Benzodiazepine Prescribing Patterns Among Medicare Providers, 2017 to 2023

Abstract

Introduction: To determine whether benzodiazepine (BZD) prescriptions in older adults (>65) generally adhere to the Beers Criteria of the American Geriatrics Society, and whether the likelihood of prescribing an average of > 30 days per beneficiary to older adults varies significantly, Medicare Part D prescribing patterns were analyzed based on prescriber location and specialty. Methods: The 2017-2023 Medicare Part D Prescriber Public Use and Summary files were evaluated, with drug event information aggregated by provider and type of drug. The most prescribed BZD and the most common prescriber specialty for each year was determined, as well as the drug utilization rate by state. Results: Medicare Part D BZD prescriptions rose from 1.7 million to 3.1 million, an increase of over 80%, between 2017-2023, while overall U.S. BZD prescriptions decreased by about one-quarter during this same period, from 110 million to 81 million. The top three most prescribed BZD medications were alprazolam, lorazepam, and clonazepam, totaling around 88% of all the BZD prescriptions being written to Part D beneficiaries. When adjusted for the number of prescribers, all classes of prescribers increased their use of BZDs. Psychiatry was the top prescribing specialty, and showed the most increase in BZD prescription rate. The southeast region of the U.S. had the highest BZD utilization rates, with approximately 25 prescriptions dispensed for every 100 beneficiaries. In 2023, psychiatrists were more likely to prescribe BZDs for >30 days compared to nurse practitioners, physician assistants, and providers in the 'other' category, but less likely than family practice, internal medicine, and geriatric medicine providers. Compared to California, significantly increased odds of prescribing >30 days were found in 13 U.S. states; significantly decreased odds occurred in 5 states. Despite guidelines recommending against prescribing BZDs to adults ≥ 65 years and limiting prescriptions to 30 days or fewer, all years studied exceeded these guidelines, averaging 108 days of BZD per beneficiary. Conclusions: Despite repeated warnings about the harms of their use in this population, BZDs are being increasingly prescribed to Medicare Part D recipients. Some states and prescriber classes prescribe BZDs significantly over 30 days per beneficiary to older adults.