Medicare Part D Drug Cost and Utilization Data

$79 / year

The 2015 Medicare Part D Drug Cost and Utilization Dataset presents drug spending and utilization information on Medicare Part D drugs (drugs patients generally administer themselves) and includes annual data for 2011 to 2015.

Complexity

Part D drug information is available from the Part D Prescription Drug Event (PDE) data and is available for a subset (~70%) of Medicare beneficiaries. For Part D drugs, spending is based on the gross drug cost, which represents total spending for the prescription claim, including Medicare, plan, and beneficiary payments.

PDE records were summarized by drug by linking National Drug Codes (NDCs), which are available in the PDE data, to the First Databank MedKnowledge database and aggregating by brand name and generic name. Any over-the-counter drugs in the PDE data were excluded from the analysis. Data from all Part D organization and plan types were included in the analysis. Data were aggregated across all strengths, dosage forms, and routes of administration, except for the unit cost change calculations, as described below.

The annual change in average cost per unit reflects the weighted percent change in average cost per unit from the prior year and is calculated for drugs utilized by more than 1,000 beneficiaries in both years. Since drugs are available in multiple strengths and dosage forms, the percentage change in unit cost was first calculated at the brand name, generic name, strength, dosage form, and route of administration level, and then a weighted average at the brand name and generic name level was calculated for inclusion in this file using the total number of claims as a weight. Note, manually calculating the percent change in unit cost using the overall “Average Cost per Unit” variables from each year may result in a difference between the weighted average percent change in unit cost reported in this file since the calculation does not account for differing strengths and dosage forms.

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

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare, CMS Drugs, CMS Drug Costs, Drug Utilization, Medicare Spending, Part D Drugs

Other Titles

Medicare Drug Spending Data, Medicare Drug Cost and Drug Spending, Medicare Part D Drug Cost and Utilization

Name Description Type Constraints
Brand_NameFirst Databank Brand Name of the drugstringrequired : 1
Generic_NameFirst Databank Generic Name of the drugstringrequired : 1
Claim_Count_2011Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refillsintegerlevel : Ratio
Total_Spending_2011Aggregate drug spending for the Part D programnumber-
Beneficiary_Count_2011Number of Medicare Part D beneficiaries utilizing the drugintegerlevel : 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 dispensed across 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 units. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit costnumber-
Beneficiary_Count_No_LIS_2011Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug costintegerlevel : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2011Average amount that beneficiaries without an LIS using the drug paid out of pocket during the yearnumber-
Beneficiary_Count_LIS_2011Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LISintegerlevel : Ratio
Average_Beneficiary_Cost_Share_LIS_2011Average amount that beneficiaries with an LIS using the drug paid out of pocket during the yearnumber-
Claim_Count_2012Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refillsintegerlevel : Ratio
Total_Spending_2012Aggregate drug spending for the Part D programnumber-
Beneficiary_Count_2012Number of Medicare Part D beneficiaries utilizing the drugintegerlevel : 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 dispensed across 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 units. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit costnumber-
Beneficiary_Count_No_LIS_2012Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug costintegerlevel : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2012Average amount that beneficiaries without an LIS using the drug paid out of pocket during the yearnumber-
Beneficiary_Count_LIS_2012Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LISintegerlevel : Ratio
Average_Beneficiary_Cost_Share_LIS_2012Average amount that beneficiaries with an LIS using the drug paid out of pocket during the yearnumber-
Claim_Count_2013Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refillsintegerlevel : Ratio
Total_Spending_2013Aggregate drug spending for the Part D programnumber-
Beneficiary_Count_2013Number of Medicare Part D beneficiaries utilizing the drugintegerlevel : 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 dispensed across 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 units. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit costnumber-
Beneficiary_Count_No_LIS_2013Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug costintegerlevel : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2013Average amount that beneficiaries without an LIS using the drug paid out of pocket during the yearnumber-
Beneficiary_Count_LIS_2013Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LISintegerlevel : Ratio
Average_Beneficiary_Cost_Share_LIS_2013Average amount that beneficiaries with an LIS using the drug paid out of pocket during the yearnumber-
Claim_Count_2014Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refillsintegerlevel : Ratio
Total_Spending_2014Aggregate drug spending for the Part D programnumber-
Beneficiary_Count_2014Number of Medicare Part D beneficiaries utilizing the drugintegerlevel : 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 dispensed across 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 units. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit costnumber-
Beneficiary_Count_No_LIS_2014Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug costintegerlevel : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2014Average amount that beneficiaries without an LIS using the drug paid out of pocket during the yearnumber-
Beneficiary_Count_LIS_2014Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LISintegerlevel : Ratio
Average_Beneficiary_Cost_Share_LIS_2014Average amount that beneficiaries with an LIS using the drug paid out of pocket during the yearnumber-
Claim_Count_2015Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refillsintegerlevel : Ratio
Total_Spending_2015Aggregate drug spending for the Part D programnumber-
Beneficiary_Count_2015Number of Medicare Part D beneficiaries utilizing the drugintegerlevel : 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 dispensed across 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 units. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit costnumber-
Beneficiary_Count_No_LIS_2015Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug costintegerlevel : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2015Average amount that beneficiaries without an LIS using the drug paid out of pocket during the yearnumber-
Beneficiary_Count_LIS_2015Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LISintegerlevel : Ratio
Average_Beneficiary_Cost_Share_LIS_2015Average amount that beneficiaries with an LIS using the drug paid out of pocket during the yearnumber-
Percent_Annual_Change_in_Average_Cost_Per_Unit_2015Weighted-average percent change in average cost per unit for all strengths, dosage forms, administration routes for the drug. Available for drugs utilized by more than 1,000 beneficiaries in 2014 and 2015integerlevel : Ratio
Brand_NameGeneric_NameClaim_Count_2011Total_Spending_2011Beneficiary_Count_2011Total_Annual_Spending_Per_User_2011Unit_Count_2011Average_Cost_Per_Unit_2011Beneficiary_Count_No_LIS_2011Average_Beneficiary_Cost_Share_No_LIS_2011Beneficiary_Count_LIS_2011Average_Beneficiary_Cost_Share_LIS_2011Claim_Count_2012Total_Spending_2012Beneficiary_Count_2012Total_Annual_Spending_Per_User_2012Unit_Count_2012Average_Cost_Per_Unit_2012Beneficiary_Count_No_LIS_2012Average_Beneficiary_Cost_Share_No_LIS_2012Beneficiary_Count_LIS_2012Average_Beneficiary_Cost_Share_LIS_2012Claim_Count_2013Total_Spending_2013Beneficiary_Count_2013Total_Annual_Spending_Per_User_2013Unit_Count_2013Average_Cost_Per_Unit_2013Beneficiary_Count_No_LIS_2013Average_Beneficiary_Cost_Share_No_LIS_2013Beneficiary_Count_LIS_2013Average_Beneficiary_Cost_Share_LIS_2013Claim_Count_2014Total_Spending_2014Beneficiary_Count_2014Total_Annual_Spending_Per_User_2014Unit_Count_2014Average_Cost_Per_Unit_2014Beneficiary_Count_No_LIS_2014Average_Beneficiary_Cost_Share_No_LIS_2014Beneficiary_Count_LIS_2014Average_Beneficiary_Cost_Share_LIS_2014Claim_Count_2015Total_Spending_2015Beneficiary_Count_2015Total_Annual_Spending_Per_User_2015Unit_Count_2015Average_Cost_Per_Unit_2015Beneficiary_Count_No_LIS_2015Average_Beneficiary_Cost_Share_No_LIS_2015Beneficiary_Count_LIS_2015Average_Beneficiary_Cost_Share_LIS_2015Percent_Annual_Change_in_Average_Cost_Per_Unit_2015
AVAGE TAZAROTENE 122431.543606.75
TL 45% UREA UREA 121581.157320.28
NASAREL FLUNISOLIDE 11527.423251.62
THIOTEPA THIOTEPA 187933.2157139.18
AVAILNEX CARBOCYSTEINE 16718.7612000.6
DELTASONE PREDNISONE 1561.6115.62030.3
PENTOPAK PENTOXIFYLLINE 11111.34200.27
RENAF SODIUM FLUORIDE 28170.8515810.12
SAXENDA LIRAGLUTIDE 1617676.2124073.65
ZOMACTON SOMATROPIN 1111469.9223397.07