Presentation Authors: George Wayne*, Miami Beach, FL, Jeffrey Wei, Vivian Wong, Elias Atri, Miami, FL, Maurilio Garcia, Juan Cedeno, Elizabeth Nagoda, Jorge Pereira, Miami Beach, FL
Introduction: Prescription drug costs represent a major source of healthcare expenditure in the United States. While medication costs are most often associated with the medical specialties, the increased use of specialty drugs for oncologic care by surgical specialists may prove to be a significant cost driver and opportunity for savings. As such, we sought to evaluate Medicare Part D Prescription Drug (MPD) utilization in order to disaggregate surgical specialty spending, evaluate cost attributed to Urologic care, and identify factors predictive of high-cost prescribing (HCP).
Methods: Indexing by NPI number and specialty code we analyzed surgical subspecialist prescription drug cost data using the 2016 &[Prime]Medicare Fee-For-Service Provider Utilization and Payment Data: Part D Prescriber Summary&[Prime]. Providers in the highest quartile of total prescription drug costs for this cohort were identified as HCP providers. Categorical data analysis and logistic regression were then used to identify factors associated with HCP.
Results: The aggregate drug cost for all surgical specialties in 2016 was noted to be $5.96 billion dollars for over 16 million MPD beneficiaries. Urology was found to have the highest median total prescriber drug cost ($90,808.10, p < 0.01), largest median number of drug claims (1,093, p < 0.01), the largest median number of MPD beneficiaries (296, p < 0.01), and the likeliest to be classified as a high-cost prescriber (Odds Ratio 3.2, p < 0.01) compared to all other surgical specialties. Share of spending varied regionally, with prescribers from the South most likely classified as high-cost prescribers (OR 1.4, p < 0.01). Over all, subspecialties with a greater emphasis on cancer care were more likely than general surgeons to be high-cost prescribers.
Conclusions: National spending on health care has attracted significant criticism and concern. A major cost-driver, prescription drug coverage, is increasingly attributable to surgical subspecialist care, with Urologists leading in volume and cost among MPD providers. Urologists must be aware of their significant role in driving these costs, in order to both lead in upending them and to ensure our patients&[prime] continued access to our care.