Others titles
- Medicare Drug Spending Data
- Medicare Drug Cost and Drug Spending
- Medicare Part B Drug Cost and Utilization
Keywords
- Medicare
- CMS Drugs
- CMS Drug Costs
- Drug Utilization
- Medicare Spending
- Part B Drugs Cost
Medicare Part B Drug Cost and Utilization Data 2011-2015
The 2015 Medicare Part B Drug Cost and Utilization Dataset presents drug spending and utilization information on Medicare Part B drugs (drugs administered in doctors’ offices and other outpatient settings) and includes annual data for 2011 to 2015.
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Description
Medicare Part B claims (e.g. physician and other suppliers, durable medical equipment and other supplies, hospital outpatient data) contain information on drugs administered and billed directly by providers. Analyses of Part B drugs are possible for all Part B fee-for-service Medicare beneficiaries, but exclude any beneficiaries in the Medicare Advantage program. Drug spending metrics for Part B drugs are based on total spending, which is derived from summing the three revenue center payment fields on the claim referring to Medicare payment, deductible, and coinsurance. This represents the full value of the product, including the Medicare payment and beneficiary liability.
Part B claims were summarized by Healthcare Common Procedure Coding System (HCPCS) codes and limited to HCPCS codes listed in the publicly available Medicare Average Sales Price (ASP) quarterly files at any point in the prior 5 years. In addition to the HCPCS listed in the ASP drug lists, oral anti-cancer drugs identified by HCPCS beginning with ‘WW’ were included. Part B claims were excluded if Medicare was not the primary payer or if the drugs were billed using “Not Otherwise Classified” (NOC) codes (e.g. J3490, J3590, or J9999), since identification of NOC drugs are not specified on the claim. In addition, Part B institutional claims submitted by critical access hospitals (CAHs), Maryland hospitals, as well as claims with total spending amounts of zero associated with the drug, which is due to bundling in Ambulatory Payment Classification groups, were excluded.
Claims data were averaged across any applicable modifiers or place of service indicators associated with a single HCPCS. Drugs with multiple strengths (e.g. 20mg, 40mg, 80mg) were not combined when individual HCPCS codes exist for different strengths (e.g., methylprednisolone has different HCPCS codes for 20mg, 40mg, and 80mg).
About this Dataset
Data Info
Date Created | 2015 |
---|---|
Last Modified | 2016-06-12 |
Version | 2016-06-12 |
Update Frequency |
Annual |
Temporal Coverage |
2011-2015 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Medicare, CMS Drugs, CMS Drug Costs, Drug Utilization, Medicare Spending, Part B Drugs Cost |
Other Titles | Medicare Drug Spending Data, Medicare Drug Cost and Drug Spending, Medicare Part B Drug Cost and Utilization |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
HCPCS_Code | Healthcare Common Procedure Coding System (HCPCS) code for the drug | string | required : 1 |
HCPCS_Description | HCPCS Description of the drug | string | required : 1 |
Claim_Count_2011 | Number of Medicare Part B claims for the year 2011 | integer | level : Ratio |
Total_Spending_2011 | Aggregate drug spending for the Part B program for 2011 | number | - |
Beneficiary_Count_2011 | Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2011 | integer | level : Ratio |
Total_Annual_Spending_Per_User_2011 | Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year | number | - |
Unit_Count_2011 | Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units) | number | level : Ratio |
Average_Cost_Per_Unit_2011 | Total Spending divided by the number of dosage units | number | - |
Average_Beneficiary_Cost_Share_2011 | Average amount that beneficiaries using the drug paid out of pocket during the year | number | - |
Claim_Count_2012 | Number of Medicare Part B claims for the year 2012 | integer | level : Ratio |
Total_Spending_2012 | Aggregate drug spending for the Part B program for 2012 | number | - |
Beneficiary_Count_2012 | Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2012 | integer | level : Ratio |
Total_Annual_Spending_Per_User_2012 | Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year | number | - |
Unit_Count_2012 | Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units) | number | level : Ratio |
Average_Cost_Per_Unit_2012 | Total Spending divided by the number of dosage units | number | - |
Average_Beneficiary_Cost_Share_2012 | Average amount that beneficiaries using the drug paid out of pocket during the year | number | - |
Claim_Count_2013 | Number of Medicare Part B claims for the year 2013 | integer | level : Ratio |
Total_Spending_2013 | Aggregate drug spending for the Part B program for 2013 | number | - |
Beneficiary_Count_2013 | Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2013 | integer | level : Ratio |
Total_Annual_Spending_Per_User_2013 | Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year | number | - |
Unit_Count_2013 | Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units) | number | level : Ratio |
Average_Cost_Per_Unit_2013 | Total Spending divided by the number of dosage units | number | - |
Average_Beneficiary_Cost_Share_2013 | Average amount that beneficiaries using the drug paid out of pocket during the year | number | - |
Claim_Count_2014 | Number of Medicare Part B claims for the year 2014 | integer | level : Ratio |
Total_Spending_2014 | Aggregate drug spending for the Part B program for 2014 | number | - |
Beneficiary_Count_2014 | Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2014 | integer | level : Ratio |
Total_Annual_Spending_Per_User_2014 | Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year | number | - |
Unit_Count_2014 | Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units) | number | level : Ratio |
Average_Cost_Per_Unit_2014 | Total Spending divided by the number of dosage units | number | - |
Average_Beneficiary_Cost_Share_2014 | Average amount that beneficiaries using the drug paid out of pocket during the year | number | - |
Claim_Count_2015 | Number of Medicare Part B claims for the year 2015 | integer | level : Ratio |
Total_Spending_2015 | Aggregate drug spending for the Part B program for 2015 | number | - |
Beneficiary_Count_2015 | Number of Medicare Part B fee-for-service beneficiaries utilizing the drug in the year 2015 | integer | level : Ratio |
Total_Annual_Spending_Per_User_2015 | Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year | number | - |
Unit_Count_2015 | Total dosage units of medication billed during the calendar year (e.g. number of tablets, grams, milliliters or other units) | number | level : Ratio |
Average_Cost_Per_Unit_2015 | Total Spending divided by the number of dosage units | number | - |
Average_Beneficiary_Cost_Share_2015 | Average amount that beneficiaries using the drug paid out of pocket during the year | number | - |
Percent_Annual_Change_in_Average_Cost_Per_Unit_2015 | Annual change in average cost per unit reflects the percent change in average cost per unit between 2014 and 2015. The average cost per unit is calculated for each year at the HCPCS level by dividing the total payment by total units and then a percentage change in unit costs between the two years is calculated. Available for drugs utilized by more than 5,000 beneficiaries in 2014 and 2015. | integer | level : Ratio |
Data Preview
HCPCS Code | HCPCS Description | Claim Count 2011 | Total Spending 2011 | Beneficiary Count 2011 | Total Annual Spending Per User 2011 | Unit Count 2011 | Average Cost Per Unit 2011 | Average Beneficiary Cost Share 2011 | Claim Count 2012 | Total Spending 2012 | Beneficiary Count 2012 | Total Annual Spending Per User 2012 | Unit Count 2012 | Average Cost Per Unit 2012 | Average Beneficiary Cost Share 2012 | Claim Count 2013 | Total Spending 2013 | Beneficiary Count 2013 | Total Annual Spending Per User 2013 | Unit Count 2013 | Average Cost Per Unit 2013 | Average Beneficiary Cost Share 2013 | Claim Count 2014 | Total Spending 2014 | Beneficiary Count 2014 | Total Annual Spending Per User 2014 | Unit Count 2014 | Average Cost Per Unit 2014 | Average Beneficiary Cost Share 2014 | Claim Count 2015 | Total Spending 2015 | Beneficiary Count 2015 | Total Annual Spending Per User 2015 | Unit Count 2015 | Average Cost Per Unit 2015 | Average Beneficiary Cost Share 2015 | Percent Annual Change in Average Cost Per Unit 2015 |
J7042 | 5% dextrose/normal saline (500 ml = 1 unit) | 53117.0 | 28351.4 | 19222.0 | 1.47 | 76110.0 | 0.37 | 0.4 | 40904 | 29753.19 | 16165.0 | 1.84 | 61037.5 | 0.49 | 0.83 | 38098.0 | 33777.38 | 14960.0 | 2.26 | 57219.5 | 0.59 | 0.87 | 34509.0 | 29668.31 | 14349.0 | 2.07 | 52042.0 | 0.57 | 0.53 | 29057.0 | 25535.06 | 11708.0 | 2.18 | 41728.0 | 0.61 | 0.53 | 7.0 |
J7060 | 5% dextrose/water (500 ml = 1 unit) | 81401.0 | 138380.97 | 18668.0 | 7.41 | 125300.0 | 1.1 | 1.53 | 70397 | 112967.71 | 15123.0 | 7.47 | 104180.0 | 1.08 | 1.7 | 66480.0 | 100479.64 | 12955.0 | 7.76 | 93046.0 | 1.08 | 1.74 | 55268.0 | 96950.88 | 11776.0 | 8.23 | 75973.0 | 1.28 | 2.0 | 49897.0 | 115745.92 | 9575.0 | 12.09 | 69135.0 | 1.67 | 3.54 | 31.0 |
J7608 | Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram | 24570.0 | 1065238.68 | 8833.0 | 120.6 | 579668.0 | 1.84 | 28.26 | 19356 | 1025455.52 | 6559.0 | 156.34 | 448775.0 | 2.29 | 34.51 | 8424.0 | 347423.48 | 2811.0 | 123.59 | 156764.0 | 2.22 | 27.73 | 11380.0 | 630909.89 | 3178.0 | 198.52 | 254318.5 | 2.48 | 42.85 | 13791.0 | 1132877.16 | 3777.0 | 299.94 | 315558.0 | 3.59 | 64.96 | |
J7611 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg | 40863.0 | 395722.36 | 19915.0 | 19.87 | 4363244.3 | 0.09 | 4.91 | 39535 | 337907.4 | 21667.0 | 15.6 | 3395624.5 | 0.1 | 3.97 | 39520.0 | 269941.18 | 25499.0 | 10.59 | 2727373.0 | 0.1 | 2.69 | 38126.0 | 232215.91 | 26322.0 | 8.82 | 2250241.5 | 0.1 | 2.25 | 36115.0 | 222865.87 | 26013.0 | 8.57 | 1896383.0 | 0.12 | 2.16 | 14.0 |
J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | 1882064.0 | 28240515.9 | 537176.0 | 52.57 | 456213793.3 | 0.06 | 13.01 | 1897919 | 26682309.5 | 558431.0 | 47.78 | 448605068.4 | 0.06 | 12.04 | 1868747.0 | 21628071.81 | 581431.0 | 37.2 | 429548238.6 | 0.05 | 9.45 | 1652877.0 | 18192615.72 | 532088.0 | 34.19 | 356184456.9 | 0.05 | 8.85 | 1553598.0 | 20603232.72 | 516660.0 | 39.88 | 321038567.3 | 0.06 | 10.17 | 26.0 |
J7620 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme | 1770476.0 | 45112301.07 | 403021.0 | 111.94 | 188450728.5 | 0.24 | 26.24 | 1738230 | 45191372.64 | 412249.0 | 109.62 | 178997798.5 | 0.25 | 27.41 | 1666052.0 | 32556978.81 | 423373.0 | 76.9 | 166778786.7 | 0.2 | 19.51 | 1513368.0 | 27132817.59 | 410209.0 | 66.14 | 150114076.0 | 0.18 | 16.94 | 1454626.0 | 23653854.78 | 415857.0 | 56.88 | 141763520.5 | 0.17 | 14.89 | -8.0 |
Q4116 | Alloderm, per square centimeter | 1337.0 | 2947818.12 | 1289.0 | 2286.9 | 92063.0 | 32.02 | 199.76 | 1023 | 2919477.09 | 987.0 | 2957.93 | 96249.0 | 30.33 | 224.34 | 737.0 | 1605650.7 | 722.0 | 2223.89 | 50376.0 | 31.87 | 217.1 | |||||||||||||||
Q4123 | Alloskin rt, per square centimeter | 11 | 8993.5 | 685.0 | 13.13 | ||||||||||||||||||||||||||||||||
Q4115 | Alloskin, per square centimeter | 471.0 | 109882.76 | 158.0 | 695.46 | 15185.0 | 7.24 | 139.09 | 464 | 183385.75 | 161.0 | 1139.04 | 21346.0 | 8.59 | 220.15 | 235.0 | 74764.84 | 105.0 | 712.05 | 8062.0 | 9.27 | 144.15 | |||||||||||||||
J7308 | Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) | 90967.0 | 15134986.02 | 60167.0 | 251.55 | 104415.0 | 144.95 | 55.83 | 109308 | 19403352.76 | 72617.0 | 267.2 | 125184.5 | 155.0 | 57.43 | 121579.0 | 22957503.71 | 81206.0 | 282.71 | 140422.5 | 163.49 | 61.69 | 130464.0 | 35289287.72 | 85969.0 | 410.49 | 150360.5 | 234.7 | 88.72 | 138421.0 | 42647134.41 | 91528.0 | 465.95 | 158923.5 | 268.35 | 100.18 | 14.0 |