Analysis & Research
Data-driven investigations into Medicare Part D prescribing patterns.
These articles are based on our analysis of 1.38 million Medicare Part D prescribers and $275.6 billion in drug costs (2023). Each piece uses real CMS data to surface patterns in opioid prescribing, fraud risk, cost outliers, and geographic disparities.
Opioid Crisis
The Medicare Opioid Crisis in Numbers
One in three Medicare prescribers write opioid prescriptions. We mapped the geographic and specialty hotspots.
Geographic Hotspots for Opioid Prescribing
State-by-state analysis reveals persistent geographic patterns in opioid prescribing.
Anatomy of a Pill Mill
What does a pill mill look like in Medicare data? The statistical fingerprints of high-risk opioid prescribers.
Nurse Practitioners: The Most Flagged Prescriber Group
NPs are 19% of prescribers but 49% of flagged providers. What structural factors drive this disproportionate risk signal?
The Controlled Substance Pipeline: Beyond Opioids
Benzodiazepines, stimulants, gabapentin — the broader controlled substance prescribing picture and multi-category risk.
How Telehealth Changed Prescribing Patterns
Remote prescribing of controlled substances, DEA waivers, and the risks of prescriber shopping via telehealth.
Spending & Costs
Who Are the Highest-Cost Prescribers?
Some providers generate millions in drug costs. What drives the spending?
The $160 Million Prescriber
One ER doctor in California generated $160.3M in Medicare drug costs — more than any other provider. We investigated why.
The Most Expensive Prescribers in Medicare
Deep dive into the top 100 prescribers by total cost. Who are they, what specialties, and is their spending justified?
The Ozempic Effect: GLP-1 Drugs Reshaping Medicare
GLP-1 drugs now cost Medicare $8.4 billion annually — tripling since 2019. The fastest-growing drug category analyzed.
The Drugs That Cost Medicare Billions
Eliquis: $7.75B. Ozempic: $4.3B. The top 20 drugs consume 22% of all Part D spending.
Pharmacy Benefit Managers: The Middlemen Problem
How PBMs control drug pricing through spread pricing, rebate clawbacks, and formulary manipulation.
Why Doctors Still Prescribe Brands When Generics Exist
Brand loyalty, pharma marketing, and specialty variation in generic drug adoption.
Where Does $275.6 Billion Go?
The big picture of Medicare Part D spending — who pays, where it flows, and policy implications.
The $275 Billion Explosion: 5 Years of Medicare Drug Cost Growth
Medicare Part D drug costs surged 50% from $183B to $275.6B in five years. What's driving the explosion?
The 50 Most Prescribed Drugs in Medicare Part D
Ranked by claims count — the most commonly prescribed drugs in Medicare, with cost-per-claim and provider data.
Fraud & Risk
How We Score Prescribing Risk
Our 10-component model plus ML fraud detection: specialty-adjusted z-scores, drug combinations, OIG matching, and machine learning.
Excluded but Still Prescribing
We found 372 providers on the OIG exclusion list who appear in active Medicare prescribing data.
How Much Medicare Part D Waste?
A data-driven estimate of Medicare waste from brand overprescribing, excluded providers, cost outliers, and opioid excess.
Pharmacy Fraud in Medicare: How We Detect It
Our multi-layered fraud detection approach using ML, statistical analysis, and OIG exclusion matching.
Doctor Shopping in Medicare Part D
The data behind multi-provider prescribing — opioid rate outliers, cost-per-beneficiary extremes, and co-prescribing red flags.
Geographic & Demographics
Geographic Disparities in Medicare Prescribing
State-level spending and opioid variations reveal a 3x cost gap and persistent rural-urban divides.
Rural America's Prescribing Problem
Rural providers have higher opioid rates, fewer generics, and higher per-patient costs. The urban-rural prescribing divide.
The State of Prescribing: 2023 Report Card
10 key findings from 1.38 million prescribers and $275.6 billion in drug costs. The annual data report card.
State Rankings: The Best and Worst of Medicare Prescribing
Ranking all 50 states by opioid rates, drug costs, risk scores, and brand prescribing.
Medicare Part D Spending by State
State-by-state rankings of total cost, per-capita cost, cost growth, and opioid spending.
Clinical Patterns
Which Medical Specialties Drive the Most Drug Spending?
From oncologists generating millions to primary care's aggregate impact — specialty prescribing patterns revealed.
The Polypharmacy Problem
Medicare patients fill 31+ prescriptions per year on average. When too many drugs meet too little coordination.
Brand vs Generic: The $130 Billion Gap
Brand-name drugs cost 10x more on average. Which providers and specialties resist generics?
Antipsychotics in the Elderly
Off-label antipsychotic use in nursing homes — a pattern linked to excess mortality.