Medicare Part D data reveal prescriber patterns

The Centers for Medicare & Medicaid Services (CMS) recently released the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for 2014 claims. Part of a broader effort to increase transparency about care in general, this dataset also gives very granular information about the prescribing patterns of providers and may be used by policy makers to further scrutinize the cost of prescription drugs in the United States.

The purpose of this article is to provide context for those who prescribe to this population, empower individuals to look up their own information, and arm urologists with information about this publicly available information that may be accessed by patients.

Next: Medicare Part D at a glance

Medicare Part D at a glance

The Medicare prescription drug benefit was authorized by the Medicare Modernization Act (2003) and went into effect in 2006. Any Medicare beneficiary (enrolled in Part A or B) is eligible for drug coverage under one of two mechanisms: a stand-alone prescription drug plan (Part D) or a Medicare Advantage Plan that offers drug coverage (sometimes called MA-PD). While CMS administers the program, private insurers actually implement approximately 1,439 different stand-alone Part D plans across the country-each with its own benefit structure and formulary (bit.ly/PartDbackground).

CMS estimates that in 2014, approximately 38 million (or 70% of all) Medicare beneficiaries had prescription drug coverage (bit.ly/PartDfactsheet), and it is the detail on those paid claims that forms the basis of the dataset and this analysis.

Next: "The average annual aggregate drug cost per urologist was $5,444, and 14 urologists prescribed in excess of $1 million in 2014."

Urologists (9,868) comprised approximately 1% of the prescribers and approximately 1% ($977,110,683) of the total drug costs in the 2014 dataset. The drugs most frequently prescribed by urologists were tamsulosin (Flomax), finasteride (Proscar), and ciprofloxacin (Cipro, Proquin) (table 1). The top three drugs prescribed by aggregate total cost were solifenacin succinate (VESIcare), dutasteride (Avodart), and mirabegron (Myrbetriq). The average annual aggregate drug cost per urologist was $5,444, and 14 urologists prescribed in excess of $1 million in 2014. The three most expensive drugs prescribed per claim were everolimus (Afinitor), enzalutamide (XTANDI), and abiraterone acetate (ZYTIGA) (table 2).

Where possible, the data were also analyzed by presumed disease state. For advanced prostate cancer drugs (enzalutamide, abiraterone, denosumab [XGEVA]), urologists accounted for 7.7% of the total drug costs while hematology/oncology or medical oncology accounted for 75.5% (figure). Dutasteride was the most expensive therapy in aggregate and per claim prescribed by urologists for BPH (presumed indication) (table 3). Solifenacin prescriptions accounted for almost half of the total cost of drugs for OAB (presumed indication), while oxybutynin chloride (Ditropan XL) was the most frequently prescribed and least expensive drug (per claim) (table 4).

A urologist (or their patient) is able to examine individual prescriber cost data with a lookup tool supplied by CMS (bit.ly/PartDlookuptool).

Next: Data come with caveats

Data come with caveats

Analysis of the dataset does come with some limitations: While Medicare beneficiaries do comprise a significant portion of the typical urology practice, the prescribing patterns and costs may not be generalizable to all patients or all payers in a typical practice. The data do not include diagnosis information, so it is not possible to know the exact indication or intent of the prescriber (unless the drug has only one indication). The impact of plan formulary is not available-physicians may have prescribed a brand, but a generic or therapeutic alternative may have been substituted.

Some of the data are suppressed where it might be possible to identify a patient. Some providers appear to be incompletely classified by specialty. Nevertheless, these publicly available data are a rich source of information with these caveats.

Bottom line: CMS continues to make publicly available data on utilization and cost in its Medicare programs. Urologists should examine their own Part D prescribing information using the tool referenced above, and understand how their prescribing patterns fit in the larger context of health care costs, the policy conversations concerning drug pricing, and the subject of transparency and accountability in health care.