CMS 'Dashboard' Reveals Costliest Drugs for Medicare

December 24, 2015

The Medicare Part D drug program spent more on sofosbuvir (Sovaldi, Gilead Sciences) for hepatitis C ($3.1 billion) than on any other drug in 2014, according to an online spending "dashboard" unveiled by the Center for Medicare & Medicaid Services (CMS) on December 21.

The interactive dashboard also shows that the pain reliever esomeprazole/naproxen (Vimovo, Horizon Pharma) posted the biggest price hike in 2014 in the Medicare Part D program. Horizon Pharma raised the unit cost from $1.94 to $12.46, a 543% increase, after it acquired the drug from AstraZeneca in late 2013, according to CMS.

The agency said in a news release that it introduced the dashboard, which also covers physician-administered drugs in Medicare Part B, to spotlight the hot-button issues of affordability and cost control. Driven in part by sharp price increases and $94,000 cures such as sofosbuvir, the nation's overall spending on prescription drugs jumped 12% in 2014, the highest increase since 2002. Part B and Part D drug spending represented 14% of total Medicare expenditures in 2014 compared with 11% in 2010, according to the agency.

The dashboard lists 40 drugs under Part D and another 40 under Part B. To compile each group, CMS selected the top 15 drugs in 2014 in terms of total program (Part D or B) spending, the top 15 in annual spending per patient, and the top 10 in unit cost increase from the prior year. However, drugs could not be chosen for the spending-per-patient category if they were among the top 15 in total outlays. Likewise, drugs in either of these two categories were not eligible for the third category of highest unit-cost increase.

Program expenditures for each drug include beneficiary payments in the form of deductible and coinsurance as well as government subsidies and other third-party payments.

The 80 drugs represent 38% of the Medicare's total spending of $143 billion on Part D and Part B drugs in 2014.

At $21.5 billion, Part B drug spending was one sixth that of Part D. The top five Part B drugs consisted of two for cancer, two for macular degeneration, and one for arthritis.

Table 1. Top Five Drugs, Medicare Part B Expenditures, 2014

Generic and Brand Name Major Indications Total Spending
Rituximab (Rituxan) Non-Hodgkin lymphoma, chronic lymphocytic leukemia $1.4 billion
Ranibizumab (Lucentis) Neovascular (wet) age-related macular degeneration, macular edema $1.3 billion
Aflibercept (Eylea) Macular degeneration, macular edema $1.3 billion
Infliximab (Remicade) Rheumatoid arthritis, psoriatic arthritis/plaque psoriasis, Crohn disease $1.2 billion
Pegfilgrastim (Neulasta) Myelosuppressive chemotherapy adjunct, myelosuppression $1.2 billion

Source: CMS

Dashboard Comes With Caveats

The CMS dashboard provides a pop-up of vital statistics for each drug that make for telling comparisons. The $3.1 billion that Medicare Part D spent on sofosbuvir was on behalf of 33,000 beneficiaries whose unsubsidized share of the $94,000 treatment regimen cost was roughly $5100 on average in 2014. Esomeprazole (Nexium), the second-highest drug on the Part D spending list, at $2.7 billion, was for 1.4 million beneficiaries. Their annual cost share without a low-income subsidy averaged only $250.

However, the dashboard comes with several caveats. In a blog post on the agency website, CMS Acting Administrator Andy Slavitt and Chief Data Officer Niall Brennan said the numbers do not do justice to the clinical or financial value of any given drug. For example, they highlighted the new hepatitis C drugs, such as sofosbuvir, that have created "a major shift from the standard of care." These agents have been touted for their higher cure rates, shorter treatment times, and fewer adverse events.

In addition, listed expenditures do not reflect any rebates or indirect payments that drug manufacturers made to Part D plan sponsors or purchasing intermediaries in Part B. CMS said it is not allowed to make such offsets public. However, factoring rebates into the drug selection process "would not substantially change" what appears in the dashboard.

More information on the CMS drug spending dashboard is available on the agency's website.


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