Medicare Releases Part D Drug Prescribing Data for First Time

Ken Terry

May 01, 2015

For the first time, the Centers for Medicare & Medicaid Services (CMS) has released Medicare drug prescribing data at the level of the individual prescriber. The new dataset includes information on the prescription drugs that physicians and other healthcare providers prescribed in 2013 under the Medicare Part D prescription drug program.

For each prescriber and drug, the dataset includes the total number of prescriptions (including new prescriptions and refills) that were dispensed and the total drug cost. This cost does not include any manufacturer rebates paid to Part D plans.

The top five drugs by total drug cost, according to a CMS fact sheet, were esomeprazole (Nexium, AstraZeneca), $2.53 billion; fluticasone propionate (Advair Diskus, GlaxoSmithKline), $2.26 billion; rosuvastatin calcium (Crestor, AstraZeneca), $2.22 billion; aripiprazole (Abilify, Otsuka America Pharmaceutical, Inc), $2.11 billion; and duloxetine (Cymbalta, Lilly), $1.96 billion.

By the number of claims filed, the top five drugs were lisinopril, simvastatin, levothyroxine sodium, hydrocodone-acetaminophen, and amlodipine besylate.

The 10 specialties with the highest number of prescribers, in order, were internal medicine, dentistry, family practice, nurse practitioner, physician assistants, emergency medicine, organized health care education/training program-student, obstetrics/gynecology, psychiatry, and optometry.

The specialties with the highest average total costs were family practice, $211,977; internal medicine, $205,923; and psychiatry, $174,274.

Internal medicine, family practice, nurse practitioners, neurology, and psychiatry were the specialties with the highest total costs. The specialties with the highest average cost per claim were hematology/oncology, neurology, and rheumatology.

Generic prescribing was fairly high across selected specialties, ranging from 76% for internal medicine to 82% for psychiatry. For the entire Part D program, the generic dispensing rate was about 76%. Across geographic regions, the generic dispensing rate ranged from 70% to 80%, with most regions in the upper end of the range.

The more than 1 million prescribers in the program prescribed $103 billion worth of prescription drugs to the 36 million people enrolled in Part D drug plans and the Part D component of Medicare Advantage plans, according to a CMS fact sheet.

CMS made a point of saying that the data may not be representative of a physician's entire practice. In addition to being confined to Medicare, the database is derived solely from Part D claims, and only 68% of Medicare beneficiaries are in Part D plans.

American Medical Association Takes Issue

Nevertheless, the American Medical Association expressed concern about the release of data on physicians' drug prescribing. "The data released today is much more complex than initially meets the eye," said American Medical Association President Robert M. Wah, MD, in a statement. "The limitations of it should be more comprehensively listed and highlighted more prominently so that patients can clearly understand them."

The Pharmaceutical Research and Manufacturers of America, the drugmakers' trade association, also assailed CMS' decision to release this data, noting that the data do not reflect drug rebates, and therefore inflate the actual amounts paid by Medicare.

CMS previously released Medicare data on inpatient hospital charges, outpatient charges, and payments to physicians. In a news release, the agency said it was issuing the prescribing data as part of the government's efforts "to make our healthcare system more transparent, affordable and accountable."

In the accompanying fact sheet, CMS elaborated: "The new dataset provides key information to consumers, providers, researchers, and other stakeholders to help drive transformation of the health care delivery system." The agency noted that the data "enables a wide range of analysis" on prescription drug utilization and spending.

ProPublica, an online investigative news organization, noted that until CMS' data release, it had been impossible to access Medicare data on physicians who prescribe in ways that may harm patients. In an earlier article, ProPublica had examined Medicare prescribing data it obtained under a Freedom of Information Act request. Among other things, Propublica said, it had discovered that "Medicare had failed to use its own records to flag doctors who prescribed thousands of dangerous, inappropriate or unnecessary medications."

Since then, it pointed out, CMS has changed its approach to supervising Part D. The agency has given itself the authority to expel from Medicare physicians who prescribe in abusive ways, and starting next month, it will require physicians to participate in Medicare as a condition for ordering medications for patients in Part D drug plans, Propublica said.

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