To steal a phrase from the report on Kaiser Health News yesterday, CMS has just “popped the cap” on data related on costs and individual physician prescribing data associated with Medicare Part D. Here are the links to the story on KHN and to the actual data made available by CMS. And here’s a link to a related story in the Wall Street Journal. (Note that these data do not include the costs of drugs administered in doctors’ offices or in hospitals and some other institutional settings.)

It cannot be disputed that the availability of these data add to the transparency increasingly sought by advocates interested in just what it costs us all to manage healthcare in America today. However, it is also appropriate to point out that these data need to be interpreted with a great deal of care — for all sorts of reasons — some of which are indicated in the KHN article.

Most of the data are not immediately that surprising:

  • Widely used but still branded products like Nexium and Advair are costing Medicare a lot of money (in the billions each year).
  • The most prescribed products are largely generic.
  • Some drugs for rare disorders are very expensive when considered on a per-prescription basis, but their total cost to Medicare may be close to irrelevant overall.
  • Family practitioners and internal medicine specialists prescribed the most drugs (but then they are two of the largest physician categories in the country and therefore see the most patients with common complaints).

What is the most interesting fact is simply that these data are now available to researchers, analysts, and advocates. The problem is that how they get interpreted will depend on the perspectives of the users. It would be nice to think that a truly neutral body of some type would conduct a detailed assessment of these data — as a data set and when correlated to other, related data sets. However, what is much more likely is that we are going to see a lot of articles and reports about these data that are closely related to the interests and prejudices of the authors — or of those paying for particular interpretations.


About Mike Scott

Mike Scott is a highly experienced health care communications strategist with Calcium. He is also a board member of three different patient advocacy organizations. To get more detail, see his profile on LinkedIn.

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