Medicare Prescription Drugs Claims

$79 / year

This de-identified dataset contains details 100% of the prescription drug claims made by Medicare beneficiaries during the year of release. This dataset is part of the Public Use Files (PUFs) released by the Centers for Medicare & Medicaid Services (CMS), which are public domain de-identified data files available for research with claim-specific information. The purpose of these files is to provide information while protecting confidentiality.
The Prescription Drug Profiles are collected from Medicare prescription drug claims for the year of the prescription filling. They include beneficiary demographics, plan characteristics, drug characteristics, prescriber characteristics and payment information. Each record corresponds to a profile or cell defined by the characteristics of the previously mentioned variables. The dataset contains all the prescription drug claims during the year for Medicare beneficiaries of Part D.

Complexity

Prescription drug events (or Part D Drug Event Files) are merged with the following files to construct the Prescription Drug Profiles PUF for the reference year:

Beneficiary Summary File;
Part D Plan Characteristics File;
Part D Prescriber Characteristics File;
RxNorm, available from the U.S National Library of Medicine, National Institutes of Health;
National Formulary, available from the Department of Veterans Affairs; and
Results of the CMS-RxHCC risk-adjustment model.

Reference: CMS. (2013). CMS.gov. Retrieved 4 April, 2016.

Date Created

2008

Last Modified

2010

Version

2010

Update Frequency

Irregular

Temporal Coverage

2010

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services (CMS)

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare Drugs Claims, Prescription Drug Profiles, Medicare Prescription Drug Claims, Medicare Beneficiaries Part D Payments, Prescription Drug Plans, Medicare Prescription Drug Payments, PUF Data, Prescription Drugs File, Drug Information, Part D Drug Event Files

Other Titles

CMS Prescription Drug Profiles PUFs, Prescription Drug Profiles PUF

Name Description Type Constraints
Beneficiary_Age_Category_CodeThis categorical variable is based on the beneficiary's age at end of the reference year (2010). In the event the beneficiary died during the reference year, the age at the date of death is used. It is based on the BENE_AGE_AT_END_REF_YR variable in the Beneficiary Summary File (BSF). 1=Under 65, 2=65-69, 3=70-74, 4=75-79, 5=80-84, 6=85 & older.integerlevel : Nominal
RxNorm_Concept_Unique_IdentifierThis variable indicates the corresponding drug's RxNorm RxCUI (RxNorm Concept Unique Identifier). RxNorm is a normalized naming system for generic and branded drugs produced by the National Library of Medicine. The PUF contains 1,229 distinct RXCUIs (including "missing" identified by a value of 0). The table below provides the frequency of the corresponding RxNorm RxCUI for the top ten drug names. It is determined by matching the PROD_SRVC_ID variable in the PDE File with the National Drug Code (NDC) in RxNorm. 36567= Simvastatin, 10582= Thyroxine, 6918=Metoprolol, 29046=Lisinopril, 214182=Acetaminophen/Hydrocodone, 17767=Amlodipine, 7646=Omeprazole, 4603=Furosemide, 6809=Metforminintegerlevel : Nominal
Drug_Major_ClassThis categorical field indicates the major class of the drug. This variable is created using the VA_CLASS variable in the Veterans Affairs National Drug File (VA‐NDF) database. The DRUG_MAJOR_CLASS group's drugs into major (Level 0) categories based on mechanism and effect. The PUF contains 30 distinct drug classes (including "missing" identified by a value of 0). The ten most frequent values for major drug class and their frequencies are provided below. CV000=Cardiovascular medications, CN000= Central Nervous System Medications, HS000=Hormones/Synthetics/Modifiers, GA000= Gastrointestinal Medications, AM000= Antimicrobials, MS000= Musculoskeletal Medications, BL000= Blood Products/Modifiers/Volume Expanders, RE000= Respiratory Tract Medications, OP000= Ophthalmic Agents.string-
Drug_ClassThis categorical field indicates the class of the drug. This variable is created using the VA_CLASS variable in the VA‐NDF database. The DRUG_CLASS group's drugs into minor (Level 1) categories based on mechanism and effect. The PUF contains 263 distinct drug classes (including "missing" identified by a value of 0). The ten most frequent values for drug class and their frequencies are provided below. CV350= Antilipemic Agents, CV100= Beta Blockers/Related, CN609= Antidepressants, CN101=Analgesics, HS502=Blood Glucose Regulation Agents, CV800=Ace Inhibitors, CV200=Calcium Channel Blockers, GA900=Gastric Medications, Other, HS851=Thyroid Modifiers.string-
Drug_Type_ClassThis categorical field indicates the type of the drug: unknown, generic drug, or brand name drug. It is determined by matching the PROD_SRVC_ID variable in the PDE File with the National Drug Code (NDC) in RxNorm. 1=Brand name, 2=Generic Name.integerlevel : Nominal
Plan_TypeThis categorical variable indicates the type of plan associated with events in the profile. It is derived from the Contract_ID code in the Part D Plan Characteristics File. This field summarizes plan type in four categories: (1) Prescription Drug Plans (PDP) (Contract_ID starts with letter “S”), (2) Medicare Advantage Part D (Contract_ID starts with letter “H” or “R”), (3) Other Plan (Contract_ID starts with letter “E”).integerlevel : Nominal
Coverage_TypeThis categorical variable indicates beneficiary liability of cost‐sharing. The beneficiary cost share group code associated with each event is taken from the month in which the event is recorded. This variable is created using the CST_SHR_GRP_CD_01 to CST_SHR_GRP_CD_12 variables in the Beneficiary Summary File. Cost‐sharing codes are classified into five categories: (1) Dual Eligible (variable values of 01, 02 or 03 in the month of the event), (2) Low Income Subsidy (LIS) (variable values of 04, 05, 06, 07, or 08 in the month of the event), (3) No Subsidy (variable values of 00, XX, 09, 10, 11, 12 or 13 in the month of event)integerlevel : Nominal
Benefit_PhaseIndicates the benefit phase in which the claim was expected to occur based on a data of service ordering of the beneficiary's claims, the beneficiary's accumulated gross drug and out‐of‐pocket costs, and the plan's deductible, initial coverage limit (ICL) and out‐of‐pocket threshold (OOPT) amount. This variable is created using the BENEFIT_PHASE variable in the PDE File. 1=Catastrophic, 2=Deductible, 3=Initial coverage limit, 4=Non-covered drug, 5=Pre-initial coverage limit.integerlevel : Nominal
Drug_Benefit_TypeIndicates the type of Part D benefit structure used by the plan benefit package. This variable is created using the DRUG_BENEFIT_TYPE variable in the Part D Plan Characteristics File. 1=Defined standard, 2=Actuarially equivalent, 3=Basic Alternative, 4=Enhanced alternative.integerlevel : Nominal
Prescriber_TypeThis categorical field indicates the type of the prescriber. This variable is created using the PRIMARY_TAXONOMY_CD variable in the Prescriber Characteristics File. It is based on the National Uniform Claims Committee (NUCC) taxonomy code reported as primary by the prescriber in the National Plan & Provider Enumeration System (NPPES) database. Prescriber codes are classified into five categories 1=Family Medicine, 2=Internal medicine, 3=Psychiatry & neurology, 4=Specialist, 5=Other.integerlevel : Nominal
Gap_CoverageIndicator for whether the plan benefit package offers gap coverage. This variable is created using the GAP_COVERAGE variable in the Part D Plan Characteristics File. It summarizes gap coverage as: (1) No gap coverage (variable values of "N"), (2) Offers gap coverage (all other variable values).integerlevel : Nominal
Tier_IDThis variable represents the minimum cost sharing tier in which the product was placed in the sponsor's formulary. This variable is created using the TIER_ID variable in the PDE File. As each plan may have different tier definitions, descriptions for variable values 1‐6 are left blank.integerlevel : Nominal
Mean_RXHCC_ScoreThis is the average of the RxHCC score associated with each beneficiary with a prescription drug event in the profile. The RxHCC score is created by the CMS‐RxHCC risk‐adjustment model. The model assigns a risk score to reflect the health status of each beneficiary according to demographic variables and the beneficiary’s diagnosis history. A higher risk score correlates to higher estimated costs for a beneficiary. Payments to Medicare Part D Plans are adjusted by CMS according to the risk scores of the beneficiaries.numberlevel : Ratio
Average_Days_SupplyThis is the arithmetic average number of days' supply of medication dispensed by the pharmacy for all events in profile. This variable is created using the DAYS_SUPLY_NUM variable in the PDE file. The following summary shows the average number of days' supply rounded to the nearest day.numberlevel : Ratio
Average_Total_Drug_CostThis is the arithmetic average dollar amount for all events in the profile on the entire cost of the prescription based on the sum of ingredient cost paid, dispensing fee paid, and total amount attributed to sales tax. This variable is created using the TOT_RX_CST_AMT variable in the PDE file. The following summary shows the average total drug cost rounded to the nearest dollar.numberlevel : Ratio
Average_Patient_Payment_AmountThis is the arithmetic average dollar amount for all events in the profile on what the beneficiary paid that is not reimbursed by a third party (e.g., copayments, coinsurance, deductible or other patient pay amounts). This variable is created using the PTNT_PAY_AMT variable in the PDE file. The following summary shows the average patient payment amount rounded to the nearest dollar.numberlevel : Ratio
PartD_Event_CountThis variable contains the number of Part D events associated with each profile. The sum of this variable (1,110,089,154) is the total number of Part D events for the 100% population of Fee‐ for‐Service beneficiaries in 2010.integerlevel : Ratio
Beneficiary_Count_CategoryThis variable is based on the number of unique beneficiaries associated with the profile. It is categorized into six values. 1=11-15, 2=16-20, 3=21-50, 4=51-100, 5=101-500, 6=501+.integerlevel : Nominal
Beneficiary_Age_Category_CodeRxNorm_Concept_Unique_IdentifierDrug_Major_ClassDrug_ClassDrug_Type_ClassPlan_TypeCoverage_TypeBenefit_PhaseDrug_Benefit_TypePrescriber_TypeGap_CoverageTier_IDMean_RXHCC_ScoreAverage_Days_SupplyAverage_Total_Drug_CostAverage_Patient_Payment_AmountPartD_Event_CountBeneficiary_Count_Category
1124.434.4271
14850258.5281
22517.937.8241
37236.833.6161
34850221229111
42127.33916301
1221128.9239181
1221428.3599231
221.821.85.3362
233428.564.5171