Healthcare Insights
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
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HCPCS Code | Description | Number of Claims | Total Charges (M) | Explore These Claims | |
1. | J2505 | Injection, pegfilgrastim 6mg | 98,784 | $1,878,198,021 | Explore This Code |
2. | J1745 | Infliximab not biosimil 10mg | 88,350 | $1,660,371,735 | Explore This Code |
3. | J9271 | Inj pembrolizumab | 49,504 | $1,637,558,943 | Explore This Code |
4. | J9299 | Injection, nivolumab | 67,191 | $1,530,111,129 | Explore This Code |
5. | J9310 | Rituximab injection | 70,725 | $1,489,744,684 | Explore This Code |
6. | J9355 | Trastuzumab injection | 96,063 | $1,216,398,366 | Explore This Code |
7. | J9035 | Bevacizumab injection | 86,907 | $1,128,099,707 | Explore This Code |
8. | J2350 | Injection, ocrelizumab, 1 mg | 9,259 | $721,851,899 | Explore This Code |
9. | J0897 | Denosumab injection | 111,158 | $674,720,112 | Explore This Code |
10. | J9306 | Injection, pertuzumab, 1 mg | 27,488 | $510,882,145 | Explore This Code |
11. | J9305 | Pemetrexed injection | 32,553 | $494,326,711 | Explore This Code |
12. | J1561 | Gamunex-C/Gammaked | 37,613 | $490,247,468 | Explore This Code |
13. | J1300 | Eculizumab injection | 5,613 | $477,672,638 | Explore This Code |
14. | J9145 | Injection, daratumumab 10 mg | 26,595 | $472,812,529 | Explore This Code |
15. | J2323 | Natalizumab injection | 24,365 | $466,278,688 | Explore This Code |
16. | J1459 | Inj IVIG privigen 500 mg | 40,561 | $452,668,490 | Explore This Code |
17. | J3380 | Injection, vedolizumab | 21,199 | $427,134,123 | Explore This Code |
18. | J9041 | Bortezomib injection | 92,502 | $365,922,407 | Explore This Code |
19. | J1569 | Gammagard liquid injection | 28,840 | $359,246,077 | Explore This Code |
20. | J2353 | Octreotide injection, depot | 18,198 | $350,398,825 | Explore This Code |
21. | J9228 | Ipilimumab injection | 5,390 | $346,157,039 | Explore This Code |
22. | J9217 | Leuprolide acetate suspnsion | 38,763 | $307,552,214 | Explore This Code |
23. | J2785 | Regadenoson injection | 255,662 | $297,920,091 | Explore This Code |
24. | J9264 | Paclitaxel protein bound | 39,436 | $290,972,674 | Explore This Code |
25. | J7030 | Normal saline solution infus | 2,426,162 | $282,341,781 | Explore This Code |
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
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HCPCS Code | Description | Number of Claims | Total Charges | Explore These Claims | |
1. | J2405 | Ondansetron hcl injection | 4,003,701 | $228,998,082 | Explore This Code |
2. | J3010 | Fentanyl citrate injection | 3,142,635 | $162,315,232 | Explore This Code |
3. | J1885 | Ketorolac tromethamine inj | 2,693,737 | $126,373,323 | Explore This Code |
4. | J2250 | Inj midazolam hydrochloride | 2,505,806 | $105,667,487 | Explore This Code |
5. | J7030 | Normal saline solution infus | 2,426,162 | $282,341,781 | Explore This Code |
6. | J2704 | Inj, propofol, 10 mg | 2,332,395 | $193,585,118 | Explore This Code |
7. | J1100 | Dexamethasone sodium phos | 2,214,976 | $98,277,324 | Explore This Code |
8. | J3490 | Drugs unclassified injection | 2,189,170 | $192,046,833 | Explore This Code |
9. | J7120 | Ringers lactate infusion | 1,443,615 | $164,242,651 | Explore This Code |
10. | J2270 | Morphine sulfate injection | 1,395,855 | $77,410,968 | Explore This Code |
11. | J0690 | Cefazolin sodium injection | 1,342,509 | $128,716,380 | Explore This Code |
12. | J1170 | Hydromorphone injection | 1,003,220 | $63,385,903 | Explore This Code |
13. | J7050 | Normal saline solution infus | 986,637 | $86,663,827 | Explore This Code |
14. | J1644 | Inj heparin sodium per 1000u | 983,135 | $74,216,942 | Explore This Code |
15. | J1200 | Diphenhydramine hcl injectio | 923,895 | $30,765,247 | Explore This Code |
16. | J2001 | Lidocaine injection | 913,434 | $26,675,902 | Explore This Code |
17. | J0696 | Ceftriaxone sodium injection | 898,979 | $111,364,693 | Explore This Code |
18. | J7040 | Normal saline solution infus | 644,132 | $49,475,147 | Explore This Code |
19. | J1642 | Inj heparin sodium per 10 u | 639,729 | $25,381,891 | Explore This Code |
20. | J1650 | Inj enoxaparin sodium | 570,650 | $81,302,520 | Explore This Code |
21. | J2765 | Metoclopramide hcl injection | 500,094 | $18,348,310 | Explore This Code |
22. | J2930 | Methylprednisolone injection | 449,666 | $36,448,626 | Explore This Code |
23. | J2060 | Lorazepam injection | 440,864 | $20,557,450 | Explore This Code |
24. | J0131 | Acetaminophen injection | 386,475 | $91,983,634 | Explore This Code |
25. | J1815 | Insulin injection | 350,228 | $33,425,956 | Explore This Code |
Fig 2. Data from Definitive Healthcare based on all-payor commercial claims analytics from CY 2018.