CMS Releases Medicare Part D Prescription Drug Spending Data
The largest amount of spending -- more than $2.5 billion -- was on Pfizer's heartburn treatment Nexium, which was prescribed to about 1.5 million beneficiaries in 2013 (Thomas/Pear, New York Times, 4/30).
The data show that brand-name drugs for common conditions, such as acid reflux and asthma, made up Medicare Part D's three largest expenditures.
Meanwhile, prescriptions for Celgene's Revlimid, which is used to treat blood cancer, and Teva's multiple sclerosis treatment Copaxone, made up only 1% of claims but one-quarter of spending (Walker/Wilde Mathews, Wall Street Journal, 4/30).
The 10 most-common prescription drugs in 2013 all were generic (Adams, CQ HealthBeat, 4/30). Lisinopril, which is used for high blood pressure, was the most frequently prescribed drug, with about 36.9 million claims. The cholesterol drug simvastatin was the second-most frequently prescribed drug, appearing on about 36.7 million claims (Herman, Modern Healthcare, 4/30).
The data show that in total, Part D spent $103.7 billion on drugs. However, accounting for rebates from drugmakers, Part D spending was $69.7 billion in 2013 (Wall Street Journal, 4/30).
In releasing the data, though, CMS Deputy Administrator Sean Cavanaugh said, "We know that there are many, many smart minds in this country," adding, "We are excited to unleash those minds and see what they can find in our data" (New York Times, 4/30). Cavanaugh said the release could "help energize the private sector" to find efficiencies and improve Part D.
Generics Coming Soon
Medicare Part D spending has increased consistently since it began in 2006, with enrollment growth driving most of the growth, according to the Journal (Wall Street Journal, 4/30). However, some of the drugs that were most costly to Part D in 2013 are or soon will be available as generics, according to the Times. For example, Nexium's patent protection ended in 2014 and is now available in generic form (New York Times, 4/30).
The Pharmaceutical Research and Manufacturers of America in a statement said the data are "misleading," given that insurers often negotiate rebates that can go as high as 20% to 30% for branded drugs (Wall Street Journal, 4/30).
Further, American Medical Association President Robert Wah in a statement said the group is "troubled by the lack of context provided with the data that could help explain physician prescribing practices and pharmacy filling practices before conclusions are drawn."
CMS officials also warned against drawing too many conclusions from the data (Neergaard, AP/Los Angeles Times, 4/30).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.