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CMS recently released drug prescription data showing drug prescription costs and use trends. Using data like this helps benchmark practices and can add perspective to your organization’s policies and practices. BHM peer review systems collect data, making comparisons more meaningful. |
The Centers for Medicare & Medicaid Services (CMS) released Part 2 in a set of data that details information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The CMS believes that The Part D Prescriber PUF data will provide healthcare professionals with important information to drive change within the industry. “These data enable a wide range of analyses on the type of prescription drugs paid for under the Medicare Part D program, and on prescription drug utilization and spending generally.”
Healthcare professionals will be able to compare data across years, since the CMS began collecting and reporting this data in 2013. Using this data for benchmarking will be critical for any organization hoping to grow with the changes in the healthcare industry.
- The new dataset can be used to examine the relative rank of drugs by utilization.
- The chart below shows the top ten drugs in 2014 by claim count
- All of the top 10 drugs are generic drugs and the top 9 drugs are among the drugs with the highest claim counts in 2013.
- The claim counts for these drugs ranged from 22.1 to 38.3 million claims and the total drug costs for each drug ranged from $136 million to $748 million.
Top Ten Drugs by Claim Count, 2014
Drug Name Total Claim Count Beneficiary Count Prescriber Count Total Drug Cost Lisinopril 38,278,860 7,454,940 464,747 $281,614,340 Levothyroxine Sodium 37,711,869 6,245,507 416,518 $631,855,415 Amlodipine Besylate 36,344,166 6,750,062 451,350 $303,779,661 Simvastatin 34,092,548 6,768,159 387,651 $346,677,118 Hydrocodone-Acetaminophen 33,446,696 8,005,790 677,865 $676,296,988 Omeprazole 33,032,770 6,707,964 475,122 $529,050,385 Atorvastatin Calcium 32,603,055 6,740,061 419,327 $747,635,818 Furosemide 27,133,430 5,176,582 456,047 $135,710,772 Metformin HCl 23,475,787 4,509,978 364,273 $203,948,989 Gabapentin 22,143,641 4,298,609 486,754 $492,557,255
The table below breakdowns the 2014 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 1. In 2014, Solvaldi had the highest total drug costs at $3.1 billion, but the costs for each of the top 10 drugs were all more than $1 billion.”
Top Ten Drugs by Costs, 2014
Drug Name Total Drug Cost Beneficiary Count Prescriber Count Total Claim Count Sovaldi $3,106,589,192 33,028 7,323 109,543 Nexium $2,660,052,054 1,405,570 286,927 7,537,736 Crestor $2,543,475,142 1,752,423 266,499 9,072,799 Abilify $2,526,731,476 405,048 130,933 2,963,457 Advair Diskus $2,276,060,161 1,420,515 281,775 6,093,354 Spiriva $2,158,219,163 1,211,919 253,277 5,852,258 Lantus SoloSTAR
$2,016,728,436 972,882 224,710 4,441,782 Januvia $1,775,094,282 789,828 190,741 4,495,964 Lantus $1,725,391,907 787,077 223,502 4,284,173 Revlimid $1,671,610,362 27,142 9,337 178,373
Overall Claim Count and Total Drug Cost, 2013 and 2014
2013 2014 Percent increase 2013-2014 Total Claim Count 1,369,415,992 1,415,145,159 3.3% Total Drug Costs $103,704,226,748 $121,445,569,093 17.1%
CMS hopes that this data will help healthcare professionals track growth trends for certain drug products. “Part D total drug costs are affected by both the volume of prescriptions filled as well as the unit prices of the individual products, and the cost trends shown here do not reflect any manufacturer rebates or discounts, which may also vary from year to year.”
Percentage Change in Total Drug Cost, 2013 vs. 2014
* Sovaldi was not available until the end of 2013, so comparisons across years are not valid.
Please note this data is all from CMS and you can read the full release here.