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CMS Announces New Medicare Prescription Drug Cost Data is Available

On April 30, 2015, the Centers for Medicare & Medicaid Services (CMS) announced the availability of new, privacy-protected data on Medicare Part D prescription drugs prescribed by physicians and other health care professionals in 2013.

The new 2013 data set contains information from over one million health care providers who collectively prescribed approximately $103 billion in prescription drugs and supplies paid under the Part D program. “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.” For the full announcement and a fact sheet on the Medicare Part D prescriber data, please click here >>

Subsequently on May 1, 2015 and May 3, 2015, the Wall Street Journal (WSJ) completed an extensive analysis of the CMS data and reported that the most widely prescribed under Medicare Part D was hydrocodone acetaminophen (generic Vicodin). It is alarming that approximately 691,000 providers prescribed the painkiller to more than eight million Medicare beneficiaries in 2013 according to the CMS data and the WSJ report. This information should be a wakeup call and a leading indicator to anyone who is involved in legacy or chronic claims considering the potential for addiction and abuse for claimant pain treatment. With more attention being placed on all Hydrocodone Combination Products (HCPs), perhaps the trend may change in the future. (See Drug Enforcement Administration (DEA) rescheduled Hydrocodone Combination Products (HCPs) commencing in October 2014).

Some additional interesting statistics from the report included that:

• Rates of use vary by state with hydrocodone acetaminophen representing more than 4% of all prescriptions in Alabama, Oklahoma and Michigan, but less than 1% in states including New Jersey and Massachusetts

• Over 68,000 family practitioners wrote almost 10 million hydrocodone acetaminophen prescriptions in 2013

• The most costly prescription medication reportedly was Nexium for gastrointestinal treatments, with over $2.5 Billion spent by Medicare in 2013

• Spending on all Medicare’s Part D prescription-drug program totaled $103.7 billion in 2013, including spending by government, insurers and beneficiaries. Out of nearly 3,500 drugs, the top 100 by total cost represented nearly 60% of total spending

For a full reading of the Wall Street Journal articles packed with interesting statistics and commentary, please click here >>

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