Bone-Active Medication Utilization from 2013-2017 Amid Beneficiaries Aged 65+ with Medicare Part D by Provider Type

Abstract As the United States’ population increasingly consists of older adults aged 65+, an increase is expected in the prevalence of osteoporosis and the number of osteoporotic fractures. Bone-active medications (BAM) delay osteoporosis progression and prevent fragility fractures, but historically low treatment persistence rates and drug utilization for BAM exist among at-risk older adults. This research assessed for differences in the BAM utilization rates over five-years in Medicare Part D by provider type: geriatric specialists (GERO), generalists, specialists, nurse practitioners (NP), and physicians’ assistants (PA). This longitudinal retrospective analysis included providers with at least one BAM prescription among beneficiaries aged 65+. An analysis of response profiles was used to model the mean BAM utilization rates overall and by provider group. Of the 50,249 providers included in this analysis, 88.15% were generalists, 5.76% specialists, 1.48% GERO, 2.73% NP, and 1.87% PA. From 2013-2017, the prevalence of BAM utilization was 6%. Over the five years, BAM utilization rates did not change significantly, but provider-specific rates were significantly different (F=12.53, p<.001). Provider-specific utilization rates were inconsistent with the highest utilization rates and most considerable variation observed among specialists (14.95%). PAs and NPs’ BAM utilization rates were stable at around 9.02% and 9.20%, but GERO and generalists exhibited the lowest utilization rates, 4.86% and 5.79%, respectively. While specialists had the higher-than-expected utilization rates, the overall and provider-specific BAM utilization rates were low and did not increase over time. Further research is needed to identify how provider-related factors, like geographic region and clinical training, influence underutilization.

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Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States

International Journal of Health Services ◽

10.1177/0020731416676226 ◽

2016 ◽

Vol 48 (1) ◽

pp. 42-56 ◽

Cited By ~ 2

Author(s):

Cheng-Chia Chen ◽

Hsien-Chang Lin ◽

Dong-Chul Seo

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Medicare Part D ◽

Health Impact ◽

The United States ◽

Medicare Part ◽

Charlson Comorbidity Index Score ◽

Control Group ◽

Drug Study ◽

Part D

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004–2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005–2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006–2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults’ overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

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Too much choice: Older adults' decision making related to Medicare part D

PsycEXTRA Dataset ◽

10.1037/e722292011-055 ◽

2007 ◽

Author(s):

Betty E. Tanius ◽

Stacey Wood ◽

Yaniv Hanoch ◽

Thomas Rice ◽

Martina Ly ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Medicare Part D ◽

Medicare Part ◽

Part D

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Opioid Prescribing to Medicare Part D Enrollees, 2013–2017: Shifting Responsibility to Pain Management Providers

Pain Medicine ◽

10.1093/pm/pnz344 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1400-1407 ◽

Cited By ~ 1

Author(s):

Adam N Romman ◽

Connie M Hsu ◽

Lin-Na Chou ◽

Yong-Fang Kuo ◽

Rene Przkora ◽

...

Keyword(s):

Pain Management ◽

Medicare Part D ◽

Medical Specialty ◽

Medicare Part ◽

Provider Type ◽

Cross Sectional ◽

Part D ◽

Opioid Prescribing ◽

Prescribing Trends ◽

Level Analysis

Abstract Objective To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. Methods We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. Results From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (–19.9%) and orthopedic surgery (–16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by –5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period. Conclusions From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.

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The association of Medicare Part D prior authorization for buprenorphine‐naloxone with adherence to opioid use disorder treatment guidelines in the United States

Addiction ◽

10.1111/add.15585 ◽

2021 ◽

Author(s):

William J. Parish ◽

Tami L. Mark ◽

Gary A. Zarkin ◽

Ellen Weber

Keyword(s):

United States ◽

Treatment Guidelines ◽

Medicare Part D ◽

The United States ◽

Opioid Use Disorder ◽

Medicare Part ◽

Prior Authorization ◽

Opioid Use ◽

Part D ◽

Disorder Treatment

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Broken Promises — How Medicare Part D Has Failed to Deliver Savings to Older Adults

New England Journal of Medicine ◽

10.1056/nejmp2027580 ◽

2020 ◽

Vol 383 (24) ◽

pp. 2299-2301

Author(s):

Stacie B. Dusetzina ◽

Benyam Muluneh ◽

Nancy L. Keating ◽

Haiden A. Huskamp

Keyword(s):

Older Adults ◽

Medicare Part D ◽

Medicare Part ◽

Part D

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Medicare Part D Enrollment in a Biracial Community-Based Population of Older Adults

The Gerontologist ◽

10.1093/geront/gnp055 ◽

2009 ◽

Vol 49 (6) ◽

pp. 828-838 ◽

Cited By ~ 11

Author(s):

K. A. Skarupski ◽

C. F. Mendes de Leon ◽

L. L. Barnes ◽

D. A. Evans

Keyword(s):

Older Adults ◽

Medicare Part D ◽

Medicare Part ◽

Community Based ◽

Part D

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Early National Dissemination of Abiraterone and Enzalutamide for Advanced Prostate Cancer in Medicare Part D

Journal of Oncology Practice ◽

10.1200/jop.2016.020206 ◽

2017 ◽

Vol 13 (8) ◽

pp. e694-e702 ◽

Cited By ~ 3

Author(s):

Megan E.V. Caram ◽

Tudor Borza ◽

Hye-Sung Min ◽

Jennifer J. Griggs ◽

David C. Miller ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

Regional Variation ◽

Medicare Part D ◽

The United States ◽

Medicare Part ◽

Castration Resistant Prostate Cancer ◽

Part D ◽

Hospital Referral ◽

Early National

Introduction: Abiraterone and enzalutamide were approved by the Food and Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer (mCRPC). Most men with mCRPC are > 65 years of age and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. Methods: We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data. We categorized HRRs by abiraterone and enzalutamide prescriptions, adjusted for prostate cancer incidence, and examined factors associated with regional variation using multilevel regression models. Results: Among providers who wrote the majority of prescriptions for abiraterone or enzalutamide in 2013 (n = 2,121), 87.5% were medical oncologists, 3.3% were urologists, and 9.2% were other provider specialties. Among prescribers, approximately 30% were responsible for three quarters of the claims for abiraterone and 20% were responsible for more than half the claims for enzalutamide. Some HRRs demonstrated low-prescribing rates despite average medical oncology and urology physician workforce density. Our multilevel model demonstrated that regional factors potentially influenced variation in care. Conclusion: The majority of prescriptions written for abiraterone and enzalutamide through Medicare Part D in 2013 were written by a minority of providers, with marked regional variation across the United States. Better understanding of the early national dissemination of these effective but expensive drugs can help inform strategies to optimize introduction of new, evidence-based mCRPC treatments.

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Impact of Medicare Part D on Antidepressant Treatment, Medication Choice, and Adherence Among Older Adults With Depression

American Journal of Geriatric Psychiatry ◽

10.1097/jgp.0b013e3182051a9b ◽

2011 ◽

Vol 19 (12) ◽

pp. 989-997 ◽

Cited By ~ 20

Author(s):

Julie M. Donohue ◽

Yuting Zhang ◽

Subashan Perera ◽

Judith R. Lave ◽

Joseph T. Hanlon ◽

...

Keyword(s):

Older Adults ◽

Antidepressant Treatment ◽

Medicare Part D ◽

Medicare Part ◽

Part D ◽

Treatment Medication ◽

Medication Choice

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Opioid Prescribing by Nurse Practitioners in Medicare Part D: Impact of State Scope of Practice Legislation

Medical Care Research and Review ◽

10.1177/1077558717725604 ◽

2017 ◽

Vol 76 (3) ◽

pp. 337-353 ◽

Cited By ~ 8

Author(s):

Elissa Ladd ◽

Casey Fryer Sweeney ◽

Anthony Guarino ◽

Alex Hoyt

Keyword(s):

Patient Safety ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

State Legislatures ◽

Medicare Part D ◽

Prescribing Patterns ◽

Medicare Part ◽

Scope Of Practice ◽

Part D ◽

Opioid Prescribing

Many state legislatures restrict nurse practitioner (NP) scope of practice as a way of addressing patient safety concerns. The purpose of this study was to investigate the influence of state NP scope of practice laws on the prescription of oxycodone and hydrocodone containing medications by NP and MD/DO/PA prescribers to Medicare Part D beneficiaries. Using the Medicare Part D public use file, we analyzed oxycodone and hydrocodone containing prescriptions per Medicare Part D beneficiary by prescriber type, NP state scope of practice, and geographic variables. Our results demonstrate that the state scope of practice variable had the same effect, in identical direction and significance, on NP opioid prescribing patterns as it had on MD/DO/PA prescribers, a group to whom NP scope of practice laws do not apply. Thus, scope of practice in this study was not an exclusive predictor of NP practice and prescribing.

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