Docs play role in the change of Medicare Part D spending patterns

Money Pills

Despite the growing costs of drugs, 10 times as many physicians prescribed more than $5 million of medications per year under Medicare’s drug program in 2015 than in 2011.

That may be because physicians don't take into account the cost of drugs when they determine the best medication for a patient, according to an investigation by ProPublica and NPR’s Shots.

The publications trace the rise in Medicare Part D spending to a sharp rise in the cost of a relatively small number of drugs. Among the more notable culprits, the article calls out newer hepatitis treatments, as well as more-established treatments for multiple sclerosis, which have still seen steadily rising costs.

Tim Gronniger, deputy chief of staff at the Centers for Medicare & Medicaid Services, called the rise in Medicare’s prescription drug payments “troubling,” adding, “It’s going to be a pressure point for patients and the program for the foreseeable future.”

Allyson Funk of the Pharmaceutical Research and Manufacturers of America pushed back on the utility of Medicare Part D spending metrics, telling the publication that spending at the point of sale does not include the substantial rebates for brand-name medicines negotiated between manufacturers and plans. ProPublica points out that the law keeps the details of those rebates confidential, though Medicare did cite an average figure of 17.5 percent for brand-name drugs in 2014.

Both Funk and Gronniger agreed that doctors themselves are less likely to be responsible for the rise in spending than drug pricing, notwithstanding the established correlation between payments from pharmaceutical companies and increased prescription rates.

While the doctors who spoke with ProPublica were generally concerned about the rising cost of drugs, most said they do not consider price when writing prescriptions. For example, Ben Thrower, M.D., a Georgia physician, told the publication he is frustrated with the cost of drugs, but in the exam room, his priority has to be on proper treatment for the patient, not the cost to the system.