New CMS pharmacy dashboards include data sets from 2013 to 2017.
The Centers for Medicare & Medicaid Services (CMS) has released its latest “CMS Drug Spending Dashboards.” While the dashboards are interactive (you can look up specific drug data), we took a broader approach and downloaded and analyzed the source data.
The dashboard has the following data sets for 2013 through 2017:
For each drug and manufacturer, the data includes:
We specifically looked at Part D drugs with spending of over $1 billion. These drugs turned out to be focused on the following diseases:
|
Disease |
Medicare D 2017 Spend |
Claims |
|
Type 1 and Type 2 Diabetes |
$8,212,926,788 |
14,686,100 |
|
Blood Clots |
$5,687,988,232 |
11,591,007 |
|
COPD |
$5,547,814,048 |
12,289,852 |
|
Type 2 Diabetes |
$3,817,588,316 |
5,785,217 |
|
Multiple Myeloma |
$3,312,773,264 |
259,693 |
|
Psoriasis |
$3,039,841,725 |
498,979 |
|
Hep C |
$2,555,839,934 |
81,898 |
|
Nerve pain |
$2,517,073,735 |
5,072,269 |
|
Multiple Sclerosis |
$1,499,493,336 |
231,973 |
|
Hyperthyroidism |
$1,436,678,980 |
985,214 |
|
Breast Cancer |
$1,399,517,851 |
125,619 |
|
Leukemia |
$1,368,727,295 |
131,205 |
|
Renal Failure |
$1,316,266,396 |
892,182 |
|
Arthritis |
$1,157,839,006 |
224,688 |
|
Dry Eye |
$1,049,441,691 |
1,646,672 |
|
Grand Total |
$43,919,810,595 |
54,502,568 |
Here are some of the critical trends we noted. First, the increase in the average Medicare costs for these drugs vastly outpaced inflation.
Xarelto, for instance, a drug for treating blood clots, had an increase in market price for a monthly supply from $258.82 in 2013 to $461.40 in 2017. Xarelto also saw an increase in Medicare Part D payment rates for the same monthly supply, from $130.91 to $192.46 the same period. This yields increases in market cost and Medicare cost of 78 and 47 percent, respectively. Over the same period of time, according to the Bureau of Labor Statistics, wages only increased 12 percent. This means the cost of the drug was increasing 4 to 7 times faster than the inflation rate for salaries.
We used salaries for two reasons in our analysis. First, because the cost of the drug is borne by people earning wages. Secondly, since the drug was fully developed, it made sense to us to use salaries since the main cost-driving production should be wages.
We noted that marketing appears to influence drug spending. Advertisements for drugs with over $1 billion in Medicare spending, including Xarelto (blood clots), Eliquis (blood clots), Harvoni (Hepatitis C) and Restasis (dry eye) seem to flood our media screens.
As a final comment, it seems that many of the costly drugs relate to disease conditions heavily impacted by our own behavior. One of the biggest causative factors in COPD, for instance, is smoking. Similarly, the prevalence of type-2 diabetes correlates with America’s struggles with obesity.
As the last comment on something that may impact future drug development, we noted that actually curing a disease does not always help the drug companies’ bottom lines. Harvoni may have been a victim of its own success. Sales of this drug that treats hepatitis C fell from $4,399,701,570 in 2016 to $2,555,839,933 in 2017 as the patients that took the drug were cured.
We can’t imagine the pharmaceutical companies are not given pause by this.
We have been talking a lot lately about the malfeasance of Medicare Advantage (MA) plans, and deservedly so. But malfeasance can be a two-way street.
While President-elect Trump’s pick for U.S. Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., put the agency in even international newspapers
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
