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Drug Use by Medicare Beneficiaries

By May 8, 2015Commentary

About 68% of Medicare beneficiaries, or 36 million people, enrolled in Part D, the drug benefit.  The Centers for Medicare & Medicaid Services has released a data set containing details of their prescription drug use during 2013, usage which cost $103 billion in total.   (CMS Release)   The drug costs do not reflect manufacturer rebates, so actual cost to the Part D plans would be somewhat lower.  The top drugs by number of prescriptions include Lisinopril, a generic blood pressure med, at 37 million prescriptions written for over 7 million beneficiaries by 457,000 different prescribers with a total drug cost of $307 million.  Next up is Simvastatin, a cholesterol med, with 37 million scripts for 7 million patients at a cost of $434 million.  Most of the highest prescriptions are for blood pressure and cholesterol-lowering drugs.  By cost, the top ten are all brand medications, led by Nexium, the anti-heartburn drug, with 8.2 million prescriptions at a total cost of $2.5 billion.  Other high cost drugs are Advair, Crestor, Abilify and Cymbalta.  You can easily see in the tables that the average claim cost for a generic is far below that for a brand name drug.  Lisinopril, the most commonly prescribed drug, for example, costs less than $10 per prescription, while Nexium, with the highest total cost, is around $300 a prescription.

Looking at specialties, internal medicine and family practice doctors represented the largest number of prescribers, at 130,640 and 105,413 respectively.  The greatest number of unique drugs prescribed was from family practice doctors at 75 and internal medicine doctors at 66.  Nurse practitioners and physician assistants accounted for a surprisingly high number of prescribers, at 97,722 and 69,180, but prescriber a smaller number of drugs.  Psychiatrists had the highest cost per prescription at $104.  The average family practice physician prescribed drugs costing $212,000 and the average internal medicine doctor $206,000; reflecting the power of the physician in controlling spending and why drug companies are willing to engage in so much marketing effort toward prescribers.  Most physicians had generic prescribing rates over 75%.  The data shows details by prescriber, which the American Medical Association has objected to, as it did with the general release of Medicare billing data by physician.  But it is critically important to be able to assess the individual practice patterns of doctors if we are to be able to identify potential abuse or inappropriate care.  And it is useful for physicians to be able to see where they stand in regard to peers.

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