To determine if Medicare Part D drug spending differs amongst neurologists based in the four United States Census Regions: Northeast, Midwest, South, and West. 

Medicare data demonstrates significant regional variation in spending, most notably for procedural costs. Prior research has not addressed if neurologists display regional variation in prescription drug spending.  

This is a secondary analysis of the 2016 Medicare Provider Utilization and Payment Data, which reports provider level prescription drug spending for Medicare Part D. We added all drug spending and total number of claims per provider. To compare mean cost per provider by Census Regions we used analysis of variance. 

Our analysis includes data from 12,689 neurologists, who treated 2,870,540 Medicare beneficiaries with 19,530,146 Part D claims. In the four Census Regions, we included 3,134 neurologists from the Northeast, 2,576 from the West, 4,192 from the South, and 2,787 from the Midwest. The mean drug spending per provider was $550,406 in the South, $517,302 in the Midwest, $449,874 in the West, and $433,647 in the Northeast (p_trend<0.001). The increase between neurologists in the South versus Northeast was 27%. A sensitivity analysis, where the cost per provider was divided by the number of claims per provider, yielded similar results. Likewise, a second sensitivity analysis correlating the number of neurologists practicing in a state with cost per provider did not find a strong association (rho=-0.064).

Medicare Part D drug spending is significantly higher for neurologists practicing in the Southern United States. Five of the ten states with the highest drug spending per neurologist were located in the American South. In the current era of potential spending cuts to Medicare, and drug spending in particular, further analysis of regional patterns of drug spending is warranted to help reduce drug spending.