A Cure for Prescriber Inefficiency? Prescriber-Level Medicare Drug Data Released for the First Time

On April 30, 2015, the Centers for Medicare & Medicaid Services (CMS) released prescriber-level Medicare Part D drug data for the first time. This new dataset provides key information to consumers, providers, researchers and other stakeholders to help drive transformation of the health care delivery system. It enables a wide range of analyses on the type of drugs prescribed in the Medicare Part D program, and on prescription drug utilization and spending generally.                                                                                                                   

Show Me the Money

Using 2013 data, CMS’ report demonstrates that the top 10 most commonly used drugs in Part D were all generics, but the 10 most expensive drugs were all brand-name drugs. It also showed which specialties prescribe the most generics (psychiatry was highest with a generic dispensing rate of 81.9 percent versus a national total generic dispensing rate of 75.3 percent). There was wide variation in generic dispensing rates in different parts of the country, from a low of 65.2 percent to a high of 81.2 percent. In total, Medicare Part D financed $103 billion in prescription drugs in 2013.

Seen and Heard

While the data is intended to assist all stakeholders in better understanding drug expenditures and prescriptions patterns, some expressed worries about how the data might be used and interpreted. The American Medical Association issued a statement that it was “troubled by the lack of context provided with the data.” PhRMA expressed concern that the data “may be confusing to beneficiaries, making it difficult for them to better understand how care is delivered under the Part D program.”

2016 and Beyond

We predict stakeholders will use this data to impact prescriber behavior, evaluate investments and track trends with the goal of improving outcomes and lowering costs. It is easy to see, for example, how payers and integrated systems could use this data to benchmark the behaviors of their prescribers. Drug manufacturers and pharmacy benefit managers (PBMs) also now have a dataset for identifying geographies and specialties that are prescribing above or below plan. The release of this Part D data is part of a broader CMS effort to support increasingly powerful consumer decision tools, better identify outlier providers and force change in the health care market.