New CMS tool tracks trends for costliest drugs

Medicare Drug Spending Dashboard gives insurers, providers, consumers access to price transparency data
Tools

Health insurers concerned about the rising cost of prescription drugs now will have access to a new tool that lets them--and the public at large--analyze spending trends on the medicines that cost the country's largest payer the most.

The Medicare Drug Spending Dashboard includes "relevant spending, utilization and trend data" about 40 Part D drugs and 40 Part B drugs that are either ranked in the top 15 in terms of total program spending, ranked among the top 10 in high unit cost increases or associated with a high annual per-user spending, according to the Centers for Medicare & Medicaid Services (CMS). The drugs selected account for 33 percent of all Part D spending and 71 percent of Part B drug spending in 2014.

"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," the agency says.

CMS plans to update the dashboard "on a regular basis" as well as release similar information relating to the Medicaid program next year. A recently released report from the Office of Inspector General finds that Medicaid could have saved more than $1.4 billion in the past decade if drug companies were required to provide rebates whenever prices for best-selling generic drugs exceeded the inflation rate.

The just-released CMS data show that the Part D drugs with highest total spending were Abilify, Advair Diskus, Crestor, Nexium and Sovaldi. Health insurers such as Aetna and Humana have previously had to negotiate with Sovaldi's manufacturer, Gilead, for better pricing on the hepatitis C drug.  All five of those prescriptions had a total drug spending greater than $2 billion in 2014, CMS says.

The five drugs with the highest total spending for Part B were aflibercept, ranibizumab, pegfilgrastim, imfliximab and rituximab. A November report from the Government Accountability Office found that new drugs accounted for the highest costs in Medicare Part B.

Five Part D drugs had increases in cost per unit of more than 100 percent from 2013 to 2014, according to the CMS data, while the highest cost-per-unit increase for a Part B drug was 78 percent for Cyanocobalamin, an injection of Vitamin B-12.

The new drug price transparency information comes amid a report from Kaiser Health News that points out it is difficult or impossible for consumers to find details online about their medical-benefit drug coverage for certain complex treatments that are injected or infused, which is separate from their health plan's pharmacy benefit.

To learn more:
- check out the dashboard
- here's the CMS fact sheet
- read the KHN report

Related Articles:
GAO: New drugs account for highest costs in Medicare Part B
Health plan CEOs: Prescription drugs pose major cost concerns
OIG report: Generic drug rebates could have saved Medicaid $1.4B
Why insurers should negotiate with manufacturers for better drug prices