The Centers for Medicare and Medicaid Services (CMS) has added a new ream of physician data to its list: Medicare Part D prescription data. The huge data set—which details millions of individual claims totaling $103.7 billion that Medicare’s Part D prescription drug program spent in 2013—lists each prescriber’s name next to the volume and cost of the particular drugs that they prescribe.
“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.”
View CMS’s Fact sheet, documenting high level spending statistics here. The top prescribed drugs were all generics. The following chart shows the top ten drugs by cost:
Limitations to Data
The Part D release only covers one element of a doctor’s prescribing patterns. “The data contains information only from Medicare beneficiaries with Part D coverage, but clinicians typically treat many other patients who do not have that form of coverage,” notes CMS. Furthermore, it is important to note that the data covers 2013–many of the top products are now off-patent.
Another important consideration is that the pharmaceutical cost information does not include manufacturer coupons or rebates that mitigate out-of-pocket costs for patients. “Significant price negotiation exists in Part D and results in rebates of as high as 20 to 30 percent for branded medicines,” states PhRMA president and CEO John Castellani in a statement. “These savings are not reflected in the data. Rebates have been a significant factor in keeping Part D program costs hundreds of billions of dollars below original estimates, while still offering beneficiaries steady premiums and a robust choice of plans.”
“The data released today is much more complex than initially meets the eye,” echoed Robert Wah, MD, president of the American Medical Association (AMA). “The limitations of it should be more comprehensively listed and highlighted more prominently so that patients can clearly understand them.” Wah notes: “We are also troubled by the lack of context provided with the data that could help explain physician prescribing practices and pharmacy filling practices before conclusions are drawn.” The AMA is concerned that the database will draw focus purely on the cost of treatment, without accounting for individual patient requirements, particular physician specialties, or potentially incorrect records–as physicians are not able to correct data.
The Future
The database allows for a variety of prescription drug analyses that compare drug use and costs by specific providers, brand versus generic drug prescribing, and to make geographic comparisons for prescribing trends. However, the database is split up into over thirty huge excel records, so it will be a hefty task to combine the files to make sense of the data.
The release of this data will likely fuel the fire of more drug cost transparency initiatives, as many news articles already have focused purely on the amount spent on brand name drugs rather than the patient benefit.
Further, expect this prescriber data to be correlated with Open Payments records in the future. “We know there are many, many smart minds in this country,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “We’re excited to unleash those minds and see what they find in our data.”