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18
November 2016
 |
US Medicare (The Total Investment & Insurance
Solutions)
The number of doctors who each
prescribe millions of dollars of medications annually in Medicare's drug
program has soared, driven by expensive hepatitis C treatments and rising drug
prices overall, federal data obtained by ProPublica shows.
The number of providers who topped the
$5 million mark for prescriptions increased more than tenfold, to 514 in 2015
from 41 in 2011. The number of prescribers—mostly physicians but also nurse
practitioners—exceeding $10 million in drug costs jumped from two to 70 over
the same time period, according to the data. The Total Investment & Insurance Solutions
Most of the doctors atop the spending
list prescribed Harvoni or Sovaldi, relatively new drugs that cure hepatitis C.
Other providers on the list prescribed pricey drugs to treat cancer, multiple
sclerosis and rheumatoid arthritis. The
Total Investment & Insurance Solutions
Medicare's drug program, known as Part
D, covers more than 41 million seniors and disabled people. In 2015, it
accounted for $137.4 billion in drug spending, before factoring in
rebates from drug companies. That was up from $121.5 billion a year earlier.
"The trends in this space are
troubling and don't show any signs of abating," said Tim Gronniger, deputy
chief of staff at the Centers for Medicare and Medicaid Services, the federal
agency that runs Medicare. "It's going to be a pressure point for patients
and the program for the foreseeable future." The Total Investment & Insurance Solutions
During the recent presidential
campaign, both Hillary Clinton and Donald Trump pledged to tackle the rising
costs of prescription drugs. Since his election, however, President-elect
Trump's transition agenda for health care hasn't featured the topic, a shift the Los Angeles Times reported.
Medicare has released top-level data
on drug spending for 2015, including the number of doctors who prescribed
medications worth more than $1 million. But the agency has only published data on individual doctors up to 2014. The Total Investment & Insurance
Solutions
Dr. Ben Thrower,
medical director of the Multiple Sclerosis Institute at the Shepherd Center in
Atlanta, was near the top of the list in 2014. He prescribed medications
costing $11.5 million that year, mostly for multiple sclerosis drugs. "We
get that it's very expensive," Thrower said. "I think all the MS
providers working in the U.S. would like to see the costs go down." But
prices have climbed steadily in recent years for drugs used to treat the
neurological condition, even those that have been on the market for
quite a while.
Most of the spending on Thrower's
prescriptions — $8.5 million — was for MS drugs Tecfidera and Copaxone, which
can slow progression of MS and reduce the chance of relapse. Thrower has received payments from the
makers of those and other
MS drugs, but said he cut ties with the companies in January of this year. The Total Investment & Insurance
Solutions
"It was kind of exciting when the
first one came out," Thrower said. "The problem we've seen is the
cost for these drugs has just gone up and up and up."
Thrower said he no longer prescribes
Tecfidera to new patients because it can lower white blood cell counts, putting
them at risk for infections.
Notes: Counts
include initial prescriptions and refills dispensed. Retail price includes
patients' out-of-pocket costs but does not reflect drug maker rebates. *Average
prescriptions per patient, per provider has been adjusted to give more weight
to doctors who treat more patients. (The unadjusted average is 5.6). The Total Investment & Insurance
Solutions
Just because a doctor prescribes
costly drugs doesn't mean he or she has done anything wrong, Gronniger said.
"It's much more about drug pricing ... than it is about the behavior of
any individual physician, many of whom are equally concerned about the price of
these products as we are." The
Total Investment & Insurance Solutions
Today, ProPublica is updating its Prescriber Checkup online tool, which allows you to look
up your doctor and see how his or her prescribing in Medicare Part D compares
to others in the same specialty and state. Our tool covers the year 2014. You
can compare the percentage of each doctor's prescriptions that were for
brand-name medications, the average cost per prescription and the average
number of prescriptions per patient, among other things.
Allyson Funk, a spokeswoman for the
Pharmaceutical Research and Manufacturers of America, the industry trade group,
said Medicare's figures leave out important context.
"It is important to note
physicians' prescribing patterns are dynamic and based on individual patient
needs," she said in a statement. "When looking at Medicare Part D,
government data on spending at the point of sale does not include the
substantial rebates for brand name medicines negotiated between manufacturers
and plans and therefore does not accurately reflect actual prescribing dollars
or program spending." The Total
Investment & Insurance Solutions
These rebates are confidential by law,
but Medicare said this week that the average rebate for brand-name drugs in 2014 was 17.5 percent.
The new data on high-spending
prescribers is the latest indication of the burden of drug prices on government
health programs. The Total Investment
& Insurance Solutions
In the past couple of years,
Medicare's drug tab has surged, in large part because it picks up the vast
majority of the cost of drugs once enrollees exceed a certain threshold each
year. In 2015, beneficiaries over the limit, which was $4,700, spent $51.3
billion on drugs. In 2013, the figure was $27.7 billion, government data shows.
(Taxpayers, through Medicare, pick up 80 percent of the cost of this so-called
catastrophic benefit.) The Associated Press first reported the ballooning cost in July. The Total Investment & Insurance Solutions
Another sign could be seen in a drug dashboard released by
Medicare this week. It
showed that 1 percent of drugs prescribed in the Part D program accounted for
more than one-third of the program's cost in 2015 (before rebates). Some drugs
were incredibly expensive. The drug H.P. Acthar Gel, used to treat several
conditions, such as multiple sclerosis relapses and a rare kidney disease, cost
an average of $162,371 for each of its 3,104 users—a higher per-user cost than
any other drug in the program. That's up significantly from several years ago,
when ProPublica flagged the drug's
expense. The Total Investment
& Insurance Solutions
Harvoni, used by more than 75,000
people, cost an average of $92,847 per person, for a total cost of $7 billion
(also before any rebates). The Total
Investment & Insurance Solutions
Michael Chernew, a professor of health
care policy and director of the Healthcare Markets and Regulation Lab at
Harvard Medical School, said the number of high-dollar prescribers in Medicare
doesn't surprise him. Given the increased cost of prescription drugs and the
latest treatment advances, "the entire distribution is shifting to the
right."
Chernew said that, in the long term,
Medicare and insurance companies have to examine the total cost of caring for
patients with certain diseases, taking into account drugs, hospital visits,
medical tests and more. Only then can anyone tell if certain expenses, such as
a pricey new drug, are justified. The
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For now, he said, "How do we know
what's good or bad?"
Physicians say their top priority must
be the patients in front of them, not the costs to the system.
Dr. Bruce Bacon,
a liver specialist at St. Louis University, had the highest total Part D drug
costs in 2014, $22.7 million. He was a frequent prescriber of Sovaldi and
Olysio, another expensive hepatitis C medication. The Total Investment & Insurance Solutions
Bacon did not return a call for
comment for this story. In a 2015 interview, he said he did not realize his
prescriptions were so costly to Medicare.
"I really don't think about the
cost," he said. "I think about taking care of the patients. Should I
not take care of the patients because the cost is expensive?"
Thrower, the multiple sclerosis
specialist, said the high cost of drugs frustrates him and his colleagues, but
ultimately the successful treatment of patients comes first.
"On one hand, we get that,"
he said. "On the other hand, when you're sitting in the exam room and
looking someone in the eye, you can't say, 2018I'm not going to treat you
because of the cost.'"The Total
Investment & Insurance Solutions
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