1. What are Prescription Drug Event (PDE) data?

Every time a beneficiary fills a prescription under Medicare Part D, a prescription drug plan sponsor must submit a summary record called the prescription drug event (PDE) data to CMS. The PDE data are not the same as individual drug claim transactions, but are summary extracts using CMS-defined standard fields.

2. What data are contained in PDE records?

The PDE record contains prescription drug cost and payment data that enables CMS to make payments to plans and otherwise administer the Part D benefit.

3. How do I obtain Part D drug data?

The Research Data Assistance Center (ResDAC) is the primary source of information about CMS data release policies and procedures to the data request community. As of December 2008, a limited set variables from the Part D drug data file is available and additional files will be released in early 2009.

ResDAC has a toll-free help desk and comprehensive website to disseminate the latest changes to CMS databases and data release policies. ResDAC offers assistance at all the major health service research conferences and conducts data use workshops 4-6 times a year.

4. Are both stand alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs) required to submit PDE data?

Yes.

5. Are PDE data available for all 44 million Medicare beneficiaries?

No. The Medicare prescription drug benefit is a voluntary insurance program and PDE records are only available for Medicare beneficiaries who are enrolled in a Part D plan. In 2008, about 25 million Medicare beneficiaries are enrolled in Part D plans. We do not have PDE data for beneficiaries who receive their drug coverage from other sources such as employers or unions with the Medicare Retiree Drug Subsidy, Veterans Administration, TRICARE, or FEHBP.

6. Can the data be linked with Medicare physician and hospital claims under Parts A and B of the program?

Yes. In 2008, there are about 17 million beneficiaries who are in Original Medicare with a stand-alone Part D prescription drug plan. These Medicare Part A, B, and D data are available for research purposes. PDE data is also available for the approximately 8 million beneficiaries enrolled in a Medicare Advantage plan (i.e., we do not have Part A and B claims for those beneficiaries). (Data source: CMS news release, Medicare Prescription Drug Benefits Projected Costs Continue to Drop, Jan. 31, 2008, with link to data files,

7. Will it be possible to obtain out-of-pocket costs paid by the beneficiary and amounts paid by insurer to study the demand for prescription drugs? What about quantity and day supply information?

Yes. Total drug cost - Ingredient cost, dispensing fee and sales tax (aggregated) will be available. Patient pay amount, plan amount, quantity dispensed and day supply will also be available.

8. What other sources of drug utilization data are available on the Medicare population?

In addition to proprietary data sets offered by various private vendors, there are nationally representative surveys available that offer longitudinal information on drug utilization and costs. Two of these are the Medical Expenditure Panel Survey (MEPS) available from AHRQ and the other is the Medicare Current Beneficiary Survey (MCBS) available from CMS.

9. Is drug utilization data available for other populations (such as working age adults or the near elderly)?

Proprietary datasets and MEPS cover the entire US population. Additionally, there is some drug information on the Medicaid population via the Medicaid Analytic Extract files which are person level files on service utilization and payments. More information (data available, statistical summaries, chart books and program description) on the Medicaid pharmacy benefit can be found here.