CMS Improves Access to Drug Expenditure Data by Brand

Image credit:  Rawpixel Ltd.  

Image credit: Rawpixel Ltd. 

The Centers for Medicare & Medicaid Services (CMS) just announced updated data access for drug spending in Medicare Part B, Medicare Part D, and Medicaid programs, as part of its goal to improve transparency, particularly with respect to changes in prescription drug prices.

The three dashboards allow the user to search by brand or generic name. For example, for each drug, the Medicare Part B dashboard displays the number of manufacturers, average spend per dosage unit in 2016 and 2015, the percent change year over year, the annual growth rate over four years, total spend, total beneficiaries, and average spend per beneficiary. 

Once a name is selected, a popup window summarizes the indicated use(s). In addition, a summary table provides manufacturer data, and a chart with manufacturer trend in average and overall spend per dosage unit over the most recent four-year reporting period.

A Part B search for Keytruda® (pembrolizumab), an anti-PD-1 immunotherapy drug introduced in 2015 and used to treat head, neck, skin, non-small cell lung cancer and Hodgkin lymphoma shows a 1% price increase from 2015 to 2016, to $1,106.19 per dosage unit. Total annual spend was $4.2 million for 88 beneficiaries, or $48,069 per beneficiary. 

A similar Part B search for Opdivo® (nivolumab), another PD-1 inhibitor, shows a 2.6% increase, to $250.64 per dosage unit. Total annual spend was $26.2 million for 544 beneficiaries, with an average spend of $48,193 per beneficiary.

A Medicaid dashboard search for Keytruda® shows a 1.9% price decrease from 2015 to 2016, to $626.65 per dosage unit. Total annual spend was $13.2 million, a 49.2% decrease from the prior year (the number of beneficiaries and average spend per beneficiary is not part of the Medicaid dashboard).

Drug spend outside of the three government programs is not included. Data can be downloaded for use in Excel.

CMS also updated the Medicare Part D Provider Utilization and Payment Data dashboard. The user can search by provider last name, organization name, national provider identifier (NPI), city and/or state. The search tool has a significant limitation, in that search terms must match the data record exactly. Quick searches for specific healthcare systems found no results, and would require additional research. There are also some user experience (UX) issues that increase the time to search. Prescription practices for privately insured patients and others are not included.