The Medicare Part D Prescribers by Provider dataset contains information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The dataset identifies providers by their National Provider Identifier (NPI) and summarizes for each prescriber the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost.

 

Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug Plans (with the exception of employer and Program of All-Inclusive Care for the Elderly plans). These non-identifiable files are available on a quarterly basis and are comprised of the following tables:

 

Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.
Geographic Locator - MA and Prescription Drug Plans region codes and county codes.
Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, and prior authorization.
Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).
Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.
Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators.
Pricing - Plan level average monthly costs for formulary Part D drugs (note: this table is only available in the quarterly files).
Partial Gap Coverage - Plan-RxCUI combinations that are on tiers that offer gap coverage for some drugs on the tier.
Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.
Insulin Beneficiary Cost File - Plan level cost sharing details for insulin at preferred, non-preferred and mail order network pharmacies.

 

These are large files and can take time to download. 

 

Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity.

 

The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information is also available to access for the monthly level information.

 

Please note:  The Part D benefit year information for plans become available in October of the year prior. For example, year 2024 data is available in the fourth quarter file of 2023. Year 2024 data continues to be available in the Q1-Q3 2024  files, then in the fourth quarter of 2024 year 2025 data becomes available. 

Estimated release dates for upcoming 2024 quarterly data (files reflect data for the quarter that ended the month before the file was released):

10/16/24
1/29/25
4/23/25
7/30/25

Files older than contract year 2019 can be purchased.

The Medicare Part D by Drug dataset presents information on spending for drugs prescribed to Medicare beneficiaries enrolled in Part D by physicians and other healthcare providers. Drugs prescribed in the Medicare Part D program are drugs patients generally administer themselves.

 

The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications.

 

Drug spending metrics for Part D drugs are based on the gross drug cost, which represents total spending for the prescription claim, including Medicare, plan, and beneficiary payments. The Part D spending metrics do not reflect any manufacturers’ rebates or other price concessions as CMS is prohibited from publicly disclosing such information.

The Medicare Part D Prescribers by Provider and Drug dataset provides information on prescription drugs prescribed to Medicare beneficiaries enrolled in Part D by physicians and other health care providers. This dataset contains the total number of prescription fills that were dispensed and the total drug cost paid organized by prescribing National Provider Identifier (NPI), drug brand name (if applicable) and drug generic name.

 

Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The Monthly Prescription Drug Plan Formulary and Pharmacy Network Information files contain formulary and pharmacy network data for Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug Plans (with the exception of employer and Program of All-Inclusive Care for the Elderly plans). These non-identifiable files are available on a monthly basis and are comprised of the following tables:

 

Plan Information - Information such as plan name, contract ID, plan ID, service area, and plan type.
Geographic Locator - MA and Prescription Drug Plans region codes and county codes.
Basic Drugs Formulary - Formulary details for each plan including National Drug Codes (NDCs), cost share tier level, and indicators for step therapy, quantity limits, and prior authorization.
Excluded Drugs Formulary - Enhanced alternative plans may elect to provide a supplemental benefit and cover excluded drugs. File includes formulary details for excluded drugs that are covered by the plan (for enhanced alternative plans only).
Beneficiary Cost - Plan level cost sharing details for preferred, non-preferred, and mail order network pharmacies.
Pharmacy Network - National Provider Identifier (NPI) numbers for each network pharmacy including preferred, retail, and mail order indicators.
Partial Gap Coverage - Plan-RxCUI combinations that are on tiers that offer gap coverage for some drugs on the tier.
Indication Based Coverage Formulary File - Includes drugs covered based on FDA-approved indication for each plan.
Insulin Beneficiary Cost File - Plan level cost sharing details for insulin at preferred, non-preferred and mail order network pharmacies.

 

These are large files and can take time to download. 
 

Please read the “Agreement for Use” in the Resources section below. This document contains important information regarding timeframes for obtaining data as well as data accuracy and integrity.

 

The Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information is also available to access for the quarterly level information. 

 

Please note: The Part D benefit year information for plans become available in October of the year prior. For example, year 2024 data is available in the October, November and December 2023 monthly files. Year 2024 data continues to be available in the January through September 2024 monthly files, then beginning in October of 2024 year 2025 data becomes available.

Estimated release dates for upcoming 2024 monthly data (files reflect data for the month in which the file is released):

9/25/24
10/16/24
11/20/24
12/18/24
1/29/25
2/26/25
3/26/25
4/23/25
5/21/25
6/18/25
7/30/25
8/27/25
9/24/25

Files older than contract year 2019 can be purchased.

The Medicare Current Beneficiary Survey (MCBS) - Survey File Microdata Public Use File (PUF) dataset provides information on topics such as Medicare beneficiaries' access to care, health status, other information regarding beneficiaries’ knowledge of, attitudes toward, and satisfaction with their health care, as well as demographic data and information on all types of health insurance coverage.

The Medicare Part D Prescribers by Geography and Drug dataset contains information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. For each drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.

The CMS Program Statistics - Medicare Part D Enrollment tables provide data on characteristics of the Medicare Part D covered population. 

For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page.

These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data.

 

Below is the list of tables:

MDCR ENROLL D 1. Medicare Part D Enrollment: Part D Enrollees by Type of Plan, Low Income Subsidy (LIS), and Retiree Drug Subsidy, Yearly Trend
MDCR ENROLL D 2. Medicare Part D Enrollment: Part D Enrollees by Type of Plan, Low Income Subsidy (LIS), and Retiree Drug Subsidy, by Demographic Characteristics
MDCR ENROLL D 3. Medicare Part D Enrollment: Part D Enrollees by Type of Plan, Low Income Subsidy (LIS), and Retiree Drug Subsidy, by Area of Residence

The Medicare Monthly Enrollment data provides current monthly information on the number of Medicare beneficiaries with hospital/medical coverage and prescription drug coverage, available for several geographic areas including national, state/territory, and county. The hospital/medical coverage data can be broken down further by health care delivery (Original Medicare versus Medicare Advantage and Other Health Plans) and the prescription drug coverage data can be examined by those enrolled in stand-alone Prescription Drug Plans and those enrolled in Medicare Advantage Prescription Drug plans. The dataset provides monthly and yearly enrollee trends.

The CMS Program Statistics - Medicare Part D tables provide use and Part D drug costs by type of Part D plan (stand-alone prescription drug plan and Medicare Advantage prescription drug plan). 

For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page.

These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data.

 

Below is the list of tables:

MDCR UTLZN D 1.  Medicare Part D Utilization:  Average Annual Prescription Drug Fills by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Generic Dispensing Rate, Yearly Trend
MDCR UTLZN D 2.  Medicare Part D Utilization:  Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend
MDCR UTLZN D 3.  Medicare Part D Utilization:  Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend
MDCR UTLZN D 4.  Medicare Part D Utilization:  Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan and Demographic Characteristics
MDCR UTLZN D 5.  Medicare Part D Utilization:  Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan and Demographic Characteristics
MDCR UTLZN D 6.  Medicare Part D Utilization:  Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan, by Area of Residence
MDCR UTLZN D 7.  Medicare Part D Utilization:  Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan, by Area of Residence
MDCR UTLZN D 8.  Medicare Part D Utilization:  Number of Part D Utilizers and Average Annual Prescription Drug Fills by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend
MDCR UTLZN D 9.  Medicare Part D Utilization:  Number of Part D Utilizers and Drug Costs by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend
MDCR UTLZN D 10.  Medicare Part D Utilization:  Number of Part D Utilizers, Average Annual Prescription Drug Events (Fills) and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Demographic Characteristics
MDCR UTLZN D 11.  Medicare Part D Utilization:  Number of Part D Utilizers, Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Area of Residence