In my last article, I profiled the outpatient drugs prescribed to elderly and disabled Medicare beneficiaries of Kentucky in 2013. While I still had the analytical templates still in hand, I extended that analysis to all 50 states. Initial inspection suggests that the relative pattern of drug prescription (and dispensing) is not greatly different than that of Kentucky. It may not be a surprise that we of the Bluegrass state consume relatively more hydrocodone, oxycodone, and gabapentin relative to other drugs, but less oral anticoagulant. A more granular comparison of Kentucky to the the the nation will require a different approach. This Medicare data allows us to separate out the proportion of a given drug product that is dispensed and billed as a generic drug; a brand name drug; or as alternate preparations such as long-acting, tamper-resistant, or solid vs. liquid. The big take-away for me is that despite the supervision of Medicare’s prescription drug programs by pharmacy benefit managers and others, much money is being spent in less than a medically defensible manner– or is frankly wasted. We as a nation are leaving billions of dollars on the table for pharmaceutical companies and those who market and distribute their products. I will summarize below national utilization and cost figures and make available an Excel file supporting the graphics.

Background. I have been exploring the inaugural release of Medicare prescription drug utilization since its publication last spring. (We should get the numbers from calendar year 2014 in the next few months, but I have Medicaid 2014 in-hand and up-next!). The database does not include all Medicare beneficiaries, only those in Medicare Managed Care or in Medicare Part-D Drug plans, but that makes up a majority of bebefuicuarues. The proportions vary from state to state, but the Medicare programs covers eligible individuals over the age of 65, and some individuals who have been certified as disabled. There is a sizable proportion of individuals who are eligible for both Medicare and Medicaid for other reasons. I frankly do not at present have a good handle on the numbers of beneficiaries in these and other categories that may be included within the present data. Continue reading “Prescription of Medicare Part-D Drugs Nationally: $Billions Left On The Table.”

Visualizing prescription patterns for Medicare patients with an eye to safety and cost.

In the name of quality, accountability, and paying for results, what began as a trickle of information previously unavailable the public about utilization, cost, and outcomes of medical services became a torrent. The challenge for professionals and patients alike is how to evaluate and act upon all this data. I include myself among the learners. My readers may have guessed correctly that I like to look at spreadsheets, pivot tables, and maps. Exciting new ways of looking at such “big data” are also becoming available. “Data visualization” is a current buzzword and I am experimenting with it.  In this article I use a new way to summarize the number of prescriptions and associated cost for all drugs prescribed for Kentucky Part-D and Medicare managed care beneficiaries in 2013. This segment of Medicare patients received over 25 million prescriptions and refills that year with a total cost of $1.6 billion. I will show that a few dozen drugs comprised half the volume and cost of all prescriptions, attempt to shock you again with the volume of opioids and other controlled narcotics prescribed to the elderly and disabled, introduce you to Kentucky’s most rapidly growing drug of abuse, and illustrate in one fell swoop how America can save $Billions nationally without any decrease in safety or quality of care. Does this sound like a late-night TV come-on?  Read on. Continue reading “A Different Look At Drug Prescribing in Kentucky.”