The 2015 Medicare Part D Drug Cost and Utilization Dataset presents drug spending and utilization information on Medicare Part D drugs (drugs patients generally administer themselves) and includes annual data for 2011 to 2015.
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Last updated:January 20, 2021
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Part D drug information is available from the Part D Prescription Drug Event (PDE) data and is available for a subset (~70%) of Medicare beneficiaries. For Part D drugs, spending is based on the gross drug cost, which represents total spending for the prescription claim, including Medicare, plan, and beneficiary payments.
PDE records were summarized by drug by linking National Drug Codes (NDCs), which are available in the PDE data, to the First Databank MedKnowledge database and aggregating by brand name and generic name. Any over-the-counter drugs in the PDE data were excluded from the analysis. Data from all Part D organization and plan types were included in the analysis. Data were aggregated across all strengths, dosage forms, and routes of administration, except for the unit cost change calculations, as described below.
The annual change in average cost per unit reflects the weighted percent change in average cost per unit from the prior year and is calculated for drugs utilized by more than 1,000 beneficiaries in both years. Since drugs are available in multiple strengths and dosage forms, the percentage change in unit cost was first calculated at the brand name, generic name, strength, dosage form, and route of administration level, and then a weighted average at the brand name and generic name level was calculated for inclusion in this file using the total number of claims as a weight. Note, manually calculating the percent change in unit cost using the overall “Average Cost per Unit” variables from each year may result in a difference between the weighted average percent change in unit cost reported in this file since the calculation does not account for differing strengths and dosage forms.
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 D Drugs
Other Titles
Medicare Drug Spending Data, Medicare Drug Cost and Drug Spending, Medicare Part D Drug Cost and Utilization
Data Fields
Name
Description
Type
Constraints
Brand_Name
First Databank Brand Name of the drug
string
required : 1
Generic_Name
First Databank Generic Name of the drug
string
required : 1
Claim_Count_2011
Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refills
integer
level : Ratio
Total_Spending_2011
Aggregate drug spending for the Part D program
number
-
Beneficiary_Count_2011
Number of Medicare Part D beneficiaries utilizing the drug
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 dispensed across 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. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Beneficiary_Count_No_LIS_2011
Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug cost
integer
level : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2011
Average amount that beneficiaries without an LIS using the drug paid out of pocket during the year
number
-
Beneficiary_Count_LIS_2011
Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LIS
integer
level : Ratio
Average_Beneficiary_Cost_Share_LIS_2011
Average amount that beneficiaries with an LIS using the drug paid out of pocket during the year
number
-
Claim_Count_2012
Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refills
integer
level : Ratio
Total_Spending_2012
Aggregate drug spending for the Part D program
number
-
Beneficiary_Count_2012
Number of Medicare Part D beneficiaries utilizing the drug
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 dispensed across 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. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Beneficiary_Count_No_LIS_2012
Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug cost
integer
level : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2012
Average amount that beneficiaries without an LIS using the drug paid out of pocket during the year
number
-
Beneficiary_Count_LIS_2012
Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LIS
integer
level : Ratio
Average_Beneficiary_Cost_Share_LIS_2012
Average amount that beneficiaries with an LIS using the drug paid out of pocket during the year
number
-
Claim_Count_2013
Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refills
integer
level : Ratio
Total_Spending_2013
Aggregate drug spending for the Part D program
number
-
Beneficiary_Count_2013
Number of Medicare Part D beneficiaries utilizing the drug
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 dispensed across 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. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Beneficiary_Count_No_LIS_2013
Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug cost
integer
level : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2013
Average amount that beneficiaries without an LIS using the drug paid out of pocket during the year
number
-
Beneficiary_Count_LIS_2013
Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LIS
integer
level : Ratio
Average_Beneficiary_Cost_Share_LIS_2013
Average amount that beneficiaries with an LIS using the drug paid out of pocket during the year
number
-
Claim_Count_2014
Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refills
integer
level : Ratio
Total_Spending_2014
Aggregate drug spending for the Part D program
number
-
Beneficiary_Count_2014
Number of Medicare Part D beneficiaries utilizing the drug
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 dispensed across 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. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Beneficiary_Count_No_LIS_2014
Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug cost
integer
level : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2014
Average amount that beneficiaries without an LIS using the drug paid out of pocket during the year
number
-
Beneficiary_Count_LIS_2014
Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LIS
integer
level : Ratio
Average_Beneficiary_Cost_Share_LIS_2014
Average amount that beneficiaries with an LIS using the drug paid out of pocket during the year
number
-
Claim_Count_2015
Number of Medicare Part D Prescription Drug Events. Includes original prescriptions and refills
integer
level : Ratio
Total_Spending_2015
Aggregate drug spending for the Part D program
number
-
Beneficiary_Count_2015
Number of Medicare Part D beneficiaries utilizing the drug
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 dispensed across 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. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Beneficiary_Count_No_LIS_2015
Number of Medicare Part D beneficiaries utilizing the drug who do not qualify for a Low Income Subsidy (LIS), a program available under the Part D program to provide extra help to pay for prescription drug cost
integer
level : Ratio
Average_Beneficiary_Cost_Share_No_LIS_2015
Average amount that beneficiaries without an LIS using the drug paid out of pocket during the year
number
-
Beneficiary_Count_LIS_2015
Number of Medicare Part D beneficiaries utilizing the drug who qualify for an LIS
integer
level : Ratio
Average_Beneficiary_Cost_Share_LIS_2015
Average amount that beneficiaries with an LIS using the drug paid out of pocket during the year
Weighted-average percent change in average cost per unit for all strengths, dosage forms, administration routes for the drug. Available for drugs utilized by more than 1,000 beneficiaries in 2014 and 2015
integer
level : Ratio
Data Preview
Brand Name
Generic Name
Claim Count 2011
Total Spending 2011
Beneficiary Count 2011
Total Annual Spending Per User 2011
Unit Count 2011
Average Cost Per Unit 2011
Beneficiary Count No LIS 2011
Average Beneficiary Cost Share No LIS 2011
Beneficiary Count LIS 2011
Average Beneficiary Cost Share LIS 2011
Claim Count 2012
Total Spending 2012
Beneficiary Count 2012
Total Annual Spending Per User 2012
Unit Count 2012
Average Cost Per Unit 2012
Beneficiary Count No LIS 2012
Average Beneficiary Cost Share No LIS 2012
Beneficiary Count LIS 2012
Average Beneficiary Cost Share LIS 2012
Claim Count 2013
Total Spending 2013
Beneficiary Count 2013
Total Annual Spending Per User 2013
Unit Count 2013
Average Cost Per Unit 2013
Beneficiary Count No LIS 2013
Average Beneficiary Cost Share No LIS 2013
Beneficiary Count LIS 2013
Average Beneficiary Cost Share LIS 2013
Claim Count 2014
Total Spending 2014
Beneficiary Count 2014
Total Annual Spending Per User 2014
Unit Count 2014
Average Cost Per Unit 2014
Beneficiary Count No LIS 2014
Average Beneficiary Cost Share No LIS 2014
Beneficiary Count LIS 2014
Average Beneficiary Cost Share LIS 2014
Claim Count 2015
Total Spending 2015
Beneficiary Count 2015
Total Annual Spending Per User 2015
Unit Count 2015
Average Cost Per Unit 2015
Beneficiary Count No LIS 2015
Average Beneficiary Cost Share No LIS 2015
Beneficiary Count LIS 2015
Average Beneficiary Cost Share LIS 2015
Percent Annual Change in Average Cost Per Unit 2015
Demos
