Prescription Drug Costs and Utilization in Maine at Retail and Mail Order Pharmacies

Public Law 2018 Chapter 406 requires the Maine Health Data Organization (MHDO) to produce an annual prescription drug (Rx) report that includes:

  1. The 25 Costliest Drugs (determined by the total amount spent in the State)
  2. The 25 Most Frequently Prescribed Drugs in the State
  3. The 25 Drugs with the Highest Year-Over-Year Cost Increases (determined by the total amount spent in the State)

Reporting Periods

Report dashboards from four reporting periods are available for review and comparison:

  1. July 1, 2022 – June 30, 2023
  2. July 1, 2021 – June 30, 2022
  3. July 1, 2020 – June 30, 2021
  4. July 1, 2019 – June 30, 2020

How to Use the Reports

  1. Select the report dashboard with the reporting period of interest.
  2. Click the buttons at the top of the dashboard to select a report.
  3. View information on brand-name or generic drugs for each payor type—Commercial, Medicaid, Medicare, or Overall for a combined view of all payor types.
  4. Hover over the column names for definitions and over the numbers in the report for additional details on each drug.

July 1, 2022 – June 30, 2023

Summary of Changes

When comparing the prior period of July 1, 2021 – June 30, 2022 to the reporting period July 1, 2022 – June 30, 2023, we note the following observations:

  • Overall, the number of prescriptions increased by 2%.
  • The total cost of prescriptions increased by 8%.
  • The cost per prescription increased from $212 to $225 (6%).
  • Among the costliest drugs, 3 new drugs were added to the Top 25 list: Ozempic, Skyrizi Pen, and Taltz.
  • Among the most utilized drugs, 5 new drugs were added to the Top 25 list: Binaxnow COVID test, Oxycodone Hcl, Ventolin Hfa, and Fluticasone Propionate. The 2022 formulation of the influenza vaccine is also new, replacing the 2021 version on last year’s report.
  • Among the drugs with the highest year over year increases, 4 new drugs were added to the Top 25 list: Rinvoq, Nubeqa, Skyrizi Pen, and Omnipod 5 G6 Pods (Gen 5).

There was a data warehouse update between when the estimates were produced for the prior reporting period to the current period. So, while the previous reporting period remains the same (July 1, 2021 – June 30, 2022), new claims have been submitted for that time period, so there may be slight differences in counts or estimates between the previous dashboard and this summary of changes.

July 1, 2021 – June 30, 2022

Summary of Changes

When comparing the prior period of July 1, 2020 – June 30, 2021 to the reporting period July 1, 2021 – June 30, 2022, we note the following observations:

  • Overall, the number of prescriptions decreased in the new reporting period by 1.8%.
  • The total cost of prescriptions increased by 6.6%.
  • The cost per prescription increased from $183 to $198 (8.2%).
  • Among the costliest drugs, 3 new drugs were added to the Top 25 list.
  • Among the most utilized drugs, 6 new drugs were added to the Top 25 list.
  • Among the drugs with the highest year over year increases, 15 new drugs were added to the Top 25 list.

July 1, 2020 – June 30, 2021

Summary of Changes

When comparing the prior period of July 1, 2019 – June 30, 2020 to the reporting period July 1, 2020 – June 30, 2021, we note the following observations:

  • Overall, the number of prescriptions increased by 1.5%.
  • The cost of prescriptions increased by 12.3%.
  • The cost per prescription increased from $165 to $183 (10.6%).
  • Among the costliest drugs, 3 new drugs were added to the Top 25 list.
  • Among the most utilized drugs, 5 new drugs were added to the Top 25 list, including both the Pfizer and Moderna COVID-19 vaccines.
  • Among the drugs with the highest year over year increases, 7 new drugs were added to the Top 25 list.

July 1, 2019 – June 30, 2020

Summary of Changes

When comparing the prior period of July 1, 2018 – June 30, 2019 to the reporting period July 1, 2019 – June 30, 2020, we note the following observations:

  • Overall, the number of prescriptions increased by 1.8%.
  • The total cost of prescriptions increased by 11.1%.
  • The cost per prescription increased from $151 to $165 (9.3%).
  • Among the costliest drugs, 6 new drugs were added to the Top 25 list.
  • Among the most utilized drugs, 5 new drugs were added to the Top 25 list.
  • Among the drugs with the highest year over year increases, 12 new drugs were added to the Top 25 list.

Methodology for Rx Costs and Utilization

The information in these reports represents the most recent 12 months of available 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 dispensed during the reporting period of interest. 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.
  • 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.