The Dartmouth Atlas of Medicare Prescription Drug Use

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Optimal use of prescription medications depends upon a clear understanding of how drugs are currently used and how they could be used more effectively.

The Issue:
With an aging population and increasing role of prescription drugs in health and health care, understanding how drugs are used in Medicare Part D informs the quality and value of care.

The Dartmouth Atlas of Health Care framework and methods are applied in this report to study Medicare Part D prescription drugs.

Key Findings

  • The average Medicare patient enrolled in Part D filled 49 standardized 30-day prescriptions in 2010; however, the number of prescriptions filled per patient across hospital referral regions varied by a factor of more than 1.6.

  • Effective prescription drug care fell below optimal levels in most hospital referral regions for heart attack survivors and diabetes patients.

  • The proportion of beneficiaries receiving two or more discretionary medications among region at the 10th and 90th percentile was 10.3 percent to 16.4 percent.

  • The use of distinct drugs targeting clinically unrelated diseases is highly correlated.

Conclusion:
The relationship of prescription to non-prescription spending is complex and heterogeneous, however, this report suggests greater prescription efficiency is achievable. This report provides insights into broader patterns of prescription drug care for patients, clinicians, and policy-makers.

About the Study:
Claims records for a 40 percent Medicare random-sample denominator file for each year from 2006 to 2010 were used. There were four cohorts—a 2010 Part D enrollment cohort, a diabetes cohort, an acute myocardial infarction (AMI) cohort, and a fragility fracture cohort.

The Dartmouth Atlas Project

For more than 20 years, the Dartmouth Atlas Project has documented variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policy-makers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America.

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