Do providers report to Medicare the drugs they prescribe?
No. Drugs are attributed to each prescriber by a pharmacy as part of a reimbursement claim. They include both original prescriptions and refills. The totals do not include prescriptions written but not filled. In some cases, physicians specializing in nursing home care told ProPublica that their totals also appear to include prescriptions by others in their practices.
Does this include prescriptions outside of Medicare?
No. ProPublica was able to get this information from Medicare because it is a public program. Private insurers are under no obligation to release prescribing data and do not.
What about the cost of drugs?
Each prescriber’s profile page notes the total retail price of their drugs and the average price per prescription. These prices include patients’ co-payments and the amount reimbursed by Part D insurance plans. But the costs do not reflect confidential rebates that drug companies negotiate with insurers. As such, the listed price is likely higher than the final price paid. A report from the Office of the Inspector General of the Department of Health and Human Services calculated overall manufacturer rebates of 19 percent for the 100 brand-name drugs that Part D spent the most money on in 2009.
What does the bar graph in the “On Prescriptions” section of a provider’s page mean?
The bar shows how similar a provider is to his or her peers based on the choice and amount of drugs prescribed. If a prescriber is far to the right of the chart, that provider is doing something very different from others. Look at the rankings below the bar graph to see how the prescriber’s top drugs differ from the rank for others in his or her specialty and state.
Is anything not included in the data?
The data don’t cover Medicare enrollees who receive drug coverage from their current or former employers, the Department of Veterans Affairs or some retiree health plans. Part D does not include drugs dispensed in a hospital, hospice or during some short rehabilitation stays in a skilled nursing facility. It also does not include medications administered in a doctor’s office, such as intravenous cancer drugs. These are covered by other parts of Medicare.
Do doctors change their favored drugs over time?
Providers may change their drug choices for a variety of reasons. New research might show that a drug works better or worse than previously thought. In addition, since 2010, some brand-name drugs have lost patent protection and doctors might now be prescribing the drug in its generic form. Additionally, new drugs have come on the market.