Prescription drug spending for Medicare Parts B and D targeted for transparency
As prescription drugs prices continue to drive up healthcare spending, the Centers for Medicare and Medicaid Services is creating a new online dashboard to increase transparency and address affordability.
The dashboard will look at Medicare prescription drug spending for Parts B and D in such categories as spending per user and drugs with the highest cost increases.
CMS intends to release a similar list for Medicaid next year, it said.
Part D's, 3,761 qualified drugs had a total program spending of $121.5 billion in 2014, according to CMS. Of those, 115 drugs had a total program spending of $76.7 billion, representing 63 percent of program spending.
The 15 drugs topping spending account for $29.1 billion and 24 percent of program spending.
CMS shows 540 represents drugs had a 25 percent cost increase for $13.7 billion, or 11 percent of program costs.
The Part D drug, Humira, used to treat rheumatoid arthritis, had more than 50,000 beneficiaries using it in 2014, with total annual Part D spending per user of approximately $24,000 and total spending of $1.2 billion, CMS said.
In comparison, about 33,000 beneficiaries were using Sovaldi, which is used to treat Hepatitis C infections, with total annual spending per user of $94,000 and total Part D spending of $3.1 billion.
For Part B, 606 drugs represent $21.5 billion in spending, with 21 representing the highest spending at $12.8 billion, or 60 percent of program costs.
The top 15 highest spending drugs totalled $11.5 billion, and represented more than half, 53 percent of program costs.
For all drugs included on the list, CMS is displaying relevant spending, utilization, and trend data and also drug product descriptions, manufacturers, and clinical indications.
For the dashboard, CMS identified 40 drugs provided through the Medicare Prescription Drug Program under Part D and 40 drugs administered by physicians and other professionals in the Medicare fee-for-service program under Part B.
The drugs are selected because they rank in the top 15 in terms of total program spending or they are associated with a high annual per user spending based on claims data analysis.
The relatively small set of medications presented on the dashboard represents a very large proportion of program spending, including 33 percent of all Part D spending and 71 percent of Part B drug spending in 2014, CMS said.
Here is the full spending data on the 80 selected drugs, from CMS:
Brand | Generic Name | Coverage Type | Total Spending | Beneficiary Count | Unit Count | Beneficiary Cost Share | Annual Spending Per User | Avg Cost Per Unit | Average Annual Beneficiary Cost Share | Claim Count |
---|---|---|---|---|---|---|---|---|---|---|
Brand | Generic Name | Coverage Type | Total Spending | Beneficiary Count | Unit Count | Beneficiary Cost Share | Annual Spending Per User | Avg Cost Per Unit | Average Annual Beneficiary Cost Share | Claim Count |
Abilify | Aripiprazole | Part D | $2,527,319,031.60 | 405,161 | 88,198,691 | $49,598,419.68 | $6,237.83 | $28.65 | * | 2,964,075 |
Abraxane | Paclitaxel Protein-Bound | Part B | $276,345,661.22 | 17,733 | 29,216,874 | $55,960,035.18 | $15,583.69 | $9.46 | $3,155.70 | 124,144 |
Activase; Cathflo Activase | Alteplase | Part B | $38,263,515.60 | 56,521 | 631,241 | $7,062,091.26 | $676.98 | $60.62 | $124.95 | 85,617 |
Advair Diskus | Fluticasone/Salmeterol | Part D | $2,276,374,748.70 | 1,420,748 | 460,372,139 | $211,936,509.12 | $1,602.24 | $4.94 | * | 6,094,244 |
Alimta | Pemetrexed Disodium | Part B | $559,204,732.70 | 22,993 | 9,462,662 | $106,180,684.54 | $24,320.65 | $59.10 | $4,617.96 | 100,741 |
Aranesp | Darbepoetin Alfa In Albumn Sol; Darbepoetin Alfa In Polysorbat | Part B | $286,631,627.79 | 63,252 | 78,439,196 | $58,890,146.84 | $4,531.58 | $3.65 | $931.04 | 350,311 |
Atripla | Efavirenz/Emtricitab/Tenofovir | Part D | $577,030,155.94 | 29,484 | 8,400,201 | $9,441,611.05 | $19,570.96 | $68.69 | * | 264,074 |
Avastin | Bevacizumab | Part B | $1,063,835,621.50 | 216,357 | 16,421,928 | $201,495,178.87 | $4,917.04 | $64.78 | $931.31 | 885,129 |
Azacitidine; Vidaza | Azacitidine | Part B | $194,446,522.59 | 8,821 | 41,906,803 | $39,577,789.73 | $22,043.59 | $4.64 | $4,486.77 | 188,122 |
Brovana | Arformoterol Tartrate | Part B | $148,844,291.83 | 68,086 | 24,183,512 | $31,735,714.83 | $2,186.12 | $6.15 | $466.11 | 409,675 |
Capecitabine; Xeloda | Capecitabine | Part B | $274,454,628.60 | 27,052 | 8,737,998 | $56,050,968.50 | $10,145.45 | $31.41 | $2,071.97 | 114,953 |
Captopril | Captopril | Part D | $37,263,265.91 | 82,827 | 44,776,539 | $2,869,016.64 | $449.89 | $0.83 | * | 458,345 |
Clobetasol Propionate | Clobetasol Propionate | Part D | $167,415,145.68 | 998,143 | 111,203,886 | $17,805,093.26 | $167.73 | $1.51 | * | 1,954,141 |
Clomipramine Hcl | Clomipramine HCL | Part D | $79,334,397.90 | 17,991 | 9,892,402 | $2,277,563.80 | $4,409.67 | $8.02 | * | 135,792 |
Copaxone | Glatiramer Acetate | Part D | $1,221,108,238.27 | 26,851 | 2,098,371 | $46,550,783.63 | $45,477.20 | $581.93 | * | 226,053 |
Crestor | Rosuvastatin Calcium | Part D | $2,543,786,425.72 | 1,752,704 | 419,224,451 | $370,196,109.42 | $1,451.35 | $6.07 | * | 9,073,952 |
Cubicin | Daptomycin | Part B | $91,580,070.34 | 15,926 | 142,106,378 | $18,617,769.77 | $5,750.35 | $0.64 | $1,169.02 | 127,456 |
Cyanocobalamin Injection | Cyanocobalamin (Vitamin B-12) | Part B | $4,822,427.48 | 583,190 | 2,334,618 | $1,286,268.93 | $8.27 | $2.07 | $2.21 | 2,322,568 |
Cyclophosphamide | Cyclophosphamide | Part B | $91,168,573.76 | 33,812 | 1,632,441 | $18,141,631.65 | $2,696.34 | $55.85 | $536.54 | 131,804 |
Digoxin; Digox | Digoxin | Part D | $217,958,706.40 | 916,472 | 232,082,170 | $38,977,521.11 | $237.82 | $0.94 | * | 5,024,757 |
Divalproex Sodium ER | Divalproex Sodium | Part D | $357,176,774.84 | 275,739 | 147,563,209 | $10,773,299.14 | $1,295.34 | $2.42 | * | 1,986,710 |
Doxazosin Mesylate | Doxazosin Mesylate | Part D | $102,415,256.03 | 599,375 | 181,545,024 | $23,522,590.16 | $170.87 | $0.56 | * | 3,125,479 |
Duloxetine HCl | Duloxetine HCl | Part D | $1,426,877,758.40 | 1,161,079 | 316,724,503 | $142,168,816.11 | $1,228.92 | $4.51 | * | 7,047,482 |
Enbrel | Etanercept | Part D | $1,198,397,787.78 | 53,459 | 1,849,495 | $45,299,112.47 | $22,417.14 | $647.96 | * | 375,300 |
Epogen; Procrit | Epoetin Alfa | Part B | $303,550,323.94 | 95,774 | 26,951,893 | $62,873,741.65 | $3,169.44 | $11.26 | $656.48 | 731,690 |
Erbitux | Cetuximab | Part B | $257,845,777.54 | 9,474 | 4,957,519 | $52,265,908.32 | $27,216.15 | $52.01 | $5,516.77 | 78,911 |
Eylea | Aflibercept | Part B | $1,295,189,434.49 | 132,511 | 1,345,094 | $263,976,678.53 | $9,774.20 | $962.90 | $1,992.11 | 625,239 |
Faslodex | Fulvestrant | Part B | $172,864,427.14 | 14,554 | 1,938,944 | $35,224,736.96 | $11,877.45 | $89.15 | $2,420.28 | 99,107 |
Gammagard Liquid | Immune Globulin,gamma(IGG) | Part B | $253,466,882.70 | 12,135 | 6,373,808 | $50,872,805.96 | $20,887.26 | $39.77 | $4,192.24 | 80,988 |
Gammaked; Gamunex; Gamunex-C | Immune Glob,gam Caprylate(IGG) | Part B | $245,937,276.29 | 9,579 | 6,246,629 | $48,964,621.02 | $25,674.63 | $39.37 | $5,111.66 | 69,669 |
Gleevec | Imatinib Mesylate | Part D | $995,836,211.55 | 14,388 | 5,534,594 | $37,726,863.34 | $69,212.97 | $179.93 | * | 118,319 |
Glucagen; Glucagon Emergency Kit | Glucagon,human Recombinant | Part B | $8,624,803.36 | 53,168 | 63,725 | $1,787,240.11 | $162.22 | $135.34 | $33.61 | 56,496 |
Harvoni | Ledipasvir/Sofosbuvir | Part D | $699,892,572.27 | 11,718 | 612,518 | $16,288,447.13 | $59,727.99 | $1,142.65 | * | 21,799 |
Herceptin | Trastuzumab | Part B | $560,661,666.26 | 18,476 | 6,994,748 | $110,327,234.34 | $30,345.40 | $80.15 | $5,971.38 | 175,613 |
Hizentra | Immune Globulin,gamma(IGG) | Part B | $162,035,365.66 | 2,964 | 11,483,983 | $32,961,851.25 | $54,667.80 | $14.11 | $11,120.73 | 32,058 |
Humira | Adalimumab | Part D | $1,239,853,884.21 | 51,557 | 931,166 | $34,774,570.43 | $24,048.22 | $1,331.51 | * | 362,301 |
Invega Sustenna | Paliperidone Palmitate | Part D | $540,403,968.98 | 43,399 | 424,436 | $2,519,703.54 | $12,451.99 | $1,273.23 | * | 360,049 |
Isentress | Raltegravir Potassium | Part D | $402,900,253.82 | 39,533 | 21,097,312 | $5,674,384.60 | $10,191.49 | $19.10 | * | 339,586 |
Januvia | Sitagliptin Phosphate | Part D | $1,775,295,532.62 | 789,934 | 183,579,143 | $156,513,130.02 | $2,247.40 | $9.67 | * | 4,496,501 |
Lantus | Insulin Glargine,Hum.Rec.Anlog | Part D | $1,725,595,628.80 | 787,204 | 80,207,645 | $144,306,997.22 | $2,192.06 | $21.51 | * | 4,284,694 |
Lantus Solostar | Insulin Glargine,Hum.Rec.Anlog | Part D | $2,016,972,756.51 | 973,018 | 92,786,715 | $204,953,012.76 | $2,072.90 | $21.74 | * | 4,442,309 |
Letairis | Ambrisentan | Part D | $396,586,842.88 | 6,566 | 1,674,225 | $14,961,141.47 | $60,400.07 | $236.88 | * | 55,082 |
Levulan | Aminolevulinic Acid HCl | Part B | $35,284,381.51 | 85,955 | 150,342 | $7,625,866.94 | $410.50 | $234.69 | $88.72 | 130,447 |
Lucentis | Ranibizumab | Part B | $1,331,252,582.94 | 141,606 | 3,412,380 | $271,419,525.61 | $9,401.10 | $390.12 | $1,916.72 | 674,456 |
Lyrica | Pregabalin | Part D | $1,404,488,159.74 | 791,187 | 327,999,529 | $122,982,180.38 | $1,775.17 | $4.28 | * | 4,487,076 |
Namenda | Memantine HCl | Part D | $1,375,513,421.03 | 722,050 | 271,104,556 | $155,620,336.55 | $1,905.01 | $5.07 | * | 5,240,372 |
Neulasta | Pegfilgrastim | Part B | $1,173,794,492.59 | 98,519 | 358,909 | $238,138,627.74 | $11,914.40 | $3,270.45 | $2,417.18 | 343,347 |
Nexium | Esomeprazole Magnesium | Part D | $2,660,421,777.37 | 1,405,799 | 340,404,485 | $169,788,270.55 | $1,892.46 | $7.82 | * | 7,538,790 |
Olysio | Simeprevir Sodium | Part D | $833,253,318.73 | 12,646 | 1,035,249 | $14,984,704.90 | $65,890.66 | $804.88 | * | 36,946 |
Orencia | Abatacept; Abatacept/Maltose | Part B | $342,183,172.43 | 20,147 | 12,536,347 | $69,911,177.14 | $16,984.32 | $27.30 | $3,470.05 | 166,300 |
Perforomist | Formoterol Fumarate | Part B | $68,528,578.16 | 28,204 | 10,192,138 | $14,584,815.82 | $2,429.75 | $6.72 | $517.12 | 170,546 |
Prednisolone Acetate | Prednisolone Acetate | Part D | $159,572,405.97 | 1,468,915 | 19,744,965 | $24,017,325.19 | $108.63 | $8.08 | * | 2,538,652 |
Prezista | Darunavir Ethanolate | Part D | $393,062,758.53 | 38,057 | 13,624,339 | $4,275,799.98 | $10,328.26 | $28.85 | * | 324,561 |
Privigen | Immune Globulin,gamma(IGG) | Part B | $189,572,071.51 | 9,327 | 5,221,835 | $37,803,173.87 | $20,325.09 | $36.30 | $4,053.09 | 57,587 |
Prolia; Xgeva | Denosumab | Part B | $767,348,546.46 | 294,936 | 54,337,459 | $157,587,692.19 | $2,601.75 | $14.12 | $534.31 | 645,230 |
Provenge | Sipuleucel-T/Lactated Ringers | Part B | $173,560,758.24 | 1,913 | 5,125 | $27,801,374.19 | $90,727.00 | $33,865.51 | $14,532.87 | 4,955 |
Rapamune; Sirolimus | Sirolimus | Part B | $52,843,561.42 | 7,692 | 3,571,903 | $10,932,574.95 | $6,869.94 | $14.79 | $1,421.29 | 60,678 |
Remicade | Infliximab | Part B | $1,172,607,401.57 | 59,748 | 16,586,908 | $237,141,973.63 | $19,625.89 | $70.69 | $3,969.04 | 347,717 |
Remodulin | Treprostinil Sodium | Part B | $165,298,156.47 | 1,235 | 2,720,585 | $33,582,264.00 | $133,844.66 | $60.76 | $27,192.12 | 10,395 |
Revlimid | Lenalidomide | Part D | $1,671,622,656.69 | 27,143 | 3,707,616 | $82,121,407.28 | $61,585.77 | $450.86 | * | 178,377 |
Rituxan | Rituximab | Part B | $1,501,312,601.36 | 68,708 | 2,181,624 | $290,093,486.20 | $21,850.62 | $688.16 | $4,222.12 | 267,815 |
Sandostatin LAR | Octreotide Acetate | Part B | $341,508,778.97 | 10,594 | 2,627,964 | $68,599,720.12 | $32,236.06 | $129.95 | $6,475.34 | 84,936 |
Sovaldi | Sofosbuvir | Part D | $3,106,960,980.51 | 33,033 | 3,055,478 | $56,680,955.28 | $94,056.28 | $1,016.85 | * | 109,556 |
Spiriva | Tiotropium Bromide | Part D | $2,158,439,227.38 | 1,212,078 | 228,994,462 | $212,320,667.29 | $1,780.78 | $9.43 | * | 5,852,896 |
Tarceva | Erlotinib HCl | Part D | $422,596,683.23 | 13,317 | 2,478,963 | $25,980,536.43 | $31,733.62 | $170.47 | * | 69,976 |
Targretin | Bexarotene | Part D | $73,523,400.47 | 829 | 504,793 | $2,601,777.12 | $88,689.26 | $145.65 | * | 4,548 |
Tecfidera | Dimethyl Fumarate | Part D | $599,047,000.15 | 16,068 | 7,082,069 | $18,935,158.08 | $37,281.99 | $84.59 | * | 100,683 |
Thyrogen | Thyrotropin Alfa | Part B | $13,680,897.08 | 5,324 | 10,757 | $2,793,557.45 | $2,569.67 | $1,271.81 | $524.71 | 8,476 |
Tracleer | Bosentan | Part D | $404,254,914.09 | 5,765 | 3,170,382 | $15,420,303.27 | $70,122.27 | $127.51 | * | 53,091 |
Treanda | Bendamustine HCl | Part B | $303,255,151.23 | 13,345 | 14,262,225 | $57,257,985.42 | $22,724.25 | $21.26 | $4,290.59 | 74,810 |
Truvada | Emtricitabine/Tenofovir | Part D | $665,461,659.29 | 58,350 | 15,309,710 | $8,576,526.66 | $11,404.66 | $43.47 | * | 495,383 |
Tysabri | Natalizumab | Part B | $256,002,009.46 | 7,302 | 18,094,113 | $52,163,007.37 | $35,059.16 | $14.15 | $7,143.66 | 59,972 |
Tyvaso | Treprostinil; Treprostinil/Neb Accessories; Treprostinil/Nebulizer/Accesor | Part B | $204,903,497.51 | 2,059 | 441,354 | $41,675,049.41 | $99,516.03 | $464.26 | $20,240.43 | 15,941 |
Ursodiol | Ursodiol | Part D | $79,888,946.03 | 71,896 | 39,563,065 | $9,852,558.44 | $1,111.17 | $2.02 | * | 370,376 |
Velcade | Bortezomib | Part B | $471,660,024.32 | 20,371 | 10,474,963 | $95,965,518.95 | $23,153.50 | $45.03 | $4,710.89 | 272,954 |
Vimovo | Naproxen/Esomeprazole Mag | Part D | $38,879,753.75 | 21,291 | 3,119,158 | $1,816,591.56 | $1,826.11 | $12.46 | * | 48,972 |
Xolair | Omalizumab | Part B | $220,125,530.69 | 11,463 | 8,432,875 | $44,902,840.91 | $19,203.13 | $26.10 | $3,917.20 | 122,625 |
Xtandi | Enzalutamide | Part D | $447,311,084.46 | 11,800 | 6,444,098 | $24,567,059.52 | $37,907.72 | $69.41 | * | 53,980 |
Yervoy | Ipilimumab | Part B | $265,378,988.15 | 2,881 | 2,059,976 | $27,560,982.18 | $92,113.50 | $128.83 | $9,566.46 | 8,026 |
Zytiga | Abiraterone Acetate | Part D | $707,097,864.76 | 17,044 | 11,836,159 | $41,003,957.93 | $41,486.61 | $59.74 | * | 98,469 |
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