Fact Sheets

Update to the Medicare Drug Spending Dashboard

Update to the Medicare Drug Spending Dashboard

As part of its effort to provide additional information on, and increase transparency with respect to the cost of prescription drugs, CMS is updating the Medicare Drug Spending Dashboard to include information for 2015. This online dashboard presents information for three categories of Medicare prescription drugs for both Part B and Part D: drugs with high spending on a per user basis, drugs with high spending for the program overall, and drugs with high unit cost increases in recent years.

Through review of 2015 data, CMS identified 80 drugs that met the criteria described below: 40 drugs provided through the Medicare Prescription Drug Program under Part D and 40 drugs administered by physicians and other professionals in the Medicare fee-for-service program under Part B. For all drugs included on the list, the dashboard displays relevant spending, utilization, and trend data and also includes consumer-friendly information on the drug product descriptions, manufacturer(s), and clinical indications. Products were selected from each respective program area if they met one of the following criteria:

1. 15 drugs with the highest total spending;
2. 15 drugs with high annual per user spending ($10,000 or more per user) and with the highest total program spending (if a drug already is selected based on (a) it is not eligible to be selected based on (b) criteria); or
3. 10 drugs with large increases in average cost per unit from 2014 to 2015 (if a drug already is selected based on (a) or (b) it is not eligible to be selected based on (c) criteria). 

The data presented in the dashboard do not reflect any manufacturers’ rebates or other price concessions since CMS is prohibited from publicly disclosing drug-specific information on manufacturer rebates. However, the drug spending dashboard website now includes aggregated Medicare Part D manufacturer rebate information for calendar year 2014, and similar rebate information will also be released for 2015 when available. Although we are only able to share high-level summary data on rebates, we believe releasing this information, even at a highly-aggregated level, helps to shed new light on the relationship between drug pricing and overall program costs. In addition, the data presented in the dashboard are important because they are the basis of beneficiary cost-sharing calculations and benefit phase determinations (deductible phase, coverage gap phase, etc.).

Changes from 2014 to 2015

One use of this dashboard is to make the trends related to drug spending for beneficiaries and for the programs administered by CMS transparent to providers, consumers, and the public. The relatively small set of medications presented as part of this dashboard represents a very large proportion of program spending, including 34 percent of all Part D spending and 69 percent of Part B drug spending in 2015, which was similar to the 2014 drug dashboard (Tables 1a and 1b). In addition to the goal of transparency and the potential use of the information to educate the public, the data can be used to spur research and public discussion of how these drug products are being used in Medicare and how they are affecting beneficiary costs.

Table 1a. Part D Dashboard Summary, CY2014 and CY2015.

* Drug Products defined by distinct Brand Name and Generic Name (First Databank), excluding
over the counter drugs.

Table 1b. Part B Dashboard Summary, CY2014 and CY2015.

^ Drug Products defined by Healthcare Common Procedure Coding System (HCPCS) codes for products with a
manufacturer reported Average Sales Price (ASP) and Part B oral cancer drugs billed in a NCPCP (National
Council for Prescription Drug Programs) format. ).

 

The 2015 Medicare Drug Spending Dashboard includes 23 drugs that were not on the 2014 dashboard – 14 Part D drugs and nine Part B drugs. Among the 14 Part D drugs, only one drug, Xarelto (Rivaroxaban; a brand name drug to prevent blood clots), was added based upon overall high spending criteria, while nine drugs were selected based upon high unit cost increases. Among the nine new Part B drugs, Prevnar-13 (pneumococcal 13-valent vaccine; a brand name pneumococcal vaccine) was added in the overall high spending category and six drugs were added in the high unit cost increases category (Tables 2a and 2b).

Table 2a. Part D Medicare Drug Dashboard: New Drugs Meeting Criteria in CY2015.

 

Table 2b. Part B Medicare Drug Dashboard: New Drugs Meeting Criteria in CY2015.

 

Trend Charts and Analyses

Charts 1a and 1b below show, for drugs selected for total program spending, the five drugs with the highest Part D and Part B drug spending, respectively, in 2015 compared to their spending in 2014. For example, the Dashboard shows that Lantus (insulin) was a top-five drug in terms of costs in Medicare Part D between 2014 and 2015, as was Havroni, the new drug to treat Hepatitis C.

The five Part D drugs with highest total spending in 2015 were Spiriva (tiotropium bromide, a brand name chronic obstructive pulmonary disease treatment), Advair Diskus (fluticasone/salmeterol; a brand name asthma and chronic obstructive pulmonary disease treatment), Crestor (rosuvastatin calcium; a brand name cholesterol drug), Lantus/Lantus Solostar (insulin glargine; a brand name diabetes drug), and Harvoni (ledipasvir/sofosbuvir; a brand name Hepatitis C virus treatment). Advair Diskus and Crestor were also among the top five drugs with the highest Part D spending in 2014, but Spiriva, Lantus, and Harvoni were not. Harvoni was introduced in October 2014 and in 2015 had just over $7 billion in spending. Sovaldi (sofosbuvir), another drug for treating Hepatitis C, had the highest spending in 2014, but was not among the top five drugs in 2015, with $1.3 billion in spending. The top five Part B drugs with highest total spending were Lucentis (ranibizumab; a brand name drug for wet age-related macular degeneration), Remicade (infliximab; a brand name rheumatoid arthritis drug), Neulasta (pegfilgrastim; a brand name white blood cell stimulator for use with cancer treatments), Rituxan (rituximab; a brand name cancer treatment), and Eylea (aflibercept; a brand name drug for wet age-related macular degeneration). These were the same five drugs with the highest Part B spending in 2014. Each of these drugs contributed more than $1 billion in spending for the Medicare Part B program.

Chart 1a. Trends in Medicare Part D Total Spending for the Top 5 Drugs in 2015.

Chart 1b. Trends in Medicare Part B Total Spending for the Top 5 Drugs in 2015.

 

Charts 2a and 2b show, for the drugs selected for high unit cost increases, the top five drugs with the largest increases in average cost per unit from 2014 to 2015 in the Part D and Part B programs, respectively. Glumetza (metformin HCl; a diabetes treatment) had the largest increase in cost per unit at over 380 percent and had total spending increases from $34.3 million to $153 million. All five of these Part D drugs had increases in cost per unit of more than 100 percent. Among Part B drugs, mitomycin (a generic chemotherapy agent), had the largest increase in average Part B cost per unit at 163 percent and had total spending increases from $5.9 million to $15.8 million. The other four Part B drugs had smaller, but still significant increases, approximately 25 to 40 percent. While EpiPen isn’t included in the Dashboard (its cost spike occurred in 2016), CMS reports that Medicare and Medicaid spending on EpiPens rose by over 500 percent from 2011 to 2015. 

Chart 2a. Medicare Part D Drugs Selected for Large Increases in Cost per Unit, 2014 to 2015.

 

Chart 2b. Medicare Part B Drugs Selected for Large Increases in Spending per Unit, 2014 to 2015.

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^ Drug Products defined by Healthcare Common Procedure Coding System (HCPCS) codes for products with a manufacturer reported Average Sales Price (ASP) and Part B oral cancer drugs billed in a NCPCP (National Council for Prescription Drug Programs) format. ).