Medicare Releases Prescription Data — But What Does it All Mean?

May 7th, 2015

Author Jill Drachenberg is managing editor at AHC Media and has primary responsibility for editing IRB Advisor, Case Management Advisor, Hospital Case Management, Medical Ethics Advisor, and Hospital Employee Health. A graduate of Georgia State University, she previously edited business and hospitality publications.

Just over a year after Medicare’s huge physician payment data dump, the agency has released another trove of information, this time a breakdown on the prescribing and costs of drugs to Medicare Part D beneficiaries. The report details which drugs were prescribed, how often, and by whom. (The full report can be found here.)

The data show that more than one million Medicare physicians prescribed $103 billion in pharmaceuticals in 2013. The costliest drug was the name brand heartburn preventive Nexium, which was filled or refilled 8 million times at a cost of $2.5 billion for 1.5 million Medicare patients. The prescribing of generics far outpaced name brand drugs; the most frequently prescribed generic was blood pressure med lisonopril, filled or refilled 37 million times by 7 million patients for a total cost of $307 million.

So why release this information that has never seen the public light of day before? CMS stated on its website that this latest data dump is to help everyone “better understand how the Medicare Part D program delivers care.” It’s also likely a way to get the ball rolling on the agency’s self-imposed goal of moving toward a mostly quality-based reimbursement; data transparency revealing how, exactly, CMS tries to keep Medicare patients out of the hospital is certainly a step in that direction.

But there is also one big, important detail missing from the data: Context. Datasets of this size – such as with the physician payment data release – without explanations or context can lead to misinterpretation; for example, consumers who view these prescribing data may not understand why a particular doctor may prescribe a lot of one type of medication, such as narcotic painkillers, and may automatically assume something is fishy. The data also leave out information on treatment and quality, according to the American Medical Association: “The data does not account for varying strengths or dosage levels of the medications or varying patient needs. For example, a physician could prescribe a low dose of a medication and at a later time need to prescribe another, stronger dosage for the same patient if the low dose isn't meeting their need or if the patient has an adverse reaction,” the association said in a statement. “The data does not include explicit information linking treatment to the quality of care provided. It solely focuses on payment and utilization so it should not be used to evaluate care provided. The utilization part of the data may not be accurate if a patient had poor medication adherence or if the patient has an adverse reaction to a pharmaceutical and requires a prescription for an alternative treatment.”

So while one could applaud CMS’ efforts for data transparency, there’s a long way to go before the public will be able to understand and draw accurate conclusions for themselves.