaries, Part D plans, and other sources.
“This transparency will give patients, researchers, and providers access to information that will help shape the future of our nation’s health for the better,” said acting CMS Administrator Andy Slavitt. “Beneficiaries’ personal information is not available; however, it’s important for consumers, their providers, researchers, and other stakeholders to know how many prescription drugs are prescribed and how much they cost the health care system, so that they can better understand how the Medicare Part D program delivers care.”
CMS created the new data set using drug claim information submitted by Medicare Advantage Prescription Drug plans and stand-alone Prescription Drug Plans. With this data, it will be possible to conduct a wide array of prescription drug analyses that compare drug use and costs for specific providers, brand versus generic drug prescribing rates, and to make geographic comparisons at the state level.
Data overview
The most common drug prescribed to Medicare part D beneficiaries by claim count is Lisinopril, a generic ACE inhibitor that treats high blood pressure and heart failure, while hydrocodone-acetaminophen, a narcotic pain reliever, is given to the most beneficiaries. Nexium, a proton pump inhibitor that treats heartburn and gastroesophageal reflux disease, accounts for the highest costs.
Below are the top 10 drugs in 2013 by claim count (Table 1a). All of the top 10 drugs are generic drugs. The claim counts for these drugs ranged from 21.0 to 36.9 million claims and the total drugs costs for each drug ranged from $145 million to $911 million.
Table 1b below shows the 2013 top 10 drugs by cost. These drugs are all brand name drugs with relatively fewer claims than the top drugs by claim seen in Table 1a above. While claim counts ranged from as few as 150,000 claims to as many as more than 9 million claims, total drug costs for each drug in Table 1b were all more than $1 billion.
The chart below shows patterns of prescribing across specialties in the Medicare program.
AMA response
The American Medical Association expressed some concern that the pharmaceutical cost information does not include manufacturer coupons or rebates or variations in price by region. The dataalsodoes not include information linking treatment to the quality of care provided. The association also pointed out that CMS did not include treatments paid for by private insurance plans, for patients not covered under Medicare Part D, which provides a limited view of the patients a physician cares for. The data are also not risk adjusted and fail to take into account patients’ health and socioeconomic status as well as medication adherence.
“The American Medical Association is committed to transparency and the availability of reliable information for patients to make informed decisions about their medical care," Robert M. Wah, MD, president of the American Medical Association. “The data released today is much more complex than initially meets the eye. The limitations of it should be more comprehensively listed and highlighted more prominently so that patients can clearly understand them. We are also troubled by the lack of context provided with the data that could help explain physician prescribing practices and pharmacy filling practices before conclusions are drawn. In addition to improving transparency with the public, we are also calling on the Centers for Medicare & Medicaid Services to provide accurate, timely and actionable data to physicians that will support the implementation of new delivery and payment models that can improve patient care.”