Second annual release provides clearer look into Part D costs

CMS’s second annual release of privacy-protected data details information on prescription drugs paid under the Medicare Part D prescription drug program. The data provides key information to consumers, providers, researchers, and other stakeholders to help transform the health care delivery system. With data from 2013 and 2014, CMS will now be able to analyze trends, prescribing habits for specific providers, brand versus generic drug prescribing rates, and state- and local-level differences in drug utilization and costs.

The new release is based on 2014 data describing the specific medications prescribed for 38 million enrollees in Medicare Advantage (MA) prescription drug plans (PDPs) and stand-alone PDPs. The 2014 data set includes new aggregated information on opioids, antibiotics, antipsychotics, and high-risk medications among the elderly. A prescriber enrollment status field has also been added to the 2014 data set to indicate whether the prescriber is enrolled, is not enrolled, or opted out of the Medicare program.

Public data set

The public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), was created by CMS using information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D. The Part D Prescriber PUF is based on information from CMS’ Chronic Conditions Data Warehouse,which contains prescription drug event records submitted by MA-PD plans and by stand-alone PDPs. The dataset identifies providers using their National Provider Identifier and presents the specific prescriptions dispensed at their direction, listed by brand and generic name.

For each prescriber and drug, the dataset includes the total number of prescriptions dispensed and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees. The total cost is based on the amounts paid by the Part D plan, Medicare beneficiary, other government subsidies, and any other third-party payers (such as employers and liability insurers). Total drug costs do not reflect any manufacturer rebates paid to Part D plan sponsors through direct and indirect remuneration or point-of sale rebates.

Drugs by claim count

For 2014, the top 10 drugs based on claim count were generic drugs, and the top nine drugs were among the drugs with the highest claim counts in 2013. The 2014 claim counts for these drugs ranged from 22.1 to 38.3 million claims,andthe total drug costs for each drug ranged from $136 million to $748 million. From 2013 to 2014, the total number of claims increased from 1.37 billion to 1.42 billion, a 3 percent increase from 2013 to 2014.

Drugs by cost

The drugs with the highest cost in 2014 were all brand name drugs. In 2014, Solvaldi® (Hepatitis C antiviral) had the highest total drug costs at $3.1 billion, with the costs for each of the top 10 drugs all more than $1 billion. Total drug costs increased from $104 billion in 2013 to $121 billion in 2014, reflecting a 17 percent increase.

Lantus Solostar® and Lantus® insulin products had the highest growth in total drug costs between 2013 and 2014 with growth rates of 47 percent and 32 percent, respectively. Abilify® (antipsychotic), Januvia® (diabetes), and Revlimid® (cancer) also had high growth rates of 20 percent or higher. Advair Discus® (asthma and COPD) had a very low growth in total drug costs of only 1 percent.

Antibiotic prescribing

The new 2014 dataset also can be used to examine patterns of antibiotic prescribing in the Medicare program. These data can inform where high rates of antibiotic prescribing are occurring across the U.S. The 2014 data shows that states in the South and Midwest have rates of antibiotic prescribing that are higher than the national average of 1.39 fills per beneficiary.