CMS releases comprehensive Medicare Part D prescription drug prescribing data

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CMS releases comprehensive Medicare Part D prescription drug prescribing data

By Michael Johnsen - 05/12/2015

BALTIMORE - As part of the Administration’s goals of better, care, smarter spending, and healthier people, the Centers for Medicare & Medicaid Services recently announced the availability of new, privacy-protected 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.   


“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.”  


The new data set contains information from over 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 over 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.  


For example, the top three drugs by claim count in 2013 were lisinopril (36.9 million claims at a cost of $307 million), simvastatin (36.7 million claims at a cost of $433.7 million) and levothyroxine sodium (35.2 million claims at a cost of $396.1 million). The top three drugs by costs in 2013 were Nexium ($2.5 billion on 8.2 million claims), Advair Diskus ($2.3 billion on 6.6 million claims) and Crestor ($2.2 billion on 9.1 million claims). 


By specialty, psychiatrists prescribed the most generics (81.9%), followed by family practice doctors (77.9%), nurse practitioners (77.4%) and neurologists and internal medicine specialists (each at 76.1%). Nationally, the generic dispensing rate for the Part D program in 2013 was 76.3%.  The dispensing rate by Hospital Referral Region (see chart) ranged from 70.3% to 80% with most regions in the upper end of the range. Alaska, most of Texas and the New York tri-state area all fell well below in generic dispensing rates, typically falling between 65.2% and 75.5%. 


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.


The Administration has set measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity, of care they give patients. This is part of a wide set of initiatives to achieve better care, smarter spending and healthier people through our health care system. Open sharing of data securely, timely and more broadly supports insight and innovation in health care delivery.


Today’s Part D prescriber data availability adds to the unprecedented information previously released on services and procedures provided to Medicare beneficiaries, including hospital charge data on common impatient and outpatient services as well as utilization and payment information for physicians and other healthcare professionals.  In addition, under the Qualified Entity program, CMS releases Medicare data to approved entities for the purposes of producing public performance reports on physicians, hospitals, and other providers. To date, CMS has certified 11 regional QEs and one national QE.