CMS Release Gold Mine of Data for Benchmarking Your Operations

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. Contact BHM for more information on our claims processing options that lead to better performance.

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 Data

(All data from CMS)

  • 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

via CMS

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

(insulin pen)

$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

via CMS

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%

via CMS

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

 via CMS

* 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.

2017-04-02T13:28:01+00:00 By |Big Data, Physician Advisor/Peer Review|

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