CMS plans to open drug data to researchers

Medicare officials say physician-specific prescribing information would be invaluable for an eventual pay-for-performance system.

By David Glendinning, AMNews staff. Nov. 20, 2006.

Washington -- Now that Medicare has been processing prescription drug claims for nearly a full year, federal officials are setting up a plan for scientists to learn from all the information. But some experts worry about researchers learning a little too much.

The Centers for Medicare & Medicaid Services recently unveiled a proposed rule that would allow government agencies and approved outside researchers to access portions of the claims data to conduct studies. Statute currently prohibits even government scientists from using the information until the administration finalizes regulations that open the door for them.

Once access is granted, researchers could begin using the vast resource presented by the hundreds of millions of prescription drug claims for people with disabilities and seniors that the government processes over the course of a year. Such a move would benefit the health care system, said then-CMS Administrator Mark McClellan, MD, PhD, who left the agency in October.

"We have seen great improvements in the quality of health care based on identifying opportunities for better care based on Medicare information," he said. "Through the appropriate use of the new prescription drug claims data, we have an unprecedented resource to help us learn more about prescription drug usage by seniors and how we can help seniors get the most benefit from prescription drugs."

Investigators could examine drug claims alongside hospital admission numbers for signs of previously undetected side effects or harmful drug interactions -- information that could be passed along to the Food and Drug Administration. Alternatively, researchers could crunch the data to determine which drug therapies for certain conditions improved the health of patients and saved Medicare money in the long run.