scholarly journals Opioid prescription patterns among urologists as compiled from within Medicare

2021 ◽  
Vol 15 (11) ◽  
Author(s):  
Michael Callegari ◽  
Tarun Jella ◽  
Amr Mahran ◽  
Anood Alfahmy ◽  
Anish Patel ◽  
...  
Keyword(s):  
New England ◽  
Secondary Analysis ◽  
Medicare Part D ◽  
The United States ◽  
Prescribing Patterns ◽  
Medicare Part ◽  
Opioid Prescription ◽  
Part D ◽  
Regional Trends ◽  
Average Proportion

Introduction: We aimed to evaluate opioid prescribing patterns of urologists across the United States (U.S.) and the District of Columbia (D.C.) using publicly available data from Medicare Part D. Our secondary analysis was to identify any loco-regional trends that may exist within the U.S. Methods: We queried publicly reported information from the Part D Prescriber database, which is compiled from beneficiaries enrolled within the Medicare Part D prescription drug program. Only providers with the specialty description of urologist were included within this study. Results: Between 2013 and 2017, a five-year average of 452 901 opioid claims by 9640 urologists — amounting to $5 357 114 (USD) and comprising 3.78% of all claims made — were identified. The state of Maine featured the highest percentage of opioid claims in relation to all claims (5.81%). West Virginia had the greatest average total opioid claims per provider (90), while Michigan featured the highest average proportion of opioid claims per provider (10.63%). The fewest opioid claims were processed within the Mid-Atlantic and New England regions. Conclusions: A multitude of factors likely contributes to variability between states. Urologists should be increasingly aware of their individual prescription tendencies and use available drug monitoring programs in order to reduce unnecessary prescriptions, all while providing more targeted and appropriate pain management.

scholarly journals Geographic Distribution of Antipsychotic Use in Medicare Part D Patients

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Angela Anthony ◽  
Raymond Degreef ◽  
Maisha Kelly Freeman
Keyword(s):  
New England ◽  
Conflicts Of Interest ◽  
Medicare Part D ◽  
The United States ◽  
Medicare Part ◽  
Data Set ◽  
Part D ◽  
Prescribing Trends ◽  
Significant Difference ◽  
Antipsychotic Prescribing

Purpose: To determine if there is a geographic variation in antipsychotic prescribing in Medicare recipients in 10 US divisions. Methods: Data was collected in the Microsoft Excel format from the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for 2013 CMS data. Antipsychotics were sorted and downloaded into separate excel formats. The states were separated into the 10 geographic according to the US Census Bureau to identify prescribing trends. The primary endpoint was to determine the difference in the rates of CMS Medicare Part D utilizers who had antipsychotic prescriptions in each of the 10 geographic divisions. 
The rate of antipsychotic prescribing was calculated by determining the number of prescription claims for each antipsychotic for the division and dividing by the number of people utilizing Medicare Part D in each division. Data was converted to SPSS (version19, Armonk, NY) for further analysis. ANOVA was used to compare the differences. Results: Approximately 35 million claims were included in the data set. Antipsychotics comprised 4.75% of the total spending on medications for Medicare Part D. New England was found to have the highest rate of claims at 0.83. No statistically significant differences in the rate of antipsychotic prescribing across geographic regions was observed; however, a statistically significant difference was observed for total claims (P<0.001) and total antipsychotic costs (P<0.017) across regions. Conclusion: Additional studies need to be conducted to determine if there is a difference in antipsychotic prescribing in the United States. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Student Project

Characteristics of Opioid Prescriptions to Veterans With Chronic Gastrointestinal Symptoms and Disorders Dually Enrolled in the Department of Veterans Affairs and Medicare Part D

2021 ◽  
Author(s):  
Salva N Balbale ◽  
Lishan Cao ◽  
Itishree Trivedi ◽  
Jonah J Stulberg ◽  
Katie J Suda ◽  
...  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Medicare Part D ◽  
Medicare Part ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Part D ◽  
Gi Symptoms ◽  
Chronic Opioid Use ◽  
Multiple Logistic Regression Modeling ◽  
Chronic Use

ABSTRACT Introduction Gastrointestinal (GI) symptoms and disorders affect an increasingly large group of veterans. Opioid use may be rising in this population, but this is concerning from a patient safety perspective, given the risk of dependence and lack of evidence supporting opioid use to manage chronic pain. We examined the characteristics of opioid prescriptions and factors associated with chronic opioid use among chronic GI patients dually enrolled in the DVA and Medicare Part D. Materials and Methods In this retrospective cohort study, we used linked, national patient-level data (from April 1, 2011, to December 31, 2014) from the VA and Centers for Medicare & Medicaid Services to identify chronic GI patients and observe opioid use. Veterans who had a chronic GI symptom or disorder were dually enrolled in VA and Part D and received ≥1 opioid prescription dispensed through the VA, Part D, or both. Chronic GI symptoms and disorders included chronic abdominal pain, chronic pancreatitis, inflammatory bowel diseases, and functional GI disorders. Key outcome measures were outpatient opioid prescription dispensing overall and chronic opioid use, defined as ≥90 consecutive days of opioid receipt over 12 months. We described patient characteristics and opioid use measures using descriptive statistics. Using multiple logistic regression modeling, we generated adjusted odds ratios and 95% CIs to determine variables independently associated with chronic opioid use. The final model included variables outlined in the literature and our conceptual framework. Results We identified 141,805 veterans who had a chronic GI symptom or disorder, were dually enrolled in VA and Part D, and received ≥1 opioid prescription dispensed from the VA, Part D, or both. Twenty-six percent received opioids from the VA only, 69% received opioids from Medicare Part D only, and 5% were “dual users,” receiving opioids through both VA and Part D. Compared to veterans who received opioids from the VA or Part D only, dual users had a greater likelihood of potentially unsafe opioid use outcomes, including greater number of days on opioids, higher daily doses, and higher odds of chronic use. Conclusions Chronic GI patients in the VA may be frequent users of opioids and may have a unique set of risk factors for unsafe opioid use. Careful monitoring of opioid use among chronic GI patients may help to begin risk stratifying this group. and develop tailored approaches to minimize chronic use. The findings underscore potential nuances within the opioid epidemic and suggest that components of the VA’s Opioid Safety Initiative may need to be adapted around veterans at a higher risk of opioid-related adverse events.

Opioid Prescribing Patterns of Optometrists in the Medicare Part D Database

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Stephen C. Dryden ◽  
Holly A. O’Malley ◽  
Lindsey R. Adams ◽  
Garrett C. Nix ◽  
Jonathan E. Rho ◽  
...  
Keyword(s):  
Medicare Part D ◽  
Prescribing Patterns ◽  
Medicare Part ◽  
Part D ◽  
Opioid Prescribing

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

2017 ◽  
Vol 13 (8) ◽  
pp. e694-e702 ◽  
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.

scholarly journals Impact of Laws Regulating Pain Clinics on Opioid Prescribing and Opioid-Related Toxicity Among Texas Medicare Part D Beneficiaries

2017 ◽  
Vol 33 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Mukaila A. Raji ◽  
Yong-Fang Kuo ◽  
Nai-Wei Chen ◽  
Hunaid Hasan ◽  
Denise M. Wilkes ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Medicare Part D ◽  
Medicare Part ◽  
Opioid Overdose ◽  
Opioid Prescription ◽  
Part D ◽  
Opioid Prescribing ◽  
Pain Clinics ◽  
The Impact ◽  
Over Time

Background: Pain management clinics are major sources of prescription opioids. Texas government passed several laws regulating pain clinics between 2009 and 2011 to reduce opioid-related toxicity. Understanding the impact of these laws can inform policy geared toward making the laws more effective in curbing the growing epidemic of opioid overdose, especially among the elderly population. Objectives: To examine the longitudinal association of laws regulating pain clinics on opioid-prescribing and opioid-related toxicity among Texas Medicare recipients. Methods: The 2007 to 2012 claims data for Texas Medicare Part D recipients were used to assess temporal trends in the percentage of patients filling any schedule II or schedule III opioid prescription, hospitalization for opioid toxicity, and their relationships to the 2009 to 2011 Texas laws regulating pain clinics. We excluded those with a cancer diagnosis. Join-point trend analysis with Bayesian Information Criterion selection methods were used to evaluate the change in monthly percentages of patients filling opioid prescriptions and hospitalization over time. Results: There was a short-lived decline in the monthly percentages of patients who filled a schedule II or schedule III opioid prescription after the 2009 laws regulating pain clinics. The decline lasted about 3 months. Subsequent new laws had no effect on the percentages of patients who filled any opioid prescription or were hospitalized for potential opioid toxicity. Hospitalizations for opioid toxicity were highest in the winter and lowest in the summer. Conclusions: Changes in the percentages of opioid-prescribing or opioid-related hospitalizations over time were not associated with laws regulating pain clinics.

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

2017 ◽  
Vol 76 (3) ◽  
pp. 337-353 ◽  
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.

scholarly journals The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare

2018 ◽  
Vol 10 (1) ◽  
pp. 77-112 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
Colleen Carey
Keyword(s):  
United States ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Medicare Part D ◽  
The United States ◽  
Medicare Part ◽  
Prescription Opioids ◽  
Part D ◽  
Monitoring Programs ◽  
Prescription Drug Monitoring Programs

The misuse of prescription opioids has become a serious epidemic in the United States. In response, states have implemented Prescription Drug Monitoring Programs (PDMPs), which record a patient’s opioid prescribing history. While few providers participated in early systems, states have recently begun to require providers to access the PDMP under certain circumstances. We find that “must access” PDMPs significantly reduce measures of misuse in Medicare Part D. In contrast, we find that PDMPs without such provisions have no effect. We find stronger effects when providers are required to access the PDMP under broad circumstances, not only when they are suspicious. (JEL H75, I11, I12, I18)

scholarly journals Early national dissemination of abiraterone and enzalutamide for advanced prostate cancer in Medicare Part D.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 35-35
Author(s):  
Megan Veresh Caram ◽  
Tudor Borza ◽  
Hye-Sung Min ◽  
Jennifer J. Griggs ◽  
David Christopher Miller ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Regional Variation ◽  
Advanced Prostate Cancer ◽  
Medicare Part D ◽  
The United States ◽  
Medicare Part ◽  
Part D ◽  
Hospital Referral ◽  
Early National

35 Background: Abiraterone and enzalutamide are oral medications approved by the Food & Drug Administration in 2011 and 2012 to treat men with advanced castration-resistant prostate cancer. Most men with advanced prostate cancer are over age 65 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 all providers who wrote prescriptions for abiraterone or enzalutamide in 2013 (n=2121), 87.5% were medical oncologists, 3.3% urologists, and 9.2% were listed as other provider specialties. Among those who prescribed either drug, 5% of providers were responsible for 75% of the claims for abiraterone, and 7% were responsible for 75% of the claims for enzalutamide. Some HRRs demonstrated low-prescribing rates despite average medical oncology and urology physician workforce density. Conclusions: 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 the early national dissemination of these effective but expensive drugs can help inform strategies to optimize introduction of new, evidence-based advanced prostate cancer treatments.

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