In an unprecedented decision, the Center for Medicare & Medicaid Services has published comprehensive data showing which physicians and other healthcare providers prescribed the highest number of drugs – by cost, claim and their type – to Medicare beneficiaries.1
The Lund Report analyzed the newly published CMS data for Oregon, and found nearly 15,000 individual physicians and healthcare providers prescribed over $1 billion in brand and generic drugs to 13,000 beneficiaries in 2013 under the Medicare Part D plan. Approximately 68 percent (36 million) of Medicare beneficiaries are enrolled in the Part D plan.2
With nearly 16 million prescription drug claims, approximately 80 percent were generic but only represented 30 percent of the total drug costs.
While the average cost of a prescribed generic drug in 2013 was $24, the average cost of a brand drug was almost 9.5 higher at $227.
The following two tables lists top 15 physicians in Oregon prescribing the highest total costs of brand and generic drugs, percentage of the associated claims and total costs.
Here are the top 10 total numbers of providers for each specialty:
- Dentist, 1905
- Internal Medicine, 1731
- Family Practice, 1701
- Nurse Practitioner, 1433
- Physician Assistant, 1015
- Pharmacist, 690
- Emergency Medicine, 593
- Student in Organized Health Care Training Program, 516
- Obstetrics/Gynecology, 445
- Optometry, 368
Internal medicine and family practice prescribed the highest total cost of brand drugs in 2013. The table below lists the top 10 prescriber specialties with the highest total cost prescribed brand drugs, along with total claims, and percentage of the total drug claim costs.
Nearly 1,500 specific drugs were dispensed in Oregon during 2013. The top 10 highest total costs per drug prescribed are listed in the table below.3
The table below lists the top 10 highest average costs per drug (with total claims per drug) prescribed in Oregon and their treatment.
CMS released the Medicare prescriptive drug data to enhance the Obama Administration’s goals for transparency, cost controls and to improve the quality of the healthcare system. At the beginning of the year, Health and Human Services announced these ambitious goals for the first time in history to shift Medicare payments from volume to value by the end of 2018.4
Prior to the Medicare data release, CMS sought stakeholder feedback through a one-month public comment period regarding physician and patient privacy, policy for disclosure and data format.5
CMS received more than 130 formal responses representing over 300 organizations and individuals. Most notably the AARP commented:
“In addition to improved oversight, we also argued that transparency of healthcare quality and cost information encourages providers and health plans to deliver high quality care; helps consumers make informed decisions about their care; and reduces health care spending.”6
Although many comments echoed AARP, respondents also emphasized the importance of accurate data reporting, and safeguards to protect individual physician and patient anonymity.
To protect patient privacy, CMS excluded information from the published data set for providers with 10 or fewer claims. CMS also cautioned that the published data report only provided cost and utilization data, and did not contain information about the quality of care by physicians and healthcare providers.
CMS noted in a document describing the public data set’s methodology that the comprehensive data set has limitations.8 The published data is from Medicare Part D only, and does not include prescribed drugs paid by other medical plans and therefore may not represent any particular drug prescribing patterns. Total drug costs include ingredient costs, dispensing and administrative fees, and sales tax. Costs are based on amounts paid by the Part D plan, Medicare beneficiary, other third party payers and any government subsidies.
Kathryn Thomsen can be reached at [email protected] and Jen Kruse at [email protected].
1 CMS data: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Part-D-Prescriber.html 2 Fact sheet: http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-30.html 3 CMS Part D public use file provides total costs in the aggregate and does not distinguish prescribed drug type by brand vs generic.4 HHS press release: http://www.hhs.gov/news/press/2015pres/01/20150126a.html 5 Request for formal comments: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Request-for-Public-Comment.pdf 6 AARP comments: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/PublicComments.pdf 8 Part D Prescriber Public Use File: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Prescriber_Methods.pdf
For fun or interest, look at the ProPublica page "Dollars for Docs" to learn which companies (those that DO report payments, which is not all drug makers) are paying which doctors for speaking, travel, research, etc. It's not simple. For example one doctor high on the list is a neurologist and may be high because of prescribing the latest branded seizure medications (from a company who has payments this doctor), which makes clinical sense. About 10% of epileptic patients have very hard-to-control seizures. A doctor is required to try new medications in the sometimes desperate effort to help them live more normal lives.
Others may take payments where a branded drug is not demonstrably better than generic alternatives in the same class; that is less justifiable. But, I must say the first several I checked showed examples of the first sort, very likely. So some brand prescribing is done for the wrong reasons (listening to drug reps' pitches and reading their selected literature; taking speaking fees or doing "company research" at high fees). But some---many---doctors in certain specialties are truly dependent on new, branded, costly drugs to give the best care to patients with hard problems.
It's worth using "Dollars for Docs" when interpreting the data, looking at specialty and comparing with the paying company's brands to see if it's a specialty with hard problems and fewer good generic choices, or is not an looks like conflict of interest. The fact some drug makers still do not report this data (it remains voluntary) adds more challenge.
Don Thieman