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Drug Spending Information Products Fact Sheet

Date
2018-05-15
Title
Drug Spending Information Products Fact Sheet
Contact
press@cms.hhs.gov

Drug Spending Information Products Fact Sheet

Today, the Centers for Medicare & Medicaid Services (CMS) announced the release of updated information products that provide greater transparency on drug spending in the Medicare and Medicaid programs. CMS is releasing updated versions of the Drug Spending Dashboards and the annual update to the Part D Prescriber Public Use File. These tools and resources, which provide data through 2016, focus on giving consumers, researchers, and other stakeholders across the healthcare system the information they need to understand drug prescribing in CMS programs, with a particular focus on spending.

CMS Drug Spending Dashboards

CMS is releasing new and improved versions of the Drug Spending Dashboards with data through 2016. These dashboards are interactive, online tools that allow consumers, researchers, policy-makers, and other stakeholders to understand changes in spending on prescription drugs in the Medicare and Medicaid programs. With this release of the dashboards, CMS is highlighting year-over-year changes in per unit spending for individual drugs at both the drug and the manufacturer-level. CMS is also expanding the dashboards to include the majority of drugs prescribed under these programs. This data is critical to providing transparency around prescription drug price increases.

The dashboards include information for Medicare Part B, Medicare Part D, and Medicaid. The tools focus on average spending per dosage unit and change in average spending per dosage unit over time. They also display consumer-friendly information on drug uses and clinical indications as well as spending information on manufacturer(s) of the drugs, where available.[1] The dashboards do not contain any patient-identifiable data. The dashboards and a downloadable, machine-readable version of the data presented in the dashboards can be accessed at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs/index.html.

Medicare Part B Drug Spending Dashboard

The Medicare Part B Drug Spending Dashboard (Part B Dashboard) presents spending information for Medicare Part B drugs, which are generally administered in doctors’ offices and other outpatient settings. Part B drug spending and utilization information is available for Medicare fee-for-service beneficiaries enrolled in Part B, but excludes any beneficiaries enrolled in Medicare Advantage (which represents approximately 30% of the Medicare population).

Figure 1 presents information pulled from the Medicare Part B Dashboard on select drugs with annual increases in spending per dosage unit from 2012 to 2016 of more than 5%. This list is derived from the 15 drugs with the highest total spending in Medicare Part B in 2016.   In 2016, total spending these 8 drugs was over $6.7 billion.

Figure 1: High Annual Increases in Spending, Medicare Part B

Medicare Part B

 

Brand Name

Generic Name

Annual Growth Rate (2012-2016)

Average Monthly Spending Per Beneficiary in 2016

Manufacturers

1

Orencia*

Abatacept*

17.2%
($22 to $41)

$2,136

BMS Primarycare

2

Neulasta

Pegfilgrastim

8.5%
($2,788 to $3,869)

$1,195

Amgen

3

Xolair

Omalizumab

8.0%
($22 to $30)

$1,821

Genentech, Inc.

4

Vaccine Influenza Injection Muscle (Fluzone High-Dose)**

 

6.9%
($30 to $39)

N/A

 

5

Sandostatin Lar*

Octreotide Acetate, mi-Spheres*

6.8%
($123 to $160)

$3,202

Novartis

6

Prevnar 13

Pneumococcal 13-Valent Vaccine

6.1%
($132 to $167)

N/A

Wyeth Pharm

7

Remicade

Infliximab

6.0%
($63 to $80)

$1,910

Janssen Biotech

8

Rituxan

Rituximab

5.6%
($615 to $765)

$1,985

Genentech, Inc.

*Indicates multiple brand and/or generic names for a specific HCPCS code.
**Indicates brand/generic names unavailable. Name reflects the HCPCS short description.

Medicare Part D Drug Spending Dashboard

The Medicare Part D Drug Spending Dashboard (Part D Dashboard) presents spending information for Medicare Part D drugs, which are generally administered by patients. Part D drug spending and utilization information is available from the Part D Prescription Drug Event (PDE) data. These data are available for the subset of Medicare beneficiaries who choose to enroll in Part D (which represents approximately 70% of Medicare beneficiaries).

Figure 2 presents information pulled from the Medicare Part D Dashboard on select drugs with annual increases in spending per dosage unit from 2012 to 2016 of more than 10%. This list is derived from the 15 drugs with the highest total spending in Medicare Part D in 2016. In 2016, total spending for these 13 drugs was over $26 billion.

Figure 2: High Annual Increases in Spending, Medicare Part D

Medicare Part D

 

Brand Name

Generic Name

Annual Growth Rate (2012-2016)

Average Monthly Spending Per Beneficiary in 2016

Manufacturers

1

Renvela

Sevelamer Carbonate

21.6%
($3 to $6)

$630

 

Genzyme

2

Lantus

Insulin Glargine, Hum.Rec.Anlog

 

18.6%
($13 to $25)

 

$209

 

Sanofi-Aventis

3

Zetia

Ezetimibe

18.3%
($5 to $9)

$181

Merck Sharp & D

4

Enbrel

Etanercept

18.2%
($498 to $972)

$2,741

Amgen

5

Humira Pen

Adalimumab

18.0%
($1,019 to $1,976)

$2,835

Abbvie US LLC

6

Lyrica

Pregabalin

17.4%
($3 to $6)

$205

Pfizer US Pharm

7

Lantus Solostar

Insulin Glargine, Hum.Rec.Anlog

14.2%
($14 to $25)

$196

Sanofi-Aventis

8

Crestor

Rosuvastatin Calcium

13.2%
($5 to $8)

$124

Astrazeneca

9

Januvia

Sitagliptin Phosphate


12.7%
($7 to $12)

$235

Merck Sharp & D

10

Xarelto

Rivaroxaban

10.6%
($8 to $12)

$202

Janssen Pharm.

11

Eliquis

Apixaban

10.4%
($4 to $6)

$194

BMS Primarycare

Medicaid Drug Spending Dashboard & Data

The Medicaid Drug Spending Dashboard (Medicaid Dashboard) presents spending information on drugs paid through the Medicaid program. Medicaid drug data represent national-level drug utilization information for covered outpatient drugs paid for by State Medicaid agencies.

Figure 3 presents information pulled from the Medicaid Dashboard on select drugs with annual increases in spending per dosage unit from 2012 to 2016 of more than 10%. This list is derived from the 15 drugs with the highest total spending in Medicaid in 2016. In 2016, total spending for these 8 drugs was nearly $6.6 billion.

Figure 3: High Annual Increases in Spending, Medicaid

Medicaid

 

Brand Name

Generic Name

Annual Growth Rate (2012-2016)

Manufacturers

1

Lantus

Insulin Glargine, Hum.Rec.Anlog

18.7%
($13 to $25)

Sanofi-Aventis

2

Latuda

Lurasidone HCl

18.6%
($17 to $33)

Sunovion Pharma

3

Lyrica

Pregabalin

17.9%
($3 to $6)

Pfizer US Pharm

4

Enbrel

Etanercept

17.6%
($487 to $933)

Amgen

5

Humira Pen

Adalimumab

17.5%
($1,007 to $1,919)

Abbvie US LLC

6

Lantus Solostar

Insulin Glargine, Hum.Rec.Anlog

14.3%
($15 to $25)

Sanofi-Aventis

7

Abilify

Aripiprazole

11.4%
($21 to $32)

Otsuka America

8

Vyvanse

Lisdexamfetamine Dimesylate

11.0%
($5 to $8)

Shire US Inc.

Part D Prescriber Public Use File

CMS is also updating the Part D Prescriber Public Use File (PUF) with data for 2016. The Part D Prescriber PUF provides key information to consumers, providers, researchers, and the public to enable a wide range of analyses on the prescribing of drugs paid for under the Medicare Part D program.  

The Part D Prescriber PUF includes summarized information on prescription drugs that were prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program in 2016. The data include the specific medications prescribed and statistics on utilization and costs organized by the prescriber National Provider Identifier (NPI), drug name (brand name in the case of trademarked drugs) and generic name. The PUF provides data on more than one million distinct health care providers who collectively prescribed $146 billion in prescription drugs under the Part D program in 2016.

The 2016 PUF and supplemental information are available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/PartD2016.html.

[1]Information on manufacturer-level spending is not available for Part B drugs since the HCPCS payment is the same across all manufacturers.

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