Medicare Part D Spending on Drugs Prescribed by Oncologists: Temporal Trends and Regional Variation

PURPOSE: Drug cost is a significant factor in the ever-increasing expenditures for cancer health care. METHODS: We used Medicare Part D administrative data to explore prescribing patterns and attributed drug costs of oncologists from 2013 to 2017. We highlighted regional variation in spending and potential associations. We used the location quotient (LQ) to measure the relative concentration of oncologists compared with the national average by hospital referral regions. Costs were reported in 2017 US dollars (inflation adjusted) for cross-year comparisons. RESULTS: Oncology’s share in Part D spending showed an uninterrupted increasing trend. In 2017, oncologists prescribed medicines with $12.8 billion in Part D costs (8.3% of all Part D payments), which exceeded 2013 costs by $7.3 billion, when their claim payments were $5.5 billion (5.0% of all Part D payments). Oncology contributed a higher annual growth in Part D drug costs compared with all other providers (15.1% and 3.1%, respectively, for 2017). The top 3 drugs increased cost by approximately $3.5 billion from 2013 to 2017. Across hospital referral regions, the oncologists’ Part D share varied (median in 2017, 7.7%; interquartile range, 6.2%-9.3%) and was higher across regions where oncologists had an LQ significantly > 1 (mostly in areas with centers that excel in cancer care) and lower for an LQ significantly < 1 (median, 9.7% v 6.2%, respectively; P < .001). CONCLUSION: Oncology increased its share in Part D drug spending, disproportionately to all other providers, with regional differences partially moderated by the oncology workforce and quality of cancer care.

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Early National Dissemination of Abiraterone and Enzalutamide for Advanced Prostate Cancer in Medicare Part D

Journal of Oncology Practice ◽

10.1200/jop.2016.020206 ◽

2017 ◽

Vol 13 (8) ◽

pp. e694-e702 ◽

Cited By ~ 3

Author(s):

Megan E.V. Caram ◽

Tudor Borza ◽

Hye-Sung Min ◽

Jennifer J. Griggs ◽

David C. Miller ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

Regional Variation ◽

Medicare Part D ◽

The United States ◽

Medicare Part ◽

Castration Resistant Prostate Cancer ◽

Part D ◽

Hospital Referral ◽

Early National

Introduction: Abiraterone and enzalutamide were approved by the Food and Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer (mCRPC). Most men with mCRPC are > 65 years of age and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. Methods: We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data. We categorized HRRs by abiraterone and enzalutamide prescriptions, adjusted for prostate cancer incidence, and examined factors associated with regional variation using multilevel regression models. Results: Among providers who wrote the majority of prescriptions for abiraterone or enzalutamide in 2013 (n = 2,121), 87.5% were medical oncologists, 3.3% were urologists, and 9.2% were other provider specialties. Among prescribers, approximately 30% were responsible for three quarters of the claims for abiraterone and 20% were responsible for more than half the claims for enzalutamide. Some HRRs demonstrated low-prescribing rates despite average medical oncology and urology physician workforce density. Our multilevel model demonstrated that regional factors potentially influenced variation in care. Conclusion: The majority of prescriptions written for abiraterone and enzalutamide through Medicare Part D in 2013 were written by a minority of providers, with marked regional variation across the United States. Better understanding of the early national dissemination of these effective but expensive drugs can help inform strategies to optimize introduction of new, evidence-based mCRPC treatments.

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Early national dissemination of abiraterone and enzalutamide for advanced prostate cancer in Medicare Part D.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.35 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 35-35

Author(s):

Megan Veresh Caram ◽

Tudor Borza ◽

Hye-Sung Min ◽

Jennifer J. Griggs ◽

David Christopher Miller ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

Regional Variation ◽

Advanced Prostate Cancer ◽

Medicare Part D ◽

The United States ◽

Medicare Part ◽

Part D ◽

Hospital Referral ◽

Early National

35 Background: Abiraterone and enzalutamide are oral medications approved by the Food & Drug Administration in 2011 and 2012 to treat men with advanced castration-resistant prostate cancer. Most men with advanced prostate cancer are over age 65 and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. Methods: We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data. We categorized HRRs by abiraterone and enzalutamide prescriptions, adjusted for prostate cancer incidence, and examined factors associated with regional variation using multilevel regression models. Results: Among all providers who wrote prescriptions for abiraterone or enzalutamide in 2013 (n=2121), 87.5% were medical oncologists, 3.3% urologists, and 9.2% were listed as other provider specialties. Among those who prescribed either drug, 5% of providers were responsible for 75% of the claims for abiraterone, and 7% were responsible for 75% of the claims for enzalutamide. Some HRRs demonstrated low-prescribing rates despite average medical oncology and urology physician workforce density. Conclusions: The majority of prescriptions written for abiraterone and enzalutamide through Medicare Part D in 2013 were written by a minority of providers with marked regional variation across the United States. Better understanding the early national dissemination of these effective but expensive drugs can help inform strategies to optimize introduction of new, evidence-based advanced prostate cancer treatments.

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Abstract P12: Medication Therapy Management Services - A Requirement for Medicare Part D Plans: Are Your Patients Eligible?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap12 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Sarah A Spinler ◽

Mark J Cziraky ◽

Paul S Chan ◽

Feng-ming Tang ◽

Gladys G Duenas ◽

...

Keyword(s):

Drug Cost ◽

Average Cost ◽

Medicare Part D ◽

Medication Therapy Management ◽

Drug Costs ◽

Medicare Part ◽

Cardiac Diseases ◽

Part D ◽

Therapy Management ◽

Medication Therapy

Background: Medication Therapy Management (MTM) is a mandated component of Medicare Part D whereby a pharmacist-patient encounter identifies, resolves and prevents medication-related problems. MTM programs have been shown to improve drug therapy goal attainment while reducing overall costs in cardiac patients; however, MTM has been greatly underutilized. The purpose of this study is to identify the proportion of patients eligible for MTM from those enrolled in the NCDR's outpatient PINNACLE Registry. Methods: MTM eligibility is based on the presence of multiple chronic diseases and medications plus the likelihood of exceeding an annual drug cost threshold ($4000 in 2009 and $3000 in 2010). Patients from PINNACLE (5/1/08 to 9/30/10) with 3 or more of the following diseases were identified: HTN, HF, dyslipidemia, DM, CAD. Patient demographics, cardiac diseases, and cardiac drug classes prescribed (individual drugs not available) were captured. To estimate individual patient drug costs to determine MTM eligibility, a weighted average cost was calculated using nationally representative drug utilization data and average wholesale prices (AWP). Sensitivity analyses for determining MTM eligibility were performed by varying drug costs using AWP for the highest cost and clinician-defined most frequently prescribed drugs in each class. Results: Of the 160,593 Medicare patients enrolled in PINNACLE, 93,089 (58%) were identified with ≥ 3 cardiac diseases. The cohort’s mean age was 74.4 ± 9.2 yrs, 54.4% were male and 86.5% were white. Patients were prescribed a mean of 3.5 cardiac drugs. The table displays drug costs and MTM eligibility results. Conclusions: A substantial number of patients met MTM eligibility requirements with this conservative approach using only cardiac drug costs, although variability existed based on cost method. These data serve to raise cardiologists' awareness of their patients' potential eligibility to receive the benefits of MTM services. Cost Methodology Median Annual Cost (IQR) 2009 MTM Eligibility [N (%)] 2010 MTM Eligibility [N (%)] Weighed average cost $1329 (915,2609) 6,202 (6.7% ) 19,903 (21.4%) Frequently prescribed cost $366 (193,1361) 1084 (1.2% ) 7326 (7.9%) High cost $3,958 (2406,5358) 46,477 (49.9% ) 59,619 (64%) 2009 and 2010 MTM eligibility based on likelihood of exceeding drug cost threshold of $4000 and $3000, respectively. IQR - interquartile range; MTM - medication therapy management.

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Opioid Prescribing Patterns of Optometrists in the Medicare Part D Database

Optometry and Vision Science ◽

10.1097/opx.0000000000001827 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Stephen C. Dryden ◽

Holly A. O’Malley ◽

Lindsey R. Adams ◽

Garrett C. Nix ◽

Jonathan E. Rho ◽

...

Keyword(s):

Medicare Part D ◽

Prescribing Patterns ◽

Medicare Part ◽

Part D ◽

Opioid Prescribing

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Impact of Laws Regulating Pain Clinics on Opioid Prescribing and Opioid-Related Toxicity Among Texas Medicare Part D Beneficiaries

Journal of Pharmacy Technology ◽

10.1177/8755122516686226 ◽

2017 ◽

Vol 33 (2) ◽

pp. 60-65 ◽

Cited By ~ 7

Author(s):

Mukaila A. Raji ◽

Yong-Fang Kuo ◽

Nai-Wei Chen ◽

Hunaid Hasan ◽

Denise M. Wilkes ◽

...

Keyword(s):

Temporal Trends ◽

Medicare Part D ◽

Medicare Part ◽

Opioid Overdose ◽

Opioid Prescription ◽

Part D ◽

Opioid Prescribing ◽

Pain Clinics ◽

The Impact ◽

Over Time

Background: Pain management clinics are major sources of prescription opioids. Texas government passed several laws regulating pain clinics between 2009 and 2011 to reduce opioid-related toxicity. Understanding the impact of these laws can inform policy geared toward making the laws more effective in curbing the growing epidemic of opioid overdose, especially among the elderly population. Objectives: To examine the longitudinal association of laws regulating pain clinics on opioid-prescribing and opioid-related toxicity among Texas Medicare recipients. Methods: The 2007 to 2012 claims data for Texas Medicare Part D recipients were used to assess temporal trends in the percentage of patients filling any schedule II or schedule III opioid prescription, hospitalization for opioid toxicity, and their relationships to the 2009 to 2011 Texas laws regulating pain clinics. We excluded those with a cancer diagnosis. Join-point trend analysis with Bayesian Information Criterion selection methods were used to evaluate the change in monthly percentages of patients filling opioid prescriptions and hospitalization over time. Results: There was a short-lived decline in the monthly percentages of patients who filled a schedule II or schedule III opioid prescription after the 2009 laws regulating pain clinics. The decline lasted about 3 months. Subsequent new laws had no effect on the percentages of patients who filled any opioid prescription or were hospitalized for potential opioid toxicity. Hospitalizations for opioid toxicity were highest in the winter and lowest in the summer. Conclusions: Changes in the percentages of opioid-prescribing or opioid-related hospitalizations over time were not associated with laws regulating pain clinics.

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Opioid Prescribing by Nurse Practitioners in Medicare Part D: Impact of State Scope of Practice Legislation

Medical Care Research and Review ◽

10.1177/1077558717725604 ◽

2017 ◽

Vol 76 (3) ◽

pp. 337-353 ◽

Cited By ~ 8

Author(s):

Elissa Ladd ◽

Casey Fryer Sweeney ◽

Anthony Guarino ◽

Alex Hoyt

Keyword(s):

Patient Safety ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

State Legislatures ◽

Medicare Part D ◽

Prescribing Patterns ◽

Medicare Part ◽

Scope Of Practice ◽

Part D ◽

Opioid Prescribing

Many state legislatures restrict nurse practitioner (NP) scope of practice as a way of addressing patient safety concerns. The purpose of this study was to investigate the influence of state NP scope of practice laws on the prescription of oxycodone and hydrocodone containing medications by NP and MD/DO/PA prescribers to Medicare Part D beneficiaries. Using the Medicare Part D public use file, we analyzed oxycodone and hydrocodone containing prescriptions per Medicare Part D beneficiary by prescriber type, NP state scope of practice, and geographic variables. Our results demonstrate that the state scope of practice variable had the same effect, in identical direction and significance, on NP opioid prescribing patterns as it had on MD/DO/PA prescribers, a group to whom NP scope of practice laws do not apply. Thus, scope of practice in this study was not an exclusive predictor of NP practice and prescribing.

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