Medicare Part B Drug Cost and Utilization Data

$179 / year

The 2015 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 2011 to 2015.

Complexity

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).

Date Created

2015

Last Modified

2016-06-12

Version

2016-06-12

Update Frequency

Annual

Temporal Coverage

2011-2015

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

NameDescriptionTypeConstraints
HCPCS_CodeHealthcare Common Procedure Coding System (HCPCS) code for the drugstringrequired : 1
HCPCS_DescriptionHCPCS Description of the drugstringrequired : 1
Claim_Count_2011Number of Medicare Part B claims for the year 2011integerlevel : Ratio
Total_Spending_2011Aggregate drug spending for the Part B program for 2011number-
Beneficiary_Count_2011Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2011integerlevel : Ratio
Total_Annual_Spending_Per_User_2011Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit yearnumber-
Unit_Count_2011Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units)numberlevel : Ratio
Average_Cost_Per_Unit_2011Total Spending divided by the number of dosage unitsnumber-
Average_Beneficiary_Cost_Share_2011Average amount that beneficiaries using the drug paid out of pocket during the yearnumber-
Claim_Count_2012Number of Medicare Part B claims for the year 2012integerlevel : Ratio
Total_Spending_2012Aggregate drug spending for the Part B program for 2012number-
Beneficiary_Count_2012Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2012integerlevel : Ratio
Total_Annual_Spending_Per_User_2012Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit yearnumber-
Unit_Count_2012Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units)numberlevel : Ratio
Average_Cost_Per_Unit_2012Total Spending divided by the number of dosage unitsnumber-
Average_Beneficiary_Cost_Share_2012Average amount that beneficiaries using the drug paid out of pocket during the yearnumber-
Claim_Count_2013Number of Medicare Part B claims for the year 2013integerlevel : Ratio
Total_Spending_2013Aggregate drug spending for the Part B program for 2013number-
Beneficiary_Count_2013Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2013integerlevel : Ratio
Total_Annual_Spending_Per_User_2013Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit yearnumber-
Unit_Count_2013Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units)numberlevel : Ratio
Average_Cost_Per_Unit_2013Total Spending divided by the number of dosage unitsnumber-
Average_Beneficiary_Cost_Share_2013Average amount that beneficiaries using the drug paid out of pocket during the yearnumber-
Claim_Count_2014Number of Medicare Part B claims for the year 2014integerlevel : Ratio
Total_Spending_2014Aggregate drug spending for the Part B program for 2014number-
Beneficiary_Count_2014Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2014integerlevel : Ratio
Total_Annual_Spending_Per_User_2014Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit yearnumber-
Unit_Count_2014Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units)numberlevel : Ratio
Average_Cost_Per_Unit_2014Total Spending divided by the number of dosage unitsnumber-
Average_Beneficiary_Cost_Share_2014Average amount that beneficiaries using the drug paid out of pocket during the yearnumber-
Claim_Count_2015Number of Medicare Part B claims for the year 2015integerlevel : Ratio
Total_Spending_2015Aggregate drug spending for the Part B program for 2015number-
Beneficiary_Count_2015Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2015integerlevel : Ratio
Total_Annual_Spending_Per_User_2015Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit yearnumber-
Unit_Count_2015Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units)numberlevel : Ratio
Average_Cost_Per_Unit_2015Total Spending divided by the number of dosage unitsnumber-
Average_Beneficiary_Cost_Share_2015Average amount that beneficiaries using the drug paid out of pocket during the yearnumber-
Percent_Annual_Change_in_Average_Cost_Per_Unit_2015Annual change in average cost per unit reflects the percent change in average cost per unit between 2014 and 2015. The average cost per unit is calculated for each year at the HCPCS level by dividing the total payment by total units and then a percentage change in unit costs between the two years is calculated. Available for drugs utilized by more than 5,000 beneficiaries in 2014 and 2015.integerlevel : Ratio
HCPCS_CodeHCPCS_DescriptionClaim_Count_2011Total_Spending_2011Beneficiary_Count_2011Total_Annual_Spending_Per_User_2011Unit_Count_2011Average_Cost_Per_Unit_2011Average_Beneficiary_Cost_Share_2011Claim_Count_2012Total_Spending_2012Beneficiary_Count_2012Total_Annual_Spending_Per_User_2012Unit_Count_2012Average_Cost_Per_Unit_2012Average_Beneficiary_Cost_Share_2012Claim_Count_2013Total_Spending_2013Beneficiary_Count_2013Total_Annual_Spending_Per_User_2013Unit_Count_2013Average_Cost_Per_Unit_2013Average_Beneficiary_Cost_Share_2013Claim_Count_2014Total_Spending_2014Beneficiary_Count_2014Total_Annual_Spending_Per_User_2014Unit_Count_2014Average_Cost_Per_Unit_2014Average_Beneficiary_Cost_Share_2014Claim_Count_2015Total_Spending_2015Beneficiary_Count_2015Total_Annual_Spending_Per_User_2015Unit_Count_2015Average_Cost_Per_Unit_2015Average_Beneficiary_Cost_Share_2015Percent_Annual_Change_in_Average_Cost_Per_Unit_2015
J3485Injection, zidovudine, 10 mg111672.6311351.47
J7505Muromonab-cd3, parenteral, 5 mg1616935.328459.63
Q4123Alloskin rt, per square centimeter118993.568513.13
J2704Injection, propofol, 10 mg3971057660.22235442.454908060.120.51
J8561Everolimus, oral, 0.25 mg32575333304.855559609.5688817661923.32
J7513Daclizumab, parenteral, 25 mg101107404.28861248.89206521.38248.57
WW141Fludarabine Phosphate, oral, 10mg57118044.23244918.51156375.52993.5
J1840Injection, kanamycin sulfate, up to 500 mg43468.263912.01637.432.54
J2504Injection, pegademase bovine, 25 iu1136858.51113350.77150245.72633.1
J1655Injection, tinzaparin sodium, 1000 iu39926284.6980328.5661234.2973.52