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Medicaid Spending by Drug
The Medicaid by Drug dataset presents information on spending for covered outpatient drugs prescribed to beneficiaries enrolled in Medicaid by physicians and other healthcare professionals. The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. Units refer to the drug unit in the lowest dispensable amount. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications. Drug spending metrics for Medicaid represent the total amount reimbursed by both Medicaid and non-Medicaid entities to pharmacies for the drug. Medicaid drug spending contains both the Federal and State reimbursement and is inclusive of any applicable dispensing fees. In addition, this total is not reduced or affected by Medicaid rebates paid to the states.
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Medicare Part B Spending by Drug
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The Medicare Part B by Drug dataset presents information on spending for drugs administered in doctors’ offices and other outpatient settings by physicians and other healthcare providers to Medicare Part B enrollees. The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. It also includes consumer-friendly descriptions of the drug uses, clinical indications, and manufacturer(s). Drug spending metrics for Part B drugs represent the full value of the product, including the Medicare payment and beneficiary liability. All Part B drug spending metrics are calculated at the HCPCS level.
Medicare Part D Spending by Drug
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The Medicare Part D by Drug dataset presents information on spending for drugs prescribed to Medicare beneficiaries enrolled in Part D by physicians and other healthcare providers. Drugs prescribed in the Medicare Part D program are drugs patients generally administer themselves. The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications. Drug spending metrics for Part D drugs are based on the gross drug cost, which represents total spending for the prescription claim, including Medicare, plan, and beneficiary payments. The Part D spending metrics do not reflect any manufacturers’ rebates or other price concessions as CMS is prohibited from publicly disclosing such information.