Chapter 10: Prescription Drug Coverage in - PowerPoint Presentation

Chapter 10:Prescription Drug Coverage in Patients with ESRD 2017 Annual Data Report Volume 2: End-Stage Renal Disease

2vol 2 Figure 10.1 Sources of prescription drug coverage in Medicare ESRD enrollees, by population, 2015 Data source: 2015 Medicare Data, point prevalent Medicare enrollees alive on January 1, 2015. Abbreviations: ESRD, end-stage renal disease; HD, hemodialysis; LIS, Low-income Subsidy; Part D, Medicare Part D prescription drug coverage; PD, peritoneal dialysis; Tx , kidney transplant.

3vol 2 Table 10.1 Percentage of general Medicare & ESRD patients enrolled in Part D General Medicare (%) All ESRD (%)Hemodialysis(%)Peritoneal dialysis (%)Transplant(%)201160.169.473.361.259.0201261.871.375.263.561.4201367.275.278.967.266.0201469.176.579.968.768.2201570.477.480.769.369.7 Data source: 2011-2015 Medicare data, point prevalent Medicare enrollees alive on January 1. Medicare data: general Medicare, 5% Medicare sample (ESRD, hemodialysis, peritoneal dialysis, and transplant, 100% ESRD population). Abbreviations: ESRD, end-stage renal disease; Part D, Medicare Part D prescription drug coverage.

4vol 2 Table 10.2 Medicare Part D parameters for defined standard benefit, 2010 & 2015   2010 2015 Deductible $310 $320 After the deductible is met, the beneficiary pays 25% of total prescription costs up to the initial coverage limit.   Initial coverage limit$2,830$2,960The coverage gap (“donut hole”) begins at this point.  The beneficiary pays 100% of their prescription costs up to the out-of-pocket threshold  Out-of-pocket threshold$4,550$4,700The total out-of-pocket costs including the “donut hole”  Total covered Part D prescription out-of-pocket spending$6,440.00$6,680.00Catastrophic coverage begins after this point (including the coverage gap).  Catastrophic coverage benefit$2.50*$2.65Generic/preferred multi-source drug$6.30 *$6.60 Other drugs   plus a 55% brand-name medication discount2015 Example:  $320 (deductible)$310.00$320 +(($2960-$320)*25%) (initial coverage)$630.00$660.00 +(($6680-$2960)*100%) (coverage gap)$3,610.00$3,720.00 Total$4,550.00$4,700.00 (maximum out-of-pocket costs prior to catastrophic coverage, excluding plan premium)   *The catastrophic coverage amount is the greater of 5% of medication cost or the values shown in the chart above. In 2015, beneficiaries were charged $2.65 for those generic or preferred multisource drugs with a retail price less than $53 and 5% for those with a retail price over $53. For brand name drugs, beneficiaries paid $6.6 for those drugs with a retail price less than $132 and 5% for those with a retail price over $132. Table adapted from http://www.q1medicare.com/PartD-The-2015-Medicare-Part-D-Outlook.php.

5vol 2 Figure 10.2 Sources of prescription drug coverage in Medicare ESRD enrollees, by age & modality, 2015 Data source: 2015 Medicare Data, point prevalent Medicare enrollees alive on January 1, 2015. Abbreviations: ESRD, end-stage renal disease; LIS, Low-income Subsidy; Part D, Medicare Part D prescription drug coverage. ESRD patients aged under 20 were not presented. (a) Di a lysis patients

6vol 2 Figure 10.2 Sources of prescription drug coverage in Medicare ESRD enrollees, by age & modality, 2015 Data source: 2015 Medicare Data, point prevalent Medicare enrollees alive on January 1, 2015. Abbreviations: ESRD, end-stage renal disease; LIS, Low-income Subsidy; Part D, Medicare Part D prescription drug coverage. ESRD patients aged under 20 were not presented. (b) Transplant patients

7vol 2 Figure 10.3 Sources of prescription drug coverage in Medicare ESRD enrollees, by race/ethnicity & modality, 2015 Data source: 2015 Medicare Data, point prevalent Medicare enrollees alive on January 1, 2015. Abbreviations: Blk / Af Am, Black or African American; ESRD, end-stage renal disease; LIS, Low-income Subsidy; Part D, Medicare Part D prescription drug coverage. (a) Dialysis patients

8vol 2 Figure 10.3 Sources of prescription drug coverage in Medicare ESRD enrollees, by race/ethnicity & modality, 2015 Data source: 2015 Medicare Data, point prevalent Medicare enrollees alive on January 1, 2015. Abbreviations: Blk / Af Am, Black or African American; ESRD, end-stage renal disease; LIS, Low-income Subsidy; Part D, Medicare Part D prescription drug coverage. (b) Transplant patients

9vol 2 Table 10.3 Percentage of Medicare Part D enrollees with the Low-income Subsidy, by age & race, 2015 General Medicare (%) All ESRD (%)Hemodialysis (%)Peritoneal dialysis (%)Transplant (%)WhiteAll ages24.253.658.246.845.120-4488.287.590.787.581.945-6452.070.175.963.657.165-7414.539.148.024.320.975+18.4 33.5 37.1 17.5 18.0Black/African AmericanAll ages57.273.675.669.064.420-4492.892.293.889.387.545-6474.880.382.773.369.865-74 41.6 58.5 62.8 40.2 39.2 75+ 48.5 58.6 60.5 35.1 38.9 Native American/Alaska Native All ages 68.0 84.4 87.7 80.5 72.6 20-44 92.7 93.1 94.7 92.4 85.045-6482.288.290.580.881.665-7455.475.881.663.855.575+56.775.180.354.554.7AsianAll ages62.966.872.054.357.220-4490.586.489.483.683.145-6465.071.877.355.565.465-7453.756.964.740.143.775+70.765.870.050.441.5Hawaiian Native/Pacific IslanderAll agesn/a70.273.660.157.520-44n/a88.489.387.585.145-64n/a76.880.561.764.465-74n/a57.362.040.244.475+n/a62.165.356.329.4Other/multiple raceAll ages30.561.272.469.751.620-4485.581.488.783.375.045-6445.167.482.488.953.865-7421.147.559.533.339.975+33.845.756.325.032.8Unknown/missingAll ages28.887.493.888.084.120-4490.593.897.691.798.445-6426.688.394.6100.078.565-7418.974.886.860.070.875+79.885.083.3.90.0 Data source: 2015 Medicare data, point prevalent Medicare enrollees alive on January 1, 2015. Abbreviations: ESRD, end-stage renal disease; LIS, Low-income Subsidy; Part D, Medicare Part D prescription drug coverage. ESRD patients aged under 20 were not presented

10vol 2 Figure 10.4 Distribution of Low-income Subsidy categories in Part D general Medicare & ESRD patients, 2015 Data source: 2015 Medicare data, point prevalent Medicare enrollees alive on January 1, 2015. Abbreviations: ESRD, end-stage renal disease; Part D, Medicare Part D prescription drug coverage.

11vol 2 Table 10.4 Total estimated Medicare Part D spending for enrollees, in billions, 2011-2015 General Medicare ($) All ESRD ($)Hemodialysis ($)Peritoneal Dialysis ($)Transplant ($)201146.01.81.40.10.2201240.12.01.60.10.3201352.12.31.80.10.3201458.12.72.10.20.4201563.43.22.50.20.5 Data source: 2011-2015 Medicare data, period prevalent Medicare enrollees alive on January 1, excluding those in Medicare Advantage Part D plans and Medicare secondary payer, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount.

12vol 2 Figure 10.5 Per person per year insurance & out-of-pocket costs for enrollees, 2015 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Medicare totals include Part D claims for Part D enrollees with traditional Medicare (Parts A & B)., Costs are per person per year for calendar year 2015, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. (a) Medicare

13vol 2 Figure 10.5 Per person per year insurance & out-of-pocket costs for enrollees, 2015 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Medicare totals include Part D claims for Part D enrollees with traditional Medicare (Parts A & B)., Costs are per person per year for calendar year 2015, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. (b) Medicare Advantage

14vol 2 Figure 10.5 Per person per year insurance & out-of-pocket costs for enrollees, 2015 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Medicare totals include Part D claims for Part D enrollees with traditional Medicare (Parts A & B)., Costs are per person per year for calendar year 2015, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. (c) Managed Care

15vol 2 Figure 10.5 Per person per year insurance & out-of-pocket costs for enrollees, 2015 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Medicare totals include Part D claims for Part D enrollees with traditional Medicare (Parts A & B)., Costs are per person per year for calendar year 2015, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. (d) Medicare by Low-income Subsidy status

16vol 2 Table 10.5 Per person per year insurance spending for enrollees, 2015 ( continued ) General ($)   All ESRD ($)  Hemodialysis($) Peritoneal dialysis($) Transplant($)Part Dwith LISPart D without LIS Part Dwith LISPart D without LIS Part Dwith LISPart D without LIS Part Dwith LISPart D without LIS Part Dwith LIS Part D without LIS Age                All5,8771,600 14,364 4,812   15,263 5,146   15,791 5,311   10,995 4,006 20-44 5,839 2,510   14,574 4,670   16,584 5,994   16,000 5,091   9,4333,02745-64 7,9092,934 15,6235,675 16,5495,944 16,3215,720 12,0274,85665-74 4,9651,514 12,9934,947 13,6055,472 13,5725,640 10,6453,92875+ 4,2081,461 10,6013,819 11,1794,077 10,6474,277 7,4352,882Sex              Male 6,0281,756 14,6894,955 15,5515,138 16,6365,317 11,6154,411Female 5,7711,484 13,9974,596 14,9455,159 15,0305,302 10,1723,384Race              White6,0291,586 13,9414,732 15,1075,167 16,1835,343 10,351 3,813 Black/African American 6,090 1,873   15,068 5,061   15,612 5,082   15,053 5,119   12,463 4,931 Native American/Alaska Native 4,774 2,605   9,218 4,533   9,204 5,185   11,767 4,355   8,438 3,607 Asian4,6371,268 14,5115,031 15,5755,622 16,9535,640 10,8954,144Native Hawaiian/Pacific-IslanderNANA 14,8984,085 15,6853,929 17,2034,875 9,1264,053Other race4,9731,599 12,4784,856 14,1756,161 12,4464,726 10,8684,397Unknown/missing4,7231,534 13,8293,347 15,1553,870 20,95733,966 10,9074,149 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Costs are per person per year for calendar year 2015, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. (a) Medicare

17vol 2 Table 10.5 Per person per year insurance spending for enrollees, 2015 ( continued) General ($) All ESRD ($) All Dialysis ($) Transplant($)AgeAll1,8366,1395,5969,18120-444,84914,16810,72520,64145-644,92810,0359,22812,29565-741,5635,8935,6197,09375+1,421 4,125 4,050 5,387 SexMale1,8365,9325,1869,915Female1,8366,3766,0578,265RaceWhite 1,855 5,738 5,249 8,305 Black/African American 2,678 7,477 6,701 13,897 Asian 1,842 7,805 7,176 11,468 Unknown 1,689 5,590 5,321 6,756 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Costs are per person per year for calendar year 2015, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. (b) Medicare Advantage

18vol 2 Table 10.5 Per person per year insurance spending for enrollees, 2015 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Costs are per person per year for calendar year 2015, using as-treated actuarial model (see ESRD Methods chapter for analytical methods). Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. (c) Managed care General ($) All ESRD ($) All Dialysis ($)Transplant($)AgeAll7448,7907,79410,19920-445047,4346,6658,13545-641,2339,1738,38410,31065-742,0188,6867,89210,60975+ 2,711 5,792 5,466 8,616SexMale7389,1478,20610,540Female7498,2607,1489,718Race White 773 9,093 8,191 10,178 Black/African American 693 7,871 6,890 11,141 Asian 413 8,009 7,701 8,395 Unknown 764 8,909 7,051 10,592

19vol 2 Table 10.6 Top 15 drug classes received by ESRD cohorts in different health plans, by modality, 2015 ( continued) Hemodialysis Peritoneal Dialysis Transplant Rank Drug class %Drug class%Drug class%1Ion-removing agents71.2Ion-removing agents61.7Antibacterials74.32β-adrenergic blocking agents63.7β-adrenergic blocking agents60.3β-Adrenergic blocking agents63.03Antibacterials58.7Antibacterials58.6Antiulcer agents and acid suppressants59.64Analgesics and antipyretics58.4Analgesics and antipyretics47.5 Lipid-lowering agents 56.6 5 Lipid-lowering agents49.6Lipid-lowering agents47.3Calcium-channel blocking agents50.36Calcium-channel blocking agents47.7Calcium-channel blocking agents46.3Analgesics and antipyretics49.27Antiulcer agents and acid suppressants46.9Renin-angiotensin-aldosterone system inhibitors42.8Adrenals47.08Renin-angiotensin-aldosterone system inhibitors38.5Antiulcer agents and acid suppressants39.7Antidiabetic agents39.1 9 Antidiabetic agents 37.1 Antidiabetic agents 33.5 Renin-angiotensin-aldosterone system inhibitors 36.3 10 Hypotensive agents 32.5 Anti-infectives 33.5 Diuretics 33.5 11 Psychotherapeutic agents 31.7 Diuretics 32.7 Psychotherapeutic agents 25.3 12 Anticonvulsants 31.4Hypotensive agents27.2Antivirals24.813Cinacalcet30.9Psychotherapeutic agents27.2Diabetic consumables 24.614Antithrombotic agents30.2Cinacalcet25.6Anticonvulsants22.315Anxiolytics, sedatives, and hypnotics26.8Replacement preparations25.1Anti-infectives20.4Data source: Medicare Part D claims and Optum Clinformatics™ claims. Ion-removing agents include phosphate-binding agents, potassium-binding agents, etc. Hypotension agents include alpha-2-agonist and vasodilators. Diabetic consumables refer to blood glucose test strips, blood glucose meters/sensors, lancets, needles, pen needles, etc.(a) Medicare

20vol 2 Table 10.6 Top 15 drug classes received by ESRD cohorts in different health plans, by modality, 2015 ( continued) Data source: Medicare Part D claims and Optum Clinformatics™ claims. Ion-removing agents include phosphate-binding agents, potassium-binding agents, etc. Hypotension agents include alpha-2-agonist and vasodilators. Diabetic consumables refer to blood glucose test strips, blood glucose meters/sensors, lancets, needles, pen needles, etc. (b) Medicare Advantage Dialysis Transplant RankDrug class%Drug class%1β-adrenergic blocking agents44.8Immunosuppressive agents48.02Lipid-lowering agents41.0Antibacterials40.93Analgesics and antipyretics40.4Adrenals38.84Antibacterials40.2β-adrenergic blocking agents35.5 5 Ion-removing agents 37.2 Lipid-lowering agents34.86Calcium-channel Blocking agents35.2Antiulcer agents and acid suppressants29.47Antiulcer agents and acid suppressants31.5Calcium-channel Blocking agents28.08Antidiabetic agents29.1Analgesics and antipyretics27.89Diuretics26.8 Renin-angiotensin-aldosterone system inhibitors 25.1 10 Renin-angiotensin-aldosterone system inhibitors 26.7 Antidiabetic agents 24.4 11 Diabetic consumables 24.8 Diabetic consumables 23.3 12 Antithrombotic agents 22.5 Diuretics 20.2 13 Hypotensive agents 22.0 Psychotherapeutic agents 15.6 14 Psychotherapeutic agents21.9Antithrombotic agents14.515Anticonvulsants20.1Anticonvulsants13.9

21vol 2 Table 10.6 Top 15 drug classes received by ESRD cohorts in different health plans, by modality, 2015 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Ion-removing agents include phosphate-binding agents, potassium-binding agents, etc. Hypotension agents include alpha-2-agonist and vasodilators. Diabetic consumables refer to blood glucose test strips, blood glucose meters/sensors, lancets, needles, pen needles, etc. (c) Managed Care Dialysis Transplant Rank Drug class%Drug class%1Ion-removing agents44.0Immunosuppressive agents52.82β-adrenergic blocking agents42.6Antibacterials43.83Analgesics and antipyretics37.8Adrenals39.34Antibacterials36.6β-adrenergic blocking agents32.05 Calcium-channel Blocking agents 35.7 Lipid-lowering agents 30.26Lipid-lowering agents31.3Calcium-channel Blocking agents26.07Renin-angiotensin-aldosterone system inhibitors28.5Renin-angiotensin-aldosterone system inhibitors25.88Antidiabetic agents24.3Analgesics and antipyretics25.69Diuretics24.0 Antiulcer agents and acid suppressants 20.6 10 Hypotensive agents 22.9 Antidiabetic agents 15.3 11 Vitamin D 20.0 Diuretics 14.3 12 Antiulcer agents and acid suppressants 19.7 Vitamin D 13.1 13 Diabetic consumables 18.9 Diabetic consumables 13.0 14 Antithrombotic agents14.9Anxiolytics, sedatives, and hypnotics11.915Anxiolytics, sedatives, and hypnotics14.5Psychotherapeutic agents11.7

22vol 2 Table 10.7 Top 15 drug classes received by different ESRD cohorts, by modality and insurance spending, 2015 ( continued ) Hemodialysis Peritoneal Dialysis Transplant Rank Drug classCosts%Drug classCosts%Drug classCosts%1Ion-removing agents$1,005.140.7Ion-removing agents$83.341.7Antivirals$152.033.42Cinacalcet$546.022.1 Cinacalcet $41.8 20.9 Antidiabetic agents$76.216.83Antidiabetic agents$192.07.8Antidiabetic agents$20.210.1Cinacalcet$40.38.94Antivirals$135.35.5Antivirals$11.15.5 Immunosuppressive agents $21.8 4.8 5 Antineoplastic agents $57.8 2.3 Antineoplastic agents $4.4 2.2 Antiulcer agents and acid suppressants $11.9 2.6 6 Antiulcer agents and acid suppressants $35.1 1.4 Lipid-lowering agents $3.0 1.5 Lipid-lowering agents $11.8 2.6 7Analgesics and antipyretics$32.21.3Antiulcer agents and acid suppressants$2.41.2Adrenocortical Insufficiency$8.51.98Lipid-lowering agents$31.91.3Antibacterials$2.11.1Antibacterials$7.71.79Psychotherapeutic agents$26.61.1Analgesics and antipyretics$1.60.8Hematopoietic agents$7.41.610Vasodilating agents$26.41.1Serums$1.50.8Antineoplastic agents$7.01.511Antibacterials$26.31.1Pituitary$1.50.8Psychotherapeutic agents$7.01.512Anticonvulsants$25.21.0Vasodilating agents$1.40.7Serums$6.41.413Caloric agents$23.71.0Anticonvulsants$1.40.7Anticonvulsants$6.21.414Anti-inflammatory agents$20.50.8Psychotherapeutic agents$1.30.6Analgesics and antipyretics$5.81.315Antithrombotic agents$15.20.6β-adrenergic blocking agents$1.10.6Antithrombotic agents$4.71.0Data source: Medicare Part D claims and Optum Clinformatics™ claims. Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. Ion-removing agents include phosphate-binding agents, potassium-binding agents, etc. Hypotension agents include alpha-2-agonists and vasodilators. Diabetic consumables refer to blood glucose test strips, blood glucose meters/sensors, lancets, needles, pen needles, etc.(a) Medicare

23vol 2 Table 10.7 Top 15 drug classes received by different ESRD cohorts, by modality and insurance spending, 2015 ( continued ) Data source: Medicare Part D claims and Optum Clinformatics™ claims. Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. Ion-removing agents include phosphate-binding agents, potassium-binding agents, etc. Hypotension agents include alpha-2-agonists and vasodilators. Diabetic consumables refer to blood glucose test strips, blood glucose meters/sensors, lancets, needles, pen needles, etc. (b) Medicare Advantage Dialysis Transplant RankDrug classCosts%Drug classCosts%1Ion-removing agents$13.927.4Immunosuppressive agents$5.234.82Cinacalcet$7.314.3Antivirals$2.819.03Antidiabetic agents$5.2 10.3 Antidiabetic agents $1.3 8.84Antineoplastic agents$2.24.3Cinacalcet$1.38.45Diabetic consumables $1.93.7Diabetic consumables $0.53.56Antivirals$1.73.4Ion-removing agents $0.4 2.8 7 Lipid-lowering agents $1.6 3.2 Lipid-lowering agents $0.3 2.2 8 Vasodilating agents $1.2 2.3 Antithrombotic agents $0.2 1.3 9 Analgesics and antipyretics $1.0 1.9 Antiulcer agents and acid suppressants $0.2 1.3 10Antiulcer agents and acid suppressants$0.81.6Antibacterials$0.21.311Calcium-channel Blocking agents$0.71.5Psychotherapeutic agents$0.21.112Psychotherapeutic agents$0.71.5Analgesics and antipyretics$0.21.013Anti-inflammatory agents$0.71.4Calcium-channel Blocking agents$0.10.914Antibacterials$0.71.4Serums$0.10.915Hypotensive agents$0.71.4β-adrenergic blocking agents$0.10.8

24vol 2 Table 10.7 Top 15 drug classes received by different ESRD cohorts, by modality and insurance spending, 2015 Data source: Medicare Part D claims and Optum Clinformatics™ claims. Part D spending represents the sum of the Medicare covered amount and the Low-income Subsidy amount. Ion-removing agents include phosphate-binding agents, potassium-binding agents, etc. Hypotension agents include alpha-2-agonists and vasodilators. Diabetic consumables refer to blood glucose test strips, blood glucose meters/sensors, lancets, needles, pen needles, etc. (c) Managed Care Dialysis   Transplant Costs RankDrug classCosts%Drug class %1Ion-removing agents$8.435.6Immunosuppressive agents$9.443.22Cinacalcet$3.213.7Antivirals$3.415.93Antidiabetic agents$2.410.3Cinacalcet$1.5 6.7 4 Antineoplastic agents $1.25.0Antidiabetic agents$1.46.45Antivirals$1.14.8Ion-removing agents$1.04.46Immunosuppressive agents$0.73.0Lipid-lowering agents$0.42.17Diabetic consumables $0.52.2Hematopoietic agents$0.41.88 Lipid-lowering agents $0.5 2.2 Antibacterials $0.4 1.6 9 Antibacterials $0.3 1.3 Diabetic consumables $0.3 1.6 10 Vasodilating agents $0.3 1.3 Antithrombotic agents $0.2 1.0 11 Calcium-channel Blocking agents $0.3 1.3Pituitary$0.21.012Hypotensive agents$0.31.2β-adrenergic blocking agents$0.20.813Hematopoietic agents$0.31.1Calcium-channel Blocking agents$0.20.714Analgesics and antipyretics$0.31.1Antifungals$0.20.715β-adrenergic blocking agents$0.31.1Psychotherapeutic agents$0.20.7

25vol 2 Figure 10.6 Estimated utilization rate of prescription NSAIDs by state, Medicare ESRD Patients, 2015 Data source: Medicare Part D claims. ESRD patients with Medicare Part D stand-alone prescription drug plans. Abbreviations: NSAIDs, nonsteroidal anti-inflammatory agents. NSAID filled under Medicare Part D represent a fraction of actual NSAID use. .

26vol 2 Figure 10.7 Estimated utilization rate of opioid analgesics by state, Medicare ESRD Patients, 2015 Data source: Medicare Part D claims. ESRD patients with Medicare Part D stand-alone prescription drug plans.