Medicare Releases Detailed Data on Prescription Drug Spending

APRIL 30, 2015, By KATIE THOMAS and ROBERT PEAR

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

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