Analysis of Medicare Part D Claims Data
Centers for Medicare & Medicaid Services
As part of the Obama Administration's efforts to make our health care system more transparent, affordable, and accountable, the Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), with information on the prescription drugs that individual physicians and other health care providers prescribed in 2013 under the Medicare Part D Prescription Drug Program. The part D Prescriber PUF is based on information from the CMS's Prescription Drug Event Standard Analytic File, which has final-action claims that are submitted by Medicare Advantage Prescription Drug (MAPD) plans and stand-alone Prescription Drug Plans (PDP). The dataset identifies providers using their National Provider Identifier (NPI) and the specific prescriptions that were dispensed on their behalf, listed by brand name (if applicable) and generic name. 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.
Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician's entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e. approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided.
Analysis of CMS Drug Claims, 2013
For this project, I was interested in studying drug claims and their associated cost to the Medicare system. This was was done by aggregating the number of claims, beneficiaries and total cost for each of the records listed in the PUF. I then took a subset of the top 200 drugs according to number of claims submitted to Medicare in order to find the most commonly prescribed drugs.
Top 5 most popular drugs by claims
Using aggregates computed from the PUF we can see that the most commonly prescribed medications include: lisinopril, simvastatin, levothyroxine, amlodipine and hydrocodone/acetaminophen. In total, these drugs represent 14.67 percent of all submitted claims and contribute to 2.48 percent of the total prescription costs payed out by Medicare. For perspective there were approximately 1.1 billion claims submitted to Medicare for 2013.
| Drug Name | Total Claims | Total Cost | Beneficiaries | Claims/Bene | $/Bene | $/Claim |
|---|---|---|---|---|---|---|
| Lisinopril | 36,206,291 | $302,019,576 | 8,096,678 | 4.47 | $37.30 | $8.34 |
| Simvastatin | 36,175,328 | $427,240,348 | 7,810,370 | 4.63 | $54.70 | $11.81 |
| Levothyroxine | 34,546,833 | $389,054,553 | 6,570,208 | 5.26 | $59.21 | $11.26 |
| Amlodipine | 33,923,856 | $337,070,649 | 7,048,170 | 4.81 | $47.82 | $9.94 |
| Hydrocodone/APAP | 33,492,392 | $554,669,704 | 10,840,998 | 3.09 | $51.16 | $16.56 |
Top 5 most costly drugs
Similarly, we can look at aggregate numbers computed from the PUF to identify the top 5 most costly drugs. These drugs include primarily brand name medications such as; Nexium, Crestor, Advair Diskus, Abilify and Spiriva. In total, these medications represent only 2.53 percent of the total number of claims submitted to Medicare but are responsible for 12.52 percent of the total prescription cost. For perspective, the total cost of prescriptions payed out by Medicare in 2013 was about $80 billion dollars.
| Drug Name | Total Claims | Total Cost | Beneficiaries | Claims/Bene | $/Bene | $/Claim |
|---|---|---|---|---|---|---|
| Nexium | 7,622,616 | $2,320,290,927 | 1,060,846 | 7.19 | $2,187.21 | $304.40 |
| Crestor | 8,602,219 | $2,089,240,350 | 1,405,895 | 6.12 | $1,486.06 | $242.87 |
| Advair Diskus | 6,050,345 | $2,069,280,702 | 1,071,364 | 5.65 | $1,931.44 | $342.01 |
| Abilify | 2,612,198 | $1,878,590,440 | 282,963 | 9.23 | $6,639.00 | $719.16 |
| Spiriva | 5,237,141 | $1,778,780,055 | 775,823 | 6.75 | $2,292.77 | $339.65 |
The plot below demonstrates the relationship between cost and the total number of prescription claims submitted to Medicare in 2013.
By default, the y-axis represents the total cost to Medicare for a particular medication while the x-axis represents the total number
of beneficiaries receiving that drug. Drugs that are located in the upper-left region of the plot contribute substantial cost to Medicare
while only only benefiting a relatively small number of beneficiaries; these are predominantly brand name medications. Alternatively,
drugs that exist in the lower-right region of the figure have minor contributions to the total prescription cost while benefiting a large
number of beneficiaries; these are predominantly generic medications. By selecting various elements in the drop down, we can explore various
relationships between the number of beneficiaries, cost and claims of the top 200 most commonly prescribed drugs from 2013.