Prescribing trends of proton pump inhibitors, antipsychotics and benzodiazepines of medicare part d providers

Abstract

Background Proton pump inhibitors, benzodiazepines, and antipsychotics are considered potentially inappropriate medications in older adults according to the American Geriatric Society Beers Criteria, and deprescribing algorithms have been developed to guide use of these drug classes. The objective of this study was to describe the number of beneficiaries prescribed these medications, provider specialty and regional trends in prescribing, and the aggregate costs for these claims in Medicare Part D. Methods This was a retrospective cross-sectional study using publicly available Medicare Provider Utilization and Payment Data: Part D Prescriber data for years 2013–2019. Descriptive statistics and the Cochrane-Armitage test were used to summarize the trends. Results Overall, 30.1%, 25.6%, 4.6% of Medicare Part D beneficiaries had a proton pump inhibitor, benzodiazepine, and antipsychotic claim in 2013, respectively. These rates decreased to 27.5%, 17.5%, 4.1% in 2019 (p-value < 0.0001). However, the number of standardized 30-day claims increased from 63 million in 2013 to 84 million in 2019 for proton pump inhibitors, remained steady for benzodiazepines and slightly increased (10 million to 13 million) for antipsychotics. Total aggregate costs decreased by almost $1.5 billion for proton pump inhibitor, $100 million for benzodiazepine, and $700 million for antipsychotic from 2013 to 2019 (p-value < 0.0001). Almost 93% of gastroenterologists prescribed a proton pump inhibitor, and 60% of psychiatrists prescribed benzodiazepines and antipsychotics all seven years. The Other region had the highest percentage of providers prescribing all three classes and the highest number of standardized 30-day benzodiazepine claims. Conclusions The overall rate of use of proton pump inhibitors, benzodiazepines, and antipsychotics decreased from 2013–2019 among Medicare Part D beneficiaries. Despite the increase in raw number of standardized 30-day claims, the costs decreased which is likely due to generics made available. These prescribing trends may aid in identifying and targeting potential deprescribing interventions.

Use of benzodiazepines and benzodiazepine‐related drugs in the Nordic countries between 2000 and 2020

“…28 Exact reasons for this higher level of BZ use in Iceland are not known, but relevant factors could include that many individuals do not have a specific general practitioner (or health centre) as is common in Denmark, Norway and Sweden, that the access to specialists is easier, and that many specialists are trained in the USA, where prescriptions practices might be more liberal. 29 Likewise, higher levels of opioid utilization have been observed among older adults in Iceland, compared to the other four countries. 30 The apparent reduction in BZH use in Finland around 2013 was a result of BZH no longer being reimbursed and thus not recorded in the Finnish Prescription Registry.…”

“…The higher levels of BZ/BZRD use in Iceland, than in the other four Nordic countries, has been documented as early as in the 1970s 28 . Exact reasons for this higher level of BZ use in Iceland are not known, but relevant factors could include that many individuals do not have a specific general practitioner (or health centre) as is common in Denmark, Norway and Sweden, that the access to specialists is easier, and that many specialists are trained in the USA, where prescriptions practices might be more liberal 29 . Likewise, higher levels of opioid utilization have been observed among older adults in Iceland, compared to the other four countries 30 …”

Considerations for long-acting antiretroviral therapy in older persons with HIV

“…It is therefore difficult to determine differences in response between younger and older (including elderly) individuals – a factor which could potentially limit the generalizability of LAI-ART's efficacy and rate of failure to older populations [60]. The median age of participants in noninferiority randomized control trials (ATLAS, FLAIR, LATTE-2) has ranged from 34–42 years (Table 3) [42,43,1–63]. Two trials (ATLAS-2 M, LATTE-2) did not report the number of enrolled participants aged 50 years or older; of other trials that did, only 228 patients enrolled were 50 years old or older, and of these, 99 were randomized to receive LAI-ART [42–45,61–63].…”

Treating and Managing Laryngopharyngeal Reflux Disease in the Over 65s: Evidence to Date

“…First, most elderly individuals take several medications and there are some drug interaction risks between PPIs and many common medications, including antiretroviral (HIV) drugs, cytostatics (eg methotrexate, dasatinib, erlotinib, and nilotinib), anti-HCV, itraconazole, immunosuppressants, and clopidogrel ( Table 2 ). 57 …”

“…56 First, most elderly individuals take several medications and there are some drug interaction risks between PPIs and many common medications, including antiretroviral (HIV) drugs, cytostatics (eg methotrexate, dasatinib, erlotinib, and nilotinib), anti-HCV, itraconazole, immunosuppressants, and clopidogrel (Table 2). 57 There are potential harms of PPI treatment, and the related potential drug interactions in elderly individuals who are characterized by polypharmacy are associated with a higher risk of long-term adverse effects. 58 Second, the long-term use of PPIs has for a long time been suspected to be associated with adverse events, eg altered mineral and vitamin absorption, fractures, orthopedic injury, acute coronary syndromes, colitis, infectious risks, and increased risk of mortality.…”