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Medicare Part D claims data released

The data, on Medicare drug claims for the 25 million Medicare beneficiaries in the Part D program, was released at the Medicare Prescription Drug Benefit Symposium on Oct. 30.

Topics covered at the symposium:

  • What is the beneficiary experience and what does new Prescription Drug Event data show?
  • What type of plan are beneficiaries selecting and what design features are most important?
  • Overview of PDEs: What do they contain and how are they used?
  • Top 100 drugs by utilization and class variations in generic dispensing rates
  • Average cost for beneficiaries and by sub-population as well as analysis of the initial coverage limit
  • Analysis of beneficiary experience
  • What Plans are Doing and What CMS is Doing
  • What tools are plans and CMS using in order to control drug costs?

Some highlights of the findings:

Consumer Preferences

  • A broad range of Part D plan options continue to be available to consumers.
  • Part D beneficiaries across the country have access to a variety of plan designs, including some with coverage in the gap and zero deductibles.
  • Among non-limited-income subsidy enrollees in 2008, 13 percent of those in prescription drug plans and 63 percent of those in Medicare Advantage Prescription Drug Plans had some form of gap coverage.
  • Enrollment trends show that enhanced alternative plans have become an increasingly popular option in Part D.

Drug Use

  • Therapeutic classes of top drugs utilized in Part D were those used to treat the most prevalent conditions in this population. 
  • Analysis using 2006 prescription drug event (PDE) data indicates that the top 100 drugs by fills represent 65.5 percent of total drug fills in 2006 and the top 100 drugs by cost represented 67 percent of total gross drug costs in 2006. 
  • Overall, the top three therapeutic classes of the top 100 drugs by cost (accounting for nearly 50 percent of total gross drug costs) are: cardiovascular drugs, psychotherapeutic drugs, and gastrointestinal drugs.
  • Lipitor ranks first among the top 10 drugs by cost across all enrollee sub-populations, except LIS beneficiaries.
  • In the first year of the program, 90 percent of Part D enrollees filled at least one prescription.
  • The use of generic drugs has been high in Part D and is increasing, from 60 percent in 2006 to 64 percent in 2007 based on PDE data.

Beneficiary Experience

  • Based on 2006 PDE data, the average monthly cost per enrolled beneficiary (including both beneficiary and program costs) was $203. The average cost was higher among PDPs ($233) than MA-PDs ($135), slightly higher among females ($209) than males ($193), and higher among the LIS ($277) than the non-LIS enrollees ($147).
  • The average number of prescriptions per enrolled beneficiary per month was 3.2 based on the total number of PDE records. The average number of prescriptions per enrolled beneficiary was slightly higher among PDPs (3.5) than MA-PDs (2.5), slightly higher among females (3.5) than males (2.8), and higher among the LIS (4.1) than the non-LIS enrollees (2.6).

More information

Additional information on the Medicare Part D Data Final Rule and access to the power point presentations from the symposium will be available next week (the week of Nov. 10, 2008).