Medicare Part B Drug Cost and Utilization Data 2019-2023
The Medicare Part B Drug Cost and Utilization Dataset presents drug spending and utilization information on Medicare Part B drugs (drugs administered in doctors’ offices and other outpatient settings) and includes annual data for 2019 to 2023.
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Medicare Part B claims (e.g. physician and other suppliers, durable medical equipment and other supplies, hospital outpatient data) contain information on drugs administered and billed directly by providers. Analyses of Part B drugs are possible for all Part B fee-for-service Medicare beneficiaries, but exclude any beneficiaries in the Medicare Advantage program. Drug spending metrics for Part B drugs are based on total spending, which is derived from summing the three revenue center payment fields on the claim referring to Medicare payment, deductible, and coinsurance. This represents the full value of the product, including the Medicare payment and beneficiary liability.
Part B claims were summarized by Healthcare Common Procedure Coding System (HCPCS) codes and limited to HCPCS codes listed in the publicly available Medicare Average Sales Price (ASP) quarterly files at any point in the prior 5 years. In addition to the HCPCS listed in the ASP drug lists, oral anti-cancer drugs identified by HCPCS beginning with ‘WW’ were included. Part B claims were excluded if Medicare was not the primary payer or if the drugs were billed using “Not Otherwise Classified” (NOC) codes (e.g. J3490, J3590, or J9999), since identification of NOC drugs are not specified on the claim. In addition, Part B institutional claims submitted by critical access hospitals (CAHs), Maryland hospitals, as well as claims with total spending amounts of zero associated with the drug, which is due to bundling in Ambulatory Payment Classification groups, were excluded.
Claims data were averaged across any applicable modifiers or place of service indicators associated with a single HCPCS. Drugs with multiple strengths (e.g. 20mg, 40mg, 80mg) were not combined when individual HCPCS codes exist for different strengths (e.g., methylprednisolone has different HCPCS codes for 20mg, 40mg, and 80mg).
**OUTLIER FLAGS**
Average Spending per Dosage Unit is a key measure in the Medicare Part B Spending by Drug dataset. Incorrect dosage unit values reported on a small percentage of records may result in a misrepresentation of the overall “Average Spending per Dosage Unit” and “Change in Average Spending per Dosage Unit”. To address this concern, potentially anomalous drugs are identified as outliers so that users can exercise caution when interpreting results.
In the full underlying data file, potentially anomalous drugs are identified using a yearly outlier flag variable, which is set to “1” when a drug’s Average Spending per Dosage Unit is substantially impacted by outlier records in a given year.
There are three methods by which drugs are identified as outliers within the Medicare Part B Spending by Drug dataset:
**1.5 IQR Outlier Identification**
– For each Medicare Part B Drug (HCPCS), lower and upper bounds for average cost per dosage unit are defined as:
– Lower Bound: 25th percentile – 1.5*Interquartile Range
– Upper Bound: 75th percentile + 1.5*Interquartile Range
– Claim lines that fall outside of these bounds are flagged. Additionally, claim lines associated with HCPCSs for which there are fewer than 30 claim lines in total are flagged.
– Average Spend per dosage unit are calculated with and without flagged claim lines; if these values differ by over 10% and $1, the drug is identified as an outlier.
**Physician vs. Outpatient Outlier Identification**
– Medicare Part B Drugs are comprised of both physician and outpatient claims. In some cases, billing units may differ between settings.
– If both the average physician spend per dosage unit and average outpatient spend per dosage unit differ from the overall average spend per dosage unit by > 10% and $1, the drug is identified as an outlier.
**Low Record Count Identification**
– Methods 1 and 2 require robust distributions of data to identify outliers (i.e. observations outside of an established norm). In cases where a drug has fewer than 30 observations, it is flagged since there is not enough data to identify outliers.
About this Dataset
Data Info
Date Created
2020
Last Modified
2025-05-29
Version
2025-05-29
Update Frequency
Annual
Temporal Coverage
2019-2023
Spatial Coverage
United States
Source
John Snow Labs; Centers for Medicare and Medicaid Services;
Source License URL
Source License Requirements
N/A
Source Citation
N/A
Keywords
Medicare, CMS Drugs, CMS Drug Costs, Drug Utilization, Medicare Spending, Part B Drugs Cost
Other Titles
Medicare Drug Spending Data, Medicare Drug Cost and Drug Spending, Medicare Part B Drug Cost and Utilization
Data Fields
Name
Description
Type
Constraints
HCPCS_Code
Healthcare Common Procedure Coding System (HCPCS) code for the drug
string
required : 1
HCPCS_Description
HCPCS Description of the drug
string
required : 1
Brand_Name
Name of the drug furnished by the provider. This includes both brand names (drugs that have a trademarked name) and generic names (drugs that do not have a trademarked name).
string
required : 1
Generic_Name
A term referring to the chemical ingredient of a drug rather than the trademarked brand name under which the drug is sold.
string
-
Total_Spending_2019
Aggregate drug spending for the Part B program for 2019
number
level : Number
Total_Dosage_Units_2019
The sum of the dosage units of medication dispensed across the calendar year 2019 (e.g. number of tablets, grams, milliliters or other units). For Part B, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2019
Number of Medicare Part B claims for the year 2019 for each drug.
integer
level : Ratio
Total_Beneficiaries_2019
Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2019.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2019
Part B drug spending divided by the number of dosage units during the year 2019.
number
level : Ratio
Average_Spending_Per_Claim_2019
Part B drug spending divided by the number of claims during the year 2019.
number
level : Ratio
Average_Spending_Per_Beneficiary_2019
Total Part B drug costs divided by the number of unique beneficiaries utilizing the drug during the benefit year 2019.
number
level : Ratio
Outlier_Flag_2019
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2019. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2020
Aggregate drug spending for the Part B program for 2020
number
level : Ratio
Total_Dosage_Units_2020
The sum of the dosage units of medication dispensed across the calendar year 2020 (e.g. number of tablets, grams, milliliters or other units). For Part B, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2020
Number of Medicare Part B claims for the year 2020 for each drug.
integer
level : Ratio
Total_Beneficiaries_2020
Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2020.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2020
Part B drug spending divided by the number of dosage units during the year 2020.
number
level : Ratio
Average_Spending_Per_Claim_2020
Part B drug spending divided by the number of claims during the year 2020.
number
level : Ratio
Average_Spending_Per_Beneficiary_2020
Total Part B drug costs divided by the number of unique beneficiaries utilizing the drug during the benefit year 2020.
number
level : Ratio
Outlier_Flag_2020
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2020. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2021
Aggregate drug spending for the Part B program for 2021.
number
level : Ratio
Total_Dosage_Units_2021
The sum of the dosage units of medication dispensed across the calendar year 2021 (e.g. number of tablets, grams, milliliters or other units). For Part B, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2021
Number of Medicare Part B claims for the year 2021 for each drug.
integer
level : Ratio
Total_Beneficiaries_2021
Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2021.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2021
Part B drug spending divided by the number of dosage units during the year 2021.
number
level : Ratio
Average_Spending_Per_Claim_2021
Part B drug spending divided by the number of claims during the year 2021.
number
level : Ratio
Average_Spending_Per_Beneficiary_2021
Total Part B drug costs divided by the number of unique beneficiaries utilizing the drug during the benefit year 2021.
number
level : Ratio
Outlier_Flag_2021
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2021. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2022
Aggregate drug spending for the Part B program for 2022.
number
level : Ratio
Total_Dosage_Units_2022
The sum of the dosage units of medication dispensed across the calendar year 2022 (e.g. number of tablets, grams, milliliters or other units). For Part B, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2022
Number of Medicare Part B claims for the year 2022 for each drug.
integer
level : Ratio
Total_Beneficiaries_2022
Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2022.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2022
Part B drug spending divided by the number of dosage units during the year 2022.
number
level : Ratio
Average_Spending_Per_Claim_2022
Part B drug spending divided by the number of claims during the year 2022.
number
level : Ratio
Average_Spending_Per_Beneficiary_2022
Total Part B drug costs divided by the number of unique beneficiaries utilizing the drug during the benefit year 2022.
number
level : Ratio
Outlier_Flag_2022
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2022. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2023
Aggregate drug spending for the Part B program for 2023.
number
level : Ratio
Total_Dosage_Units_2023
The sum of the dosage units of medication dispensed across the calendar year 2023 (e.g. number of tablets, grams, milliliters or other units). For Part B, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2023
Number of Medicare Part B claims for the year 2023 for each drug.
integer
level : Ratio
Total_Beneficiaries_2023
Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2023.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2023
Part B drug spending divided by the number of dosage units during the year 2023.
number
level : Ratio
Average_Spending_Per_Claim_2023
Part B drug spending divided by the number of claims during the year 2023.
number
level : Ratio
Average_Spending_Per_Beneficiary_2023
Total Part B drug costs divided by the number of unique beneficiaries utilizing the drug during the benefit year 2023.
number
level : Ratio
Outlier_Flag_2023
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2023. The description of dataset contains additional details.
The constant average change in spending per unit over the most recent five years (2019-2023) of data availability, calculated using the compound annual growth rate (CAGR).
number
level : Ratio
Data Preview
HCPCS Code
HCPCS Description
Brand Name
Generic Name
Total Spending 2019
Total Dosage Units 2019
Total Claims 2019
Total Beneficiaries 2019
Average Spending Per Dosage Unit 2019
Average Spending Per Claim 2019
Average Spending Per Beneficiary 2019
Outlier Flag 2019
Total Spending 2020
Total Dosage Units 2020
Total Claims 2020
Total Beneficiaries 2020
Average Spending Per Dosage Unit 2020
Average Spending Per Claim 2020
Average Spending Per Beneficiary 2020
Outlier Flag 2020
Total Spending 2021
Total Dosage Units 2021
Total Claims 2021
Total Beneficiaries 2021
Average Spending Per Dosage Unit 2021
Average Spending Per Claim 2021
Average Spending Per Beneficiary 2021
Outlier Flag 2021
Total Spending 2022
Total Dosage Units 2022
Total Claims 2022
Total Beneficiaries 2022
Average Spending Per Dosage Unit 2022
Average Spending Per Claim 2022
Average Spending Per Beneficiary 2022
Outlier Flag 2022
Total Spending 2023
Total Dosage Units 2023
Total Claims 2023
Total Beneficiaries 2023
Average Spending Per Dosage Unit 2023
Average Spending Per Claim 2023
Average Spending Per Beneficiary 2023
Outlier Flag 2023
Percent Change In Average Spending Per Dosage Unit 22 23
Percent Annual Growth Rate In Avg Spending Per Dosage Unit 19 23
90371
Hepatitis b immune globulin for injection into muscle
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Hepatitis B Immune Globulin*
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Rabies immune globulin for injection
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0
0.044688767000000004
0.01193584
90376
Rabies immune globulin for injection beneath the skin and/or into muscle, heat-treated
Imogam Rabies-HT
Rabies Immune Globulin/PF
1258402.96
4708.0
498.0
491.0
267.2903483
2526.9135739999997
2562.938819
0.0
888330.15
3303.0
348.0
348.0
268.9464578
2552.672845
2552.672845
0.0
871343.32
3065.0
333.0
329.0
284.2881958
2616.646607
2648.459939
0.0
1162752.22
3457.0
373
372
336.3471854
3117.298177
3125.678011
0
481219.13
1791.0
207
207
268.6873981
2324.7300969999997
2324.7300969999997
0
-0.201160557
0.001304125
90377
Rabies immune globulin for injection beneath the skin and/or into muscle
Kedrab
Rabies Immune Globulin/PF
41097.88
183.0
16.0
16.0
224.57857919999998
2568.6175
2568.6175
1.0
713054.99
3078.0
336
334
231.66179010000002
2122.18747
2134.89518
0
2018800.83
8585.0
864
862
235.15443560000003
2336.5750350000003
2341.996323
0
0.015076485
0.023275137999999997
90632
Hepatitis a vaccine adult dosage
Havrix*
Hepatitis A Virus Vaccine/PF*
80365.23
1408.0
1408.0
1318.0
57.07757813
57.07757813
60.97513657
0.0
38403.54
657.0
657.0
649.0
58.45287671
58.45287671
59.17340524
0.0
6230.07
95.0
95.0
88.0
65.57968421
65.57968421
70.79625
0.0
4945.47
77.0
77
69
64.22688312
64.22688312
71.67347826
0
7695.51
91.0
91
89
84.56604396
84.56604396
86.46640449
1
0.316676754
0.103272059
90662
Influenza vaccine split virus, preservative free
Fluzone High-Dose 2017-2018*
Flu Vacc TS2017-18(65yr Up)/PF*
428151655.8
8274233.0
8263912.0
8149914.0
51.74517757
51.80980337
52.53449985
0.0
473373374.9
8280408.7
8270242.0
8112063.0
57.16787565
57.23815275
58.35425278
0.0
477053148.1
7674493.7
7674248.0
7631960.0
62.16086256
62.16285271
62.50729146
0.0
541191611.5
8178440.9
8168347
8069863
66.17295621
66.25472835
67.06329606
0
428126152.0
6190009.4
6189923
6134456
69.16405523
69.16502063
69.79040228
0
0.04520123
0.07523314099999999
90670
Pneumococcal vaccine, 13-valent
Prevnar 13
Pneumoc 13-Val Conj-Dip Crm/PF
389206761.9
1947818.0
1947732.0
1931520.0
199.8168011
199.82562380000002
201.5028381
0.0
282435113.8
1292895.1
1292858.0
1284878.0
218.4516855
218.4579542
219.8147324
0.0
129033793.8
559938.0
559848.0
555013.0
230.4430022
230.4800477
232.4878764
0.0
55181214.98
235723.5
235701
232092
234.0929733
234.11531980000004
237.7557821
0
13946103.9
59419.0
59404
58121
234.70781910000002
234.7670847
239.94948300000001
0
0.002626503
0.041055515
90671
Pneumococcal conjugate vaccine, 15 valent (pcv15), for intramuscular use
Vaxneuvance
Pneumoc 15-Val Conj-Dip Crm/PF
5843123.82
24566.0
24565
24463
237.8541
237.86378259999998
238.8555705
0
9219596.56
39234.5
39235
38719
234.9869773
234.9839827
238.115565
0
-0.012054124
-0.012054124
90672
Influenza vaccine, quadrivalent for nasal administration
Flumist Quad 2018-2019*
Flu Vacc Qv Live 2018(2-49yrs)*
10407.75
391.0
391.0
388.0
26.61828645
26.61828645
26.82409794
0.0
12966.53
396.0
396.0
394.0
32.74376263
32.74376263
32.90997462
1.0
13316.69
352.0
352.0
346.0
37.83150568
37.83150568
38.48754335
1.0
8569.49
324.0
324
319
26.44904321
26.44904321
26.86360502
0
7635.84
314.0
314
310
24.31796178
24.31796178
24.63174194
0
-0.080573101
-0.022342426000000002
90674
Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free
Demos
