Benzodiazepine prescribing patterns among Medicare providers, 2017 to 2023

Area of Science:

• Geriatric Pharmacology
• Public Health Prescribing Patterns
• Medication Safety in Older Adults

Background:

• Benzodiazepines (BZDs) are frequently prescribed to older adults, but carry significant risks, including falls, cognitive impairment, and dependence.
• Guidelines, such as the Beers Criteria, recommend caution and limited durations for BZD use in individuals aged 65 and older.
• Understanding current prescribing trends is crucial for assessing adherence to guidelines and identifying areas for intervention.

Purpose of the Study:

• To evaluate adherence to Beers Criteria for benzodiazepine (BZD) prescriptions in Medicare Part D recipients aged 65 and older.
• To determine if the duration of BZD prescriptions (>30 days) for older adults varies significantly by prescriber specialty and geographic location.
• To analyze trends in BZD prescribing patterns within the Medicare Part D population from 2017 to 2023.

Main Methods:

• Analysis of Medicare Part D Prescriber Public Use and Summary files from 2017 to 2023.
• Aggregation of drug event information by provider and drug type to identify most prescribed BZDs and specialties.
• Calculation of drug utilization rates by state and analysis of prescribing duration (>30 days) across different prescriber types and regions.

Main Results:

• Medicare Part D BZD prescriptions increased by over 80% (1.7 to 3.1 million) from 2017-2023, contrasting with a national decrease.
• Alprazolam, lorazepam, and clonazepam were the most prescribed BZDs, accounting for 88% of prescriptions.
• Psychiatry was the top prescribing specialty, showing the largest increase in BZD prescription rates; the Southeast U.S. had the highest utilization. Prescriptions frequently exceeded 30 days, averaging 108 days per beneficiary.

Conclusions:

• Despite warnings, benzodiazepine prescribing to older Medicare Part D recipients is increasing, with durations often exceeding guideline recommendations.
• Significant variations in prescribing duration exist across different U.S. states and prescriber specialties, indicating a need for targeted interventions.
• Current prescribing practices for BZDs in older adults on Medicare Part D do not consistently align with established geriatric safety guidelines.