Medicare Part D Prescriber Utilization and Payment Data 2013

$395 / year

The Medicare Part D Prescriber Public Use File provides information on prescription drug events (PDEs) incurred by Medicare beneficiaries with a Part D prescription drug plan for the year 2013. The Part D Prescriber PUF is organized by National Provider Identifier (NPI) and drug name and contains information on drug utilization (claim counts and day supply) and total drug costs.

Complexity

The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other healthcare providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.

Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries).

Date Created

2015-04-30

Last Modified

2017-05-25

Version

2017-05-25

Update Frequency

Annual

Temporal Coverage

2013

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

Prescriber Data, Prescription Drug Plans, Medicare Part D, Medicare Advantage, Medicare Prescription Drug Coverage, Medicare Claims Data, Provider Summary

Other Titles

Medicare Part D Prescriber Public Use File Data 2013, Medicare Provider Utilization And Payment Part D Prescriber Data 2013

Name Description Type Constraints
National_Provider_IdentifierNational Provider Identifier (NPI) for the performing provider on the claim.string-
Last_Name_Organization_NameWhen the provider is registered in NPPES as an individual, this is the provider’s last name. When the provider is registered as an organization, this is the organization name.string-
First_NameWhen the provider is registered in NPPES as an individual, this is the provider’s first name. When the provider is registered as an organization, this will be blank.string-
Middle_InitialMiddle Initial of the Providerstring-
CredentialsCredentials of the Providerstring-
GenderGender of the Providerstring-
Entity_CodeEntity Type of the Provider, Individual or organizationstring-
Street_Address_1Street Address 1 of the Providerstring-
Street_Address_2Street Address 2 of the Providerstring-
CityThe city where the provider is located, as reported in NPPESstring-
Zip_CodeZip Code of the Providerstring-
State_AbbreviationThe state where the provider is located, as reported in NPPES. The fifty U.S. states and the District of Columbia are reported by the state postal abbreviation.string-
Country_CodeCountry Code of the Providerstring-
Provider_Specialty_TypeProvider Specialty Typestring-
Source_Of_Provider_SpecialtySource of Provider Specialtystring-
Beneficiaries_CountThe total number of unique Medicare Part D beneficiaries with at least one claim for the drug. Counts fewer than 11 are suppressed and are indicated by a blank.integerlevel : Ratio
Total_Claim_CountThe number of Medicare Part D claims. This includes original prescriptions and refills. Aggregated records based on total_claim_count fewer than 11 are not included in the data file.numberlevel : Ratio
Total_Drug_CostThe aggregate total drug cost paid for all associated claims. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. The total drug cost is based on the amounts paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.number-
Total_Day_SupplyThe aggregate number of day’s supply for which this drug was dispensed.numberlevel : Ratio
Beneficiary_Count_Of_Age_65The total number of unique Medicare Part D beneficiaries age 65 and older with at least one claim for the drug. A blank indicates the value is suppressedintegerlevel : Ratio
Supression_Reason_Of_Beneficiary_Count_Age_65A flag indicating the reason the bene_count_ge65 variable is suppressed. * = Primary suppressed due to bene_count_ge65 between 1 and 10. # = Counter suppressed because the “less than 65 year old” group (not explicitly displayed) contains a beneficiary count between 1 and 10, which can be mathematically determined from bene_count_ge65 and bene_count.string-
Total_Claim_Count_Age_65The number of Medicare Part D claims for beneficiaries age 65 and older. This includes original prescriptions and refills. A blank indicates the value is suppressednumberlevel : Ratio
Supression_Reason_Age_65A flag that indicates the reason the variable is suppressed. * = Primary suppressed due to total_claim_count_ge65 between 1 and 10. # = Counter suppressed because the “less than 65 year old” group (not explicitly displayed) contains a small claim count between 1 and 10, which can be mathematically determined from the total_claim_count_ge65 and total_claim_count.string-
Total_Drug_Cost_Age_65The aggregate total drug cost paid for all associated claims for beneficiaries aged 65 and older. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If total_claim_count_ge65 is suppressed, this variable is suppressed. A blank indicates the value is suppressed.number-
Total_Day_Supply_Age_65The aggregate number of day’s supply for which this drug was dispensed, for beneficiaries age 65 or older. If total_claim_count_ge65 is suppressed, this variable is suppressed. A blank indicates the value is suppressed.numberlevel : Ratio
Brand_Claim_CountTotal claims of brand-name drugs, including refills. This is based on the Food and Drug Administration approval category of New Drug Application (NDA), NDA authorized generic, or Biologic License Application (BLA). A blank indicates the value is suppressed.numberlevel : Ratio
Brand_Supression_FlagA flag indicating the reason the brand_claim_count and brand_drug_cost variables are suppressed. * = Primary suppressed due to brand_claim_count between 1 and 10. # = Counter suppressed because the claim count from at least one of the corresponding claim count categories (generic_claim_count or other_claim_count) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.string-
Brand_Drug_CostAggregate total drug cost paid for brand-name drugs. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. This is based on the Food and Drug Administration approval category of NDA, NDA authorized generic, or BLA. If brand_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed.number-
Generic_Claim_CountTotal claims of generic drugs, including refills. This is based on the Food and Drug Administration approval category of Abbreviated New Drug Application (ANDA). A blank indicates the value is suppressed.numberlevel : Ratio
Generic_Supression_FlagA flag indicating the reason the generic_claim_count and generic_drug_cost variables are suppressed. * = Primary suppressed due to generic_claim_count between 1 and 10. # = Counter suppressed because the claim count from at least one of the corresponding claim count categories (brand_claim_count or other_claim_count) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.string-
Generic_Drug_CostAggregate cost paid for generic drugs. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. This is based on the Food and Drug Administration approval category of ANDA. If generic_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed.number-
Other_Claim_CountTotal claims of other drugs, including refills. This is based any other Food and Drug Administration approval categories not included in the brand or generic definitions above. A blank indicates the value is suppressed.numberlevel : Ratio
Other_Supression_FlagA flag indicating the reason other_claim_count and other_drug_cost variables are suppressed. * = Primary suppressed due to other_claim_count between 1 and 10. # = Counter suppressed because the claim count from at least one of the corresponding claim count categories (brand_claim_count or generic_claim_count) is between 1 and 10. Counter suppression prevents the disclosure of a primary suppressed value when all categories sum to the total value.string-
Other_Drug_CostAggregate cost paid for all other drugs not classified as brand or generic. This amount includes ingredient cost, dispensing fee and sales tax. This is based any other Food and Drug Administration approval categories not included in the brand or generic definitions above. If other_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed.number-
MAPD_Claim_CountThe number of claims for beneficiaries covered by MAPD plans. A blank indicates the value is suppressed.numberlevel : Ratio
MAPD_Supression_FlagA flag indicating the reason the mapd_claim_count and mapd_drug_cost variables are suppressed. * = Primary suppressed due to mapd_claim_count between 1 and 10. # = Counter suppressed because the pdp_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the mapd_claim_count and total_claim_count.string-
MAPD_Drug_CostAggregate cost paid for claims filled by beneficiaries in MAPD plans. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If mapd_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed.number-
PDP_Claim_CountThe number of claims for beneficiaries covered by standalone PDPs. A blank indicates the value is suppressed.numberlevel : Ratio
PDP_Supression_FlagA flag indicating the reason the pdp_claim_count and pdp_drug_cost variables are suppressed. * = Primary suppressed due to pdp_claim_count between 1 and 10. # = Counter suppressed because the mapd_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the pdp_claim_count and total_claim_count.string-
PDP_Drug_CostAggregate total drug cost paid for claims filled by beneficiaries in standalone PDPs. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If pdp_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed.number-
LIS_Claim_CountTotal number of claims from this prescriber, including refills, for beneficiaries with a Part D low-income subsidy. A blank indicates the value is suppressed.numberlevel : Ratio
LIS_Supression_FlagA flag indicating the reason the lis_claim_count and lis_drug_cost variables are suppressed. * = Primary suppressed due to lis_claim_count between 1 and 10. # = Counter suppressed because nonlis_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the lis_claim_count and total_claim_count.string-
LIS_Drug_CostAggregate total drug cost paid for claims for beneficiaries with a Part D low-income subsidy. This amount includes ingredient cost, dispensing fee and sales tax. If lis_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed.number-
Non_LIS_Claim_CountTotal number of claims from this prescriber, including refills, for beneficiaries without a Part D low-income subsidy. A blank indicates the value is suppressed.numberlevel : Ratio
Non_LIS_Supression_FlagA flag indicating the reason the nonlis_claim_count and nonlis_drug_cost variables are suppressed. * = Primary suppressed due to nonlis_claim_count between 1 and 10. # = Counter suppressed because lis_claim_count contains a claim count between 1 and 10, which can be mathematically determined from the nonlis_claim_count and total_claim_count.string-
Non_LIS_Drug_CostAggregate total drug cost paid for claims for beneficiaries without a Part D lowincome subsidy. This amount includes ingredient cost, dispensing fee, sales tax, and any applicable vaccine administration fees. If nonlis_claim_count is suppressed this variable is suppressed. A blank indicates the value is suppressed.number-
National_Provider_IdentifierLast_Name_Organization_NameFirst_NameMiddle_InitialCredentialsGenderEntity_CodeStreet_Address_1Street_Address_2CityZip_CodeState_AbbreviationCountry_CodeProvider_Specialty_TypeSource_Of_Provider_SpecialtyBeneficiaries_CountTotal_Claim_CountTotal_Drug_CostTotal_Day_SupplyBeneficiary_Count_Of_Age_65Supression_Reason_Of_Beneficiary_Count_Age_65Total_Claim_Count_Age_65Supression_Reason_Age_65Total_Drug_Cost_Age_65Total_Day_Supply_Age_65Brand_Claim_CountBrand_Supression_FlagBrand_Drug_CostGeneric_Claim_CountGeneric_Supression_FlagGeneric_Drug_CostOther_Claim_CountOther_Supression_FlagOther_Drug_CostMAPD_Claim_CountMAPD_Supression_FlagMAPD_Drug_CostPDP_Claim_CountPDP_Supression_FlagPDP_Drug_CostLIS_Claim_CountLIS_Supression_FlagLIS_Drug_CostNon_LIS_Claim_CountNon_LIS_Supression_FlagNon_LIS_Drug_Cost
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