Top 25 Drugs Used in Outpatient Procedures

There is a growing emphasis on outpatient care in the United States. Outpatient care facilities play an important role in reducing healthcare costs while also satisfying patient desires for convenient, quality care. New technologies and changing guidelines from the Centers for Medicaid and Medicare Services (CMS) have incentivised this shift in focus from inpatient to outpatient services.

Ambulatory surgery centers (ASCs) pose another challenge for hospital outpatient departments. Though ASCs only get reimbursed at 60 percent the rate of hospitals, some patients consider them a more convenient alternative to traditional settings. ASCs can have shorter wait times for surgeries, and can also be more flexible in bundling certain procedures. The procedures themselves may also take less time at an ASC than at a hospital outpatient facility. Some hospital leaders have chosen to avoid this direct conflict by acquiring, building, or partnering with ASCs. This keeps patients in-network, stemming revenue loss.

Outpatient services have become a greater source of hospital revenue in the past 20 years. In the 1990s, outpatient care services constituted between 10 and 15 percent of a hospital’s income. Now, that average is just over 50 percent according to Definitive Healthcare data.

All five off the top drugs used in outpatient procedures (by total charges), are used in the treatment of cancer, and two are also used to treat autoimmune disorders. All of the top 25 drugs by total payments were administered by injection or infusion. The most-used outpatient drugs by number of claims were much more diverse than the top by charges. Included in the top five drugs are an anti-nausea medication, opioid pain reliever, and anti-inflammatory drug.

Top 25 Drugs Used in Outpatient Procedures by Charges

	HCPCS Code	Description	Number of Claims	Total Charges (M)
1.	J2505	Injection, pegfilgrastim 6mg	98,784	$1,878,198,021
2.	J1745	Infliximab not biosimil 10mg	88,350	$1,660,371,735
3.	J9271	Inj pembrolizumab	49,504	$1,637,558,943
4.	J9299	Injection, nivolumab	67,191	$1,530,111,129
5.	J9310	Rituximab injection	70,725	$1,489,744,684
6.	J9355	Trastuzumab injection	96,063	$1,216,398,366
7.	J9035	Bevacizumab injection	86,907	$1,128,099,707
8.	J2350	Injection, ocrelizumab, 1 mg	9,259	$721,851,899
9.	J0897	Denosumab injection	111,158	$674,720,112
10.	J9306	Injection, pertuzumab, 1 mg	27,488	$510,882,145
11.	J9305	Pemetrexed injection	32,553	$494,326,711
12.	J1561	Gamunex-C/Gammaked	37,613	$490,247,468
13.	J1300	Eculizumab injection	5,613	$477,672,638
14.	J9145	Injection, daratumumab 10 mg	26,595	$472,812,529
15.	J2323	Natalizumab injection	24,365	$466,278,688
16.	J1459	Inj IVIG privigen 500 mg	40,561	$452,668,490
17.	J3380	Injection, vedolizumab	21,199	$427,134,123
18.	J9041	Bortezomib injection	92,502	$365,922,407
19.	J1569	Gammagard liquid injection	28,840	$359,246,077
20.	J2353	Octreotide injection, depot	18,198	$350,398,825
21.	J9228	Ipilimumab injection	5,390	$346,157,039
22.	J9217	Leuprolide acetate suspnsion	38,763	$307,552,214
23.	J2785	Regadenoson injection	255,662	$297,920,091
24.	J9264	Paclitaxel protein bound	39,436	$290,972,674
25.	J7030	Normal saline solution infus	2,426,162	$282,341,781

Fig 1. Data from Definitive Healthcare based on all-payor commercial claims analytics from CY 2018.

Top 25 Drugs Used in Outpatient Procedures by Claims

	HCPCS Code	Description	Number of Claims	Total Charges
1.	J2405	Ondansetron hcl injection	4,003,701	$228,998,082
2.	J3010	Fentanyl citrate injection	3,142,635	$162,315,232
3.	J1885	Ketorolac tromethamine inj	2,693,737	$126,373,323
4.	J2250	Inj midazolam hydrochloride	2,505,806	$105,667,487
5.	J7030	Normal saline solution infus	2,426,162	$282,341,781
6.	J2704	Inj, propofol, 10 mg	2,332,395	$193,585,118
7.	J1100	Dexamethasone sodium phos	2,214,976	$98,277,324
8.	J3490	Drugs unclassified injection	2,189,170	$192,046,833
9.	J7120	Ringers lactate infusion	1,443,615	$164,242,651
10.	J2270	Morphine sulfate injection	1,395,855	$77,410,968
11.	J0690	Cefazolin sodium injection	1,342,509	$128,716,380
12.	J1170	Hydromorphone injection	1,003,220	$63,385,903
13.	J7050	Normal saline solution infus	986,637	$86,663,827
14.	J1644	Inj heparin sodium per 1000u	983,135	$74,216,942
15.	J1200	Diphenhydramine hcl injectio	923,895	$30,765,247
16.	J2001	Lidocaine injection	913,434	$26,675,902
17.	J0696	Ceftriaxone sodium injection	898,979	$111,364,693
18.	J7040	Normal saline solution infus	644,132	$49,475,147
19.	J1642	Inj heparin sodium per 10 u	639,729	$25,381,891
20.	J1650	Inj enoxaparin sodium	570,650	$81,302,520
21.	J2765	Metoclopramide hcl injection	500,094	$18,348,310
22.	J2930	Methylprednisolone injection	449,666	$36,448,626
23.	J2060	Lorazepam injection	440,864	$20,557,450
24.	J0131	Acetaminophen injection	386,475	$91,983,634
25.	J1815	Insulin injection	350,228	$33,425,956

Fig 2. Data from Definitive Healthcare based on all-payor commercial claims analytics from CY 2018.

Top 25 Drugs Used In Outpatient Procedures

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Top 25 Drugs Used in Outpatient Procedures by Charges

Top 25 Drugs Used in Outpatient Procedures by Claims

Top 25 Drugs Used In Outpatient Procedures

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Top 25 Drugs Used in Outpatient Procedures by Charges

Top 25 Drugs Used in Outpatient Procedures by Claims