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Nathan William Anderson Liles, Maria A Woodward, Paula Anne Newman-Casey, Lindsay Delott; Geographic Variation in Medicare Part D Spending on Ophthalmic Drugs. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5222.
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© ARVO (1962-2015); The Authors (2016-present)
$3.2 billion is spent annually on drugs prescribed to Medicare beneficiaries by eye care providers, and eye care providers prescribe more brand medications than other specialists. However, little is known about the regional variation in the prescribing patterns and how that might influence spending on ophthalmic drugs. Therefore, we analyzed publically available Medicare Part D data to explore the geographic differences in spending on ophthalmic drugs.
A retrospective analysis of ophthalmic medication prescribing for Medicare Part D beneficiaries from 2013-2015 were explored using the Prescriber Public Use Files (PUF) and summary files. The PUF contains prescription drug event information at the provider level for each prescriber using the National Provider Identifier. The primary outcome investigated was mean cost for a thirty-day-supply of ophthalmic medication from 2013 to 2015. Covariates investigated included state, year, proportion of branded medications prescribed, gender of the provider, provider type (ophthalmologist or optometrist), median household-income, and percentage of the population below the poverty level in the zip-code of the provider’s registered address. Costs related to health status differences in provider populations were adjusted using the Medicare hierarchical condition categories’ risk-adjustment model.
Monthly ophthalmic drug costs for beneficiaries varied significantly at the state level. The adjusted cost of a 30-day supply of an ophthalmic medication over 2013 to 2015 ranged from $54.28 to $112.26 in the in the lowest and highest quintiles of states (mean: $79.80). Isolating the monthly costs for brand or generic drugs, each were approximately 55% higher in the highest quintile of states compared to the lowest. Regional differences in cost per prescription accounted for 72% of the state variability in the monthly spending per beneficiary on ophthalmic drugs, after adjusting for all covariates including provider patient mix.
Substantial regional variation in Medicare spending on ophthalmic drugs exists and is driven by regional differences in cost per prescription unrelated to the health or socioeconomic status of the patients. Current policies create an unbalanced playing field for Medicare expenditures on ophthalmic drugs.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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