Medicare Enrollment

Call a Licensed Insurance Agent Today!
1-800-485-6202 TTY 711

Medicare Enrollment



Medicare Advantage

Medicare Part D

Our Pledge To You

Medicare Enrollment

About

Contact

Call a Licensed
Insurance Agent Today!
TTY 711

The heartburn drug Nexium, also known as the “purple pill,” was prescribed to 1.5 million Medicare patients in 2013, for a total cost of over $2.5 billion making it the largest amount spent on any drug prescribed through the Medicare program, according to newly released data today from government officials.

These findings actually represent the most detailed prescription data issued by the government since 2006, when Medicare was expanded to include prescription benefits. The information was collected from more than one million distinct health care providers. These providers prescribed $103 billion in prescription drugs under the Part D program, and the federal government was responsible for $50 billion.

According to the nonpartisan Congressional Budget Office (CBO), these lower costs occurred naturally. This is most likely due to brand-name drugs losing their patent protection and being replaced in the U.S. by cheaper generics. The CMS also collected data concerning the specific medications prescribed, as well as their costs and utilization. Health care experts state that this data provides insight into the drugs — brand-name and otherwise — that are driving Medicare Part D costs.
[callus]
Exploring Medicare Part D’s Most Prescribed Drugs
With millions enrolling in Part D Drug Plans (PDPs), it’s important to determine which prescription drugs Medicare beneficiaries are taking. Not only does it provide key information to ensure and improve Medicare, but the national health care delivery system, in general. “CMS seems to be on a path toward greater transparency [when] it comes to how money is being spent, and who is spending it,” said Juliette Cubanski, associate director of the Program on Medicare Policy at the Kaiser Family Foundation. “This is another step on this path.”
Below, we’ve provided tables from CMS below showcasing the most popular prescribed medications. And, we’ve provided brief descriptions as to these drugs’ main purposes. In this first table, you’ll find the ten biggest generic drugs, in terms of total prescriptions dispensed. “Claim counts” are also provided; this refers to prescription drug fills, which can cover varying time lengths. This table is used to determine the relative rank of these drugs by utilization.
Table 1a. Top Ten Drugs by Claim Count, 2013

Drug Name Total Claim Count Beneficiary Count Prescriber Count Total Drug Cost
Lisinopril 36,880,274 7,006,650 457,683 $307,033,173
Simvastatin 36,746,410 7,030,295 399,127 $433,687,284
Levothyroxine Sodium 35,175,372 5,738,528 407,726 $396,128,533
Hydrocodone-Acetaminophen 34,756,062 8,086,006 691,028 $567,735,880
Amlodipine Besylate 34,598,901 6,244,693 441,869 $343,338,072
Omeprazole 32,250,368 6,381,404 468,856 $643,037,584
Atorvastatin Calcium 26,672,349 5,345,756 390,105 $910,768,027
Furosemide 26,441,045 5,002,942 446,350 $144,880,536
Metformin Hcl 22,041,166 4,134,345 357,620 $226,623,581
Metoprolol Tartrate 21,035,020 3,900,221 405,902 $162,047,499

Table 1a. Drug Descriptions

  • Lisinopril – One of a group of drugs called angiotensin converting enzyme (ACE) inhibitors. It’s used to treat high blood pressure (hypertension), congestive heart failure and improving survival after a heart attack.
  • Simvastatin – Used to reduce lipids (cholesterol, fats) and for the prevention of cardiovascular disease.
  • Levothyroxine Sodium – A synthetic version of the main thyroid hormone. It’s used to treat hypothyroidism (a condition in which the thyroid gland doesn’t produce enough thyroid hormone) and other thyroid-related conditions.
  • Hydrocodone-Acetaminophen – Hydrocodone is a prescribed cough medicine and suppressant and pain reliever.  Acetaminophen is an over-the-counter pain reliever, as well as a fever-reducing medication.
  • Amlodipine Besylate – A calcium channel blockers, Amlodipine works by relaxing blood vessels, so blood can flow more easily. It’s taken to treat high blood pressure and certain types of angina (chest pain) and may help to increase the ability to exercise. It can be taken alone or with other medications
  • Omeprazole – This drug is used to treat dyspepsia (indigestion), peptic ulcer disease and gastroesophageal reflux disease (GERD, in which stomach acid flows into the esophagus).
  • Atorvastatin Calcium – This “statin,” drugs that reduce the amount of cholesterol made by the liver, helps lower “bad” cholesterol and fats (LDL, triglycerides) and raise “good” cholesterol (HDL).
  • Furosemide – A water pill taken to prevent the body from absorbing excess salt, instead allowing it to pass through urine. It treats hypertension, as well as fluid retention (edema).
  • Metformin Hcl – Taken by Type 2 diabetes patients, this drug helps to control high blood sugar. Metformin works by restoring the body’s proper response to naturally produced insulin. It also decreases the amount of naturally produced sugar in the body.
  • Metoprolol Tartrate – A “beta blocker,” drugs that block the action of certain natural chemicals in your body, lowering blood pressure and heart rate, preventing strokes and reducing the strain on the heart.

This second table involves the ten biggest drugs – all brand names — in terms of cost. All of the drugs in the table below have relatively fewer claims than those by claim. However, they all have total drug costs of more than $1 billion. “Total drug costs” include the medications’ ingredient costs, dispensing fees, sales tax and any applicable administration fees.
These drug costs are based on amounts paid, including: the Part D plan; Medicare beneficiaries; other government subsidies; and any other third-party payers (i.e., liability insurers, employers). These total drug costs don’t reflect manufacturer rebates paid to Part D plan sponsors.
Table 1b. Top Ten Drugs by Costs, 2013

Drug Name Total Drug Cost Beneficiary Count Prescriber Count Total Claim Count
Nexium $2,526,306,069 1,484,011 294,246 8,192,362
Advair Diskus $2,262,995,221 1,527,217 288,140 6,605,423
Crestor $2,216,193,162 1,732,787 262,938 9,066,409
Abilify $2,107,091,535 396,764 127,070 2,886,837
Cymbalta $1,961,132,000 1,032,774 266,510 6,887,543
Spiriva $1,958,581,193 1,181,599 247,099 5,735,127
Namenda $1,564,775,426 798,714 176,825 6,878,399
Januvia $1,460,522,984 761,776 186,130 4,358,783
Lantus Solostar $1,371,996,461 862,887 212,687 3,863,847
Revlimid $1,349,964,592 24,637 8,888 153,782

Table 1b. Drug Descriptions

  • Nexium – see “Omeprazole” in previous list
  • Advair Diskus – This drug’s taken to prevent asthma attacks and for preventing chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis and emphysema. Advair contains fluticasone, a steroid that prevents the release of inflammatory substances. It also contains salmeterol, a “bronchodilator,” which relaxes muscles in the airways to improve breathing.
  • Crestor – This statin reduces high cholesterol and triglyceride levels and may lower risks for heart attack, stroke and blood vessel problems.
  • Abilify – An antipsychotic, this drug works by blocking the brain’s dopamine pathways. Abilify is taken and primarily used to treat schizophrenia and bipolar disorder, as well as major depressive disorder.
  • Cymbalta – This drug’s a serotonin–norepinephrine reuptake inhibitor (SNRI), an antidepressant drug used in the treatment of major depressive disorder (MDD) and other mood disorders. Cymbalta’s typically prescribed for major depressive disordergeneralized anxiety disorder (GAD), fibromyalgia and neuropathic (nerve) pain.
  • Spiriva – A bronchodilator taken to prevent symptoms of bronchospasm (sudden constriction of the muscles in the walls of the passageways by which air passes through the nose or mouth to the lungs. These spasms are those caused by emphysema, chronic bronchitis or COPD.
  • Namenda – This drug’s taken to treat (but not cure) moderate to severe confusion (dementia) related to Alzheimer’s disease. It may improve memory, awareness and the ability to perform daily functions. Namenda works by blocking the action of glutamate (a natural substance in the brain) that may be linked to Alzheimer’s symptoms.
  • Januvia — An anti-diabetic drug, Januvia increases levels of natural substances called incretins, which may help to control high blood sugar by increasing insulin release, especially after meals. It may also reduce the amount of sugar made in the liver.
  • Lantus Solostar – This synthetic form of insulin is taken to control high blood sugar in both Types 1 and 2 diabetes patients. This drug works more slowly and lasts longer than regular insulin.
  • Revlimid – This drug’s an immunomodulator, which works by decreasing the immune system’s response. Revlimid is taken to treat anemia in patients with certain blood and bone marrow disorders (myelodysplastic syndromes; MDS). It may reduce the need for blood transfusions. And, this drug may be used to treat certain cancers

Part D In Action: Pennsylvania’s Prescription Preferences
Let’s now take a look at how Medicare Part D spending breaks down in one state, Pennsylvania. In 2013, Pennsylvania’s Medicare beneficiaries spent $5.35 billion on prescriptions. In the “Keystone State,” prescriptions for asthma and other respiratory issues are leading the pack. For example, Advair inhalers are the state’s leading brand-name prescription.
In 2013, Medicare patients filled Advair prescriptions 424,000 times, accounting for $141.34 million in federal spending. Advair’s placement may be due to higher levels of COPD hospitalizations and over-65 asthma rates than the national averages. And even though Advair lost its U.S. patent protection in 2010, there’s still no direct generic equivalent available. This helps explain why Advair’s price of Advair has doubled from 2010 to 2015. The second biggest drug in terms of spending was the insulin medications for diabetes, Lantus, and its sister drug Lantus SoloSTAR, with $131.21 million being spent. And third was Nexium, with $117.05 million in spending.
Research shows that in Pennsylvania, low-cost generics top the list of the most-prescribed drugs. The cholesterol and medication Simvastatin was prescribed 2.12 million times to 372,000 Medicare beneficiaries. This was followed by lisinopril; it was prescribed 2.03 million times to more than 356,000 Pennsylvanian members. The state’s senior Medicare members also spent about $18.7 million on multiple brand-name and generic pain-relievers. And nearly 307,000 senior beneficiaries spent more than $95 million on various types of Oxycodone (brand-name, generic).