TABLE 1.
Changes in Pharmaceutical Spending, Utilization, and Claim Cost in Medicare Part B, Overall, by Drug Type, and by Therapeutic Class, 2008-2016
| Spending per beneficiary-year | Number of claims per beneficiary-year | Cost per claim | Contribution toward 2008-2016 overall | Contribution toward 2008-2016 overall | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 2008 | 2016 | Change | 2008 | 2016 | Change | 2008 | 2016 | Change | Spending increase | Utilization decrease | |
| Overall (N = 597) | 213.2 | 286.6 | 34.4% | 0.7848 | 0.6886 | −12.3% | 271.7 | 416.3 | 53.2% | 100.0% | 100.0% |
| Drug type | |||||||||||
| Specialty drugs (n = 159) | 160.9 | 251.1 | 56.1% | 0.1598 | 0.1689 | 5.7% | 1,006.9 | 1,486.5 | 47.6% | 113.7% | −71.1% |
| Nonspecialty drugs (n = 438) | 52.4 | 35.5 | −32.1% | 0.6250 | 0.5197 | −16.9% | 83.8 | 68.4 | −18.4% | −13.7% | 171.1% |
| Therapeutic class | |||||||||||
| Ophthalmic preparationsa (n = 13) | 18.0 | 68.6 | 280.9% | 0.0145 | 0.0491 | 238.3% | 1,242.0 | 1,398.2 | 12.6% | 57.3% | −113.8% |
| Antiarthritic and immunologic agentsb (n = 35) | 10.1 | 26.1 | 159.0% | 0.0337 | 0.0403 | 19.4% | 298.3 | 647.0 | 116.9% | 18.5% | −29.7% |
| Hospital solutionsc (n = 43) | 4.1 | 8.8 | 117.0% | 0.0647 | 0.0294 | −54.5% | 62.7 | 299.1 | 377.1% | 5.6% | 95.2% |
| Musculoskeletal agentsd (n = 13) | 8.3 | 14.8 | 77.1% | 0.0109 | 0.0168 | 54.4% | 769.0 | 881.8 | 14.7% | 7.8% | −21.6% |
| Gastrointestinal agentse (n = 14) | 17.3 | 23.1 | 33.2% | 0.0123 | 0.0101 | −17.8% | 1,404.0 | 2,274.9 | 62.0% | 7.9% | 3.7% |
| Other classesf (n = 302) | 16.4 | 21.2 | 29.2% | 0.4050 | 0.3976 | −1.8% | 40.5 | 53.3 | 31.6% | 6.8% | −82.9% |
| Antineoplastic agentsg (n = 119) | 95.5 | 89.0 | −6.7% | 0.0911 | 0.0613 | −32.7% | 1,047.9 | 1,451.5 | 38.5% | 1.6% | 70.8% |
| Blood factors and hemostatic modifiersh (n = 59) | 43.5 | 35.0 | −19.5% | 0.1525 | 0.0839 | −45.0% | 285.2 | 417.2 | 46.3% | −5.4% | 178.3% |
Notes: Estimates of spending were adjusted for inflation using the Consumer Price Index.13 Drug classes are ordered by descending changes in spending per beneficiary-year. Numbers may not sum up to totals due to rounding. All calculations were conducted from unrounded values.
a Ophthalmic preparations include products with USC level 2 code 61000 and off-label intravitreal bevacizumab. We determined the intravitreal use of bevacizumab when HCPCS code J9035 (bevacizumab injection) and CPT code 67028 (under vitreous procedures on the posterior segment of the eye) were concomitantly billed under the same claim.12 Our study sample included 597 HCPCS codes. However, given the split between off-label ophthalmic bevacizumab (J9035 + 67028) and oncologic bevacizumab (J9035), the therapeutic class sample included 598 codes.
b Antiarthritic and immunologic agents include products with USC level 2 codes 09000 and 86000.
c Hospital solutions include products with USC level 2 code 53000.
d Musculoskeletal agents include products with USC level 2 code 59000.
e Gastrointestinal agents include products with USC level 2 code 23000.
f Other classes include all other USC level 2 codes.
g Antineplastic agents include products with USC level 2 codes 30000 and 35000.
h Blood factor and hemostatic modifiers include products with USC level 2 codes 11000 and 48000.
CPT = Current Procedural Terminology; HCPCS = Healthcare Common Procedure Coding System; USC = Uniform System of Classification.