Prescription Drug Costs and Utilization in Maine at Retail and Mail Order Pharmacies (July 1, 2019 – June 30, 2020)
Public Law Chapter 406 requires the Maine Health Data Organization (MHDO) to produce an annual prescription drug (Rx) report that includes:
- The 25 Costliest Drugs (determined by the total amount spent in the State)
- The 25 Most Frequently Prescribed Drugs in the State
- The 25 Drugs with the Highest Year-Over-Year Cost Increases (determined by the total amount spent in the State)
How to Use This Report
- Click the buttons at the top of the dashboard to select a report.
- View information on brand-name or generic drugs for each payer type—Commercial, Medicaid, Medicare Advantage or for a combined view of all payer types select Overall.
- Hover over the column names for definitions and over the numbers in the report for additional details on each drug.
Summary of Changes from Version 2 (July 1, 2018 – June 30, 2019) to Version 3 (July 1, 2019 – June 30, 2020)
Overall, the number of prescriptions increased in the new reporting period by 1.8% while the cost of prescriptions increased by 11.1%. The cost per prescription increased from $151 to $165 (9.3%). For the costliest drugs, there are 6 new drugs that make the Top 25 list (24%). Of the most utilized drugs, there are 5 new drugs that make the Top 25 list (20%). Of the drugs with the highest year over year increases, there are 12 new drugs that make the Top 25 list (48%).
Methodology for Rx Costs and Utilization
The information in these reports represents the most recent available 12 months of data as of the date of publication. The data were extracted from pharmacy claims data in the MHDO All-Payer Claims Database (APCD) for medications prescribed July 1, 2019 – June 30, 2020. The reports focus on prescription drugs purchased at a retail pharmacy, including mail-order; they do not include medications that appear on medical claims and those purchased over the counter without a prescription.
- NDC and Drug Name – Each analysis is conducted at the level of the 11-digit National Drug Code (NDC), a unique, three-segment number that serves as a universal product identifier for drugs. All pharmacy products with an NDC are included in the analyses. The NDC identifies the chemical compound in the drug, the labeler (usually the manufacturer), and the type of packaging, for example pill or liquid form.
- Drug Class(es) – The reports use the American Hospital Formulary Service (AHFS) Drug Information to provide Drug Classes, the contextual information on the types of therapies each drug is prescribed for.
- Number of Prescriptions – Calculated across all prescriptions for a specific drug, regardless of variation in the quantity dispensed or the number of days of supply.
- Number of Prescription Users – Count of individuals with at least one pharmacy claim for the drug during the reporting period. Note that the number of prescription users is not comparable between Version 2 and Version 3 due to implemented improvements in tracking individuals across insurance changes.
- Cost – Total dollar amount insurance companies and insured individuals paid a pharmacy for prescriptions of the drug throughout the State.
- Cost Per Prescription – Total dollar amount insurance companies and insured individuals paid a pharmacy for prescriptions of the drug divided by the number of individuals that filled the prescription during the year.
- Increase – Data from the previous 12 months were analyzed to ascertain year-over-year cost increases.