Medicare Part D Drug Cost and Utilization 2016-2020
Keywords
Medicare
CMS Drugs
CMS Drug Costs
Drug Utilization
Medicare Spending
Part D Drugs
Medicare Part D Drug Cost and Utilization Data 2016-2020
The 2020 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 2016 to 2020.
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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
2020-01-21
Last Modified
2020-01-27
Version
2020-01-27
Update Frequency
Annual
Temporal Coverage
2016-2020
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 2016-2020, Medicare Drug Cost and Drug Spending, Medicare Part D Drug Cost and Utilization 2016-2020
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
Number_Of_Manufacturers
Number of Medicare Part D Prescription Drug manufacturers.
integer
level : Ratio
Total_Spending_2016
Aggregate drug spending for the Part D program for 2016.
number
-
Total_Dosage_Units_2016
The sum of the dosage units of medication dispensed across the calendar year 2016 (e.g. number of tablets, grams, milliliters or other units). For Part D, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2016
Number of Medicare Part D Prescription Drug Events for 2016. Includes original prescriptions and refills.
integer
level : Ratio
Total_Beneficiaries_2016
Number of Medicare Part D beneficiaries utilizing the drug for 2016.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2016
Total Spending divided by the number of dosage units for 2016. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Average_Spending_Per_Claim_2016
Part D drug spending divided by the number of claims during the year 2016.
number
level : Ratio
Average_Spending_Per_Beneficiary_2016
Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year 2016.
number
-
Outlier_Flag_2016
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2016. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2017
Aggregate drug spending for the Part D program for 2017.
number
-
Total_Dosage_Units_2017
The sum of the dosage units of medication dispensed across the calendar year 2017 (e.g. number of tablets, grams, milliliters or other units). For Part D, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
integer
level : Ratio
Total_Claims_2017
Number of Medicare Part D Prescription Drug Events for 2017. Includes original prescriptions and refills.
integer
level : Ratio
Total_Beneficiaries_2017
Number of Medicare Part D beneficiaries utilizing the drug for 2017.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2017
Total Spending divided by the number of dosage units for 2017. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Average_Spending_Per_Claim_2017
Part D drug spending divided by the number of claims during the year 2017.
number
level : Ratio
Average_Spending_Per_Beneficiary_2017
Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year 2017.
number
-
Outlier_Flag_2017
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2017. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2018
Aggregate drug spending for the Part D program for 2018.
number
-
Total_Dosage_Units_2018
The sum of the dosage units of medication dispensed across the calendar year 2018 (e.g. number of tablets, grams, milliliters or other units). For Part D, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2018
Number of Medicare Part D Prescription Drug Events for 2018. Includes original prescriptions and refills.
integer
level : Ratio
Total_Beneficiaries_2018
Number of Medicare Part D beneficiaries utilizing the drug for 2018.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2018
Total Spending divided by the number of dosage units for 2018. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Average_Spending_Per_Claim_2018
Part D drug spending divided by the number of claims during the year 2018.
number
level : Ratio
Average_Spending_Per_Beneficiary_2018
Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year 2018.
number
-
Outlier_Flag_2018
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2018. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2019
Aggregate drug spending for the Part D program for 2019.
number
-
Total_Dosage_Units_2019
The sum of the dosage units of medication dispensed across the calendar year 2019 (e.g. number of tablets, grams, milliliters or other units). For Part D, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2019
Number of Medicare Part D Prescription Drug Events for 2019. Includes original prescriptions and refills.
integer
level : Ratio
Total_Beneficiaries_2019
Number of Medicare Part D beneficiaries utilizing the drug for 2019.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2019
Total Spending divided by the number of dosage units for 2019. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Average_Spending_Per_Claim_2019
Part D drug spending divided by the number of claims during the year 2019.
number
level : Ratio
Average_Spending_Per_Beneficiary_2019
Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year 2019.
number
-
Outlier_Flag_2019
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2019. The description of dataset contains additional details.
integer
level : Nominal
Total_Spending_2020
Aggregate drug spending for the Part D program for 2020.
number
-
Total_Dosage_Units_2020
The sum of the dosage units of medication dispensed across the calendar year 2020 (e.g. number of tablets, grams, milliliters or other units). For Part D, the quantity of a drug in a dosage unit is the same as the quantity of the drug in a HCPCS billing unit.
number
level : Ratio
Total_Claims_2020
Number of Medicare Part D Prescription Drug Events for 2020. Includes original prescriptions and refills.
integer
level : Ratio
Total_Beneficiaries_2020
Number of Medicare Part D beneficiaries utilizing the drug for 2020.
integer
level : Ratio
Average_Spending_Per_Dosage_Unit_2020
Total Spending divided by the number of dosage units for 2019. For drugs with multiple strengths, dosage forms and routes of administration, this is a claim-weighted average unit cost
number
-
Average_Spending_Per_Claim_2020
Part D drug spending divided by the number of claims during the year 2019.
number
level : Ratio
Average_Spending_Per_Beneficiary_2020
Total Spending divided by the number of unique beneficiaries utilizing the drug (Beneficiary Count) during the benefit year 2020.
number
-
Outlier_Flag_2020
Set to 1 when outliers in data cause Average Spending per Dosage Unit to change by at least 10% and $1, or there are not enough records to identify outliers during the year 2020. The description of dataset contains additional details.
The constant average change in spending per unit over the most recent five years (2016-2020) of data availability, calculated using the compound annual growth rate (CAGR).
number
level : Ratio
Data Preview
Brand Name
Generic Name
Number Of Manufacturers
Total Spending 2016
Total Dosage Units 2016
Total Claims 2016
Total Beneficiaries 2016
Average Spending Per Dosage Unit 2016
Average Spending Per Claim 2016
Average Spending Per Beneficiary 2016
Outlier Flag 2016
Total Spending 2017
Total Dosage Units 2017
Total Claims 2017
Total Beneficiaries 2017
Average Spending Per Dosage Unit 2017
Average Spending Per Claim 2017
Average Spending Per Beneficiary 2017
Outlier Flag 2017
Total Spending 2018
Total Dosage Units 2018
Total Claims 2018
Total Beneficiaries 2018
Average Spending Per Dosage Unit 2018
Average Spending Per Claim 2018
Average Spending Per Beneficiary 2018
Outlier Flag 2018
Total Spending 2019
Total Dosage Units 2019
Total Claims 2019
Total Beneficiaries 2019
Average Spending Per Dosage Unit 2019
Average Spending Per Claim 2019
Average Spending Per Beneficiary 2019
Outlier Flag 2019
Total Spending 2020
Total Dosage Units 2020
Total Claims 2020
Total Beneficiaries 2020
Average Spending Per Dosage Unit 2020
Average Spending Per Claim 2020
Average Spending Per Beneficiary 2020
Outlier Flag 2020
Percent Change In Average Spending Per Dosage Unit 2020
Percent Annual Growth Rate In Avg Spending Per Dosage Unit 2016 2020
Demos
