Medicare Releases Detailed Data on Prescription Drug Spending


The heartburn drug Nexium — whose advertisements have long been ubiquitous on television — was prescribed to 1.5 million Medicare patients in 2013, for a total cost of more than $2.5 billion, the largest amount spent on any drug prescribed through the government program, according to data released by Medicare officials on Thursday.

The data was the most detailed breakdown ever provided by government officials about the prescription claims of Medicare beneficiaries. It included information about 36 million patients, one million prescribers and $103 billion in spending on drugs under the program’s Part D in the year 2013, the most recent year available. The data did not take into account rebates that the drug manufacturers pay to the insurers that operate the Medicare beneficiaries’ drug plans.

Although the government has previously released similar data to outside entities — including ProPublica, the nonprofit news group — officials said they decided to make the information available on a public website to encourage experts to weigh in, potentially leading to new solutions for policy challenges, like how to contain costs.

“We know that there are many, many smart minds in this country,” Sean Cavanaugh, a deputy administrator at the Centers for Medicare and Medicaid Services, said in a conference call with reporters on Thursday. “We are excited to unleash those minds and see what they can find in our data.”

The list of the most-prescribed drugs included less expensive generics to treat common conditions like high blood pressure, cholesterol and diabetes. And almost all of the drugs that accounted for the most in spending — Nexium was followed by the asthma treatment Advair Diskus and Crestor, a cholesterol drug — were used in the treatment of common conditions. One exception was the cancer drug Revlimid, the 10th-costliest drug, which was prescribed to 24,600 patients but cost nearly $1.35 billion.

Some of the costliest drugs in 2013 are now available as less expensive generics, or will be available soon. Nexium, for example, lost its patent protection in 2014 and is now available as a generic; Pfizer, which bought the rights to sell Nexium from AstraZeneca, also sells an over-the-counter version.

Nexium treats a reflux condition known as gastroesophageal reflux disease, or GERD, leading Niall Brennan, Medicare’s chief data officer, to quip on Twitter: “One nation under GERD?”

In some ways, 2013 “was a year of relative calm,” David Whitrap, a spokesman for the pharmacy benefits manager Express Scripts, which handles the prescription claims of millions of Medicare beneficiaries, said in an email on Thursday. His company’s analysis of a representative sample of its members showed that total drug spending in Medicare rose 2.6 percent in 2013. A year later, in 2014, spending jumped 13.8 percent, mainly owing to the arrival on the market of high-priced medications to treat hepatitis C.

More recently, insurers and government health care programs have fretted over the skyrocketing costs of so-called specialty drugs, which treat serious and chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis.

Medicare did not provide a breakdown of top prescribers, but an analysis by The New York Times of the data showed that those who wrote prescriptions leading to the highest total drug costs varied widely in their specialty and geography.

Dr. Gavin Awerbuch, a Michigan neurologist, topped the list of high-prescribing Medicare doctors: The analysis showed he was responsible for $16.6 million in total drug costs in 2013, for 1,300 Medicare patients. He was arrested last year after federal prosecutors said he defrauded Medicare of $7 million and improperly prescribed a pain drug, Subsys.

Mark J. Kriger, a lawyer for Dr. Awerbuch, said he could not comment on the data because he had not analyzed it himself.

Dr. Daniel J. Hurley of Beech Grove, Ind., was listed as responsible for more than $10 million of Medicare prescriptions, the fifth-highest total. “I run a large nursing home practice with four doctors and seven nurse practitioners,” Dr. Hurley said in a telephone interview. “All the patients are in my name. All the prescriptions we write, for 11 or 12 providers, are written in my name.”

Some experts and organizations, including the American Medical Association, have cautioned against drawing too many conclusions about high-prescribing physicians, noting that the data does not include information about patients’ medical conditions. “You don’t know anything about those people, and I think that’s an important missing link,” said Juliette Cubanski, associate director of the Program on Medicare Policy at the nonpartisan Kaiser Family Foundation.

Several health care experts said they were intrigued by Medicare’s analysis showing a wide geographic variation in the use of generic drugs by Medicare beneficiaries. In some areas of the country, including Texas, the South and the Northeast, use of generic drugs was relatively low, accounting for between 65 and 76 percent of prescriptions. Other regions, including the Midwest and Northwest, used generic drugs far more frequently.

Caroline F. Pearson, a senior vice president of Avalere Health, a consulting company, said that the geographic differences in use of generic drugs may reflect that some areas of the country have higher poverty rates. Low-income Medicare beneficiaries can qualify for extra help with their prescription drug costs. This assistance reduces their out-of-pocket costs, so they may have less incentive to take generics.

In addition, Ms. Pearson said, low-income Medicare patients “may be sicker and more likely to need newer brand-name medications” for which generic versions are not available.

Sarah Cohen and Griff Palmer contributed reporting.

A version of this article appears in print on May 1, 2015, on page B2 of the New York edition with the headline: Medicare Releases Detailed Data on Prescription Drug Spending. Order Reprints| Today’s Paper|Subscribe

The Surprising New Realities of Today’s Older Americans


In 1985, American Richard Bass accomplished an amazing feat. He had set for himself the task of climbing the world’s highest mountains in all seven continents. In that year, at age 55, he completed the climb of the last of his seven mountains, Mt Everest and in doing so became the first person to climb all seven mountains and the oldest person ever to successfully climb Mt Everest.

But now Mr Bass’s record has been eclipsed.

The oldest person to climb Mt Everest is Yuichiro Miura of Japan, who reached the summit of Mt Everest in 2013 at age 80. And the oldest person to have climbed all seven mountains in seven continents is Takao Arayama of Tanzania who climbed the last of those mountains at age 74 in 2010.

Over time, as life expectancy increases and people become healthier, older people can do things which were previously the domain of those younger. Indeed, no one would be surprised if, within the next decade, both the above records were broken.

Well, perhaps not exactly no one.

People who analyze population aging using conventional measures assume that none of the attributes that are important for understanding aging change over time or differ in localities. But a wide variety of attributes can be used to study aging. An important one for 65-year-olds, for example, is their projected remaining life expectancy. Another one is how well those 65-year-olds can remember things.

Our research findings challenge the view that the only thing that matters in the study of aging is chronological age; we also dispute the idea that the attributes of elderly people do not matter.

We believe that it is time for aging measurements to account for the new reality of today’s old age, including how well the elderly actually function.

Limitations of the Conventional View on Aging
In the conventional view used by most demographers and policy-makers it is irrelevant that life expectancy at older ages is increasing. Such views don’t account for the observation that older people are healthier and are achieving ever higher scores on cognitive status tests than in the past.

And many find no relevance in the fact that people in their mid-80s and beyond will be able to climb the world’s highest mountains in the future. We seek to challenge this misconception.

An analysis of population aging has two aspects. First, based on chronological age, most countries of the world are in the process of growing older. The proportions of populations 65+ years old are increasing. The proportions 80+ are increasing even faster and median ages of the populations are also increasing.

The conventional approach to the study of population aging ends here, but in doing so, it ignores the second and equally important aspect of aging.

Today’s Elderly Are Not Your Father’s Grandparents
The characteristics of people at each age are changing. For example, in 1950, 65-year-old Swedish men had a life expectancy of 13.5 more years. In 2011, their life expectancy was 18.4 years more, almost 5 years longer.

In contrast in 2010, 65-year-old Russian men had a life expectancy of 11.9 more years, which is less than that of Swedish men in 1900. By ignoring changes in the attributes of people and looking only at chronological age, the conventional approach provides a misleading picture of the future.

In a series of articles we show how to incorporate the changing characteristics of people into measures of population aging. In particular, we have defined a new measure called “prospective age.”

Prospective age is a measurement based on the average number of years that people have left to live. We categorize people as being “old” not at age 65, but when people at their age have an average of 15 more years to live.

Using this criterion, a Swedish man in 1900 would be considered old at age 60. In 1960, he would have been considered old at age 63, and in 2010 at age 69. Russian men would have been considered old at age 62 in 1960, about the same age at which Swedish men would have been considered old at that time. In 2010, however, Russian men would have been considered old at age 59, 3 years younger than in 1960. This reflects the mortality crisis in Russia after the dissolution of the Soviet Union.

In our article in PLOS ONE we describe our discovery of a new and counterintuitive aspect of population aging based on those new measures. Using measures of aging based on prospective age, we found that these measures of aging increase more slowly when life expectancy increase is faster.

For example, we looked at what would happen to measures of aging based on prospective age, if life expectancy were to continue to increase at its current pace in many developed countries of around 1.5 additional years of life per decade. We also looked at what would happen if increases in life expectancy were to stop. We found that our measures of aging were lower in the scenario in which life expectancy was increasing.

In other words, if people lived longer, healthier and more productive lives, we would have less to worry about, in terms of population aging, than if they if they lived shorter, less healthy and less productive lives.

Worries About Increases in Life Expectancies
When people think about aging from the conventional perspective, they tend to fear rapid increases in life expectancy for four reasons.

First, rapid increases in life expectancy may affect the sustainability of pension systems. But more and more countries are adopting pension systems that automatically adjust for changes in life expectancy. For this growing list of countries, the challenge of sustaining pension systems has already been successfully addressed. The United States, unfortunately, is not one of those countries, but it could be in the future.

The second fear centers on health-care costs. But health-care costs are highest in the last few years of life and these years occur later as life expectancy increases.

The third fear is that there will be so many seriously disabled people in the future that it will be difficult to care for all of them. The evidence, however, tends not to support this concern because the rates of severe disability at each stage of older age tend to decrease with increasing life expectancy.

The last fear is that when life expectancy increases there will be more people not working. However, simultaneous with the increases in the life expectancy and health of Americans, the labor force participation rates of 65- to 69-year-olds has jumped (according to figures from the US Bureau of Labor Statistics) from 21.8% in 1990 to 30.8% in 2010.

The life expectancy of a child born in a wealthy country today could well be 100 years. By the end of the century, the populations of many of those countries could have median ages above 65.

We need to think about a future in which more than half of the population would be older than the age at which most people retire today. Pension systems, tax systems, educational systems, and labor markets will all have to adjust.

Population aging does produce challenges. It does us no good, however, to misunderstand those changes based on insufficient measurements. It is time for us to understand aging not just on the basis of how many years people have lived, but on the basis of how well they function. When we understand this, we will be in a better position to plan for the changes that we will have to make.

Warren Sanderson is a professor of economics at Stony Brook University. Sergei Scherbov is deputy director of the World Population Program at International Institute for Applie Systems Analysis.

This article was originally published on The Conversation. Read the original article.