Medicare Part D Prescriber Data

Key facts

Published by

CMS, on data.cms.gov, one calendar year per release

Built from

Part D prescription drug event (PDE) records submitted by Part D plans

Granularity

Prescriber NPI by brand name and generic name

First data year

2013

Suppression

Prescriber and drug rows with fewer than 11 claims are excluded

What is Medicare Part D Prescriber data?

CMS builds the Medicare Part D Prescribers dataset each year from prescription drug event (PDE) records, the claim-like records Part D plans submit for covered prescription fills. Both stand-alone prescription drug plans and Medicare Advantage plans with drug coverage contribute. Prescribers are identified by National Provider Identifier (NPI), name, location and prescriber type.

The data covers Medicare Part D claims only. It does not include prescriptions paid by commercial insurance, Medicaid, other programs or cash, and it does not include drugs administered in a physician office or hospital outpatient department that Medicare Part B pays for.

How the Part D Prescriber data is structured

CMS releases several views built from the same underlying records:

• By Provider and Drug: one row per prescriber and drug, with total claims, 30-day fills, days supply, total drug cost and beneficiary count.
• By Provider: one row per prescriber, with totals and breakdowns such as brand, generic and opioid prescribing.
• By Geography and Drug: totals for each drug nationally and by state.

Why Part D Prescriber data matters

The dataset is one of the few free sources that ties named prescribers to specific drugs. Pharmaceutical commercial teams use it to find physicians and nurse practitioners who prescribe a therapy class, size markets by specialty and state, and measure uptake of competing brands and generics among Medicare patients.

Policy analysts and journalists use it to study opioid prescribing, brand versus generic use and spending on high-cost drugs. Because rows carry an NPI, the data joins directly to National Plan and Provider Enumeration System (NPPES) records and to Medicare Physician and Other Practitioners data.

Limitations of Part D Prescriber data

The files reflect prescribing to Medicare Part D enrollees, who qualify for Medicare mainly through age 65 or disability. Prescribers who mostly treat younger, commercially insured or Medicaid patients, such as pediatricians and obstetricians, look small or absent.

Total drug cost is a gross figure that includes plan, beneficiary and other payments but not manufacturer rebates, so it overstates net spending for many brand drugs. Rows with fewer than 11 claims are excluded, drugs are grouped by name rather than National Drug Code (NDC), and each release describes prescriptions from roughly one to two years earlier.