PHP19 - Geographic Variation of High-Risk Medication Use Among Medicare Beneficiaries in the United States

Abstract

Understanding geographic patterns of high-risk medication (HRM) use among older adults may help the Centers for Medicare & Medicaid Services (CMS) and their partners develop and tailor prevention strategies. We examined HRM use patterns among Medicare beneficiaries enrolled in Medicare Advantage prescription drug plans (MA-PDs) vs. stand-alone prescription drug plans (PDPs) across geographic areas over time. This cross-sectional study used a 5% national Medicare sample (2011–2013). Among beneficiaries aged ≥65 who were continuously enrolled in MA-PDs or PDPs (~1.3 million each year), we identified those with ≥2 prescriptions for the same HRM (e.g., amitriptyline) during the year based on the HRM list provided by CMS and Pharmacy Quality Alliance. Multivariable logistic regression was used to estimate adjusted annual HRM use rates across 306 Dartmouth Atlas of Health Care hospital referral regions (HRRs), adjusting for sociodemographic, health-status, and access-to-care factors. PDP beneficiaries (n=2,346,037) were more likely to be older (75.8±7.8 vs.74.8±7.3 years), female (65% vs. 61%), white (85% vs. 82%), and have low-income-subsidy/dual-eligibility status (28% vs. 17%) compared to MA-PD beneficiaries (n=1,455,553) (p<0.001). HRM use significantly decreased over time among MA-PD beneficiaries (13.1% to 8.4%, p<0.0001) and PDP beneficiaries (16.2% to 12.2%, p<0.0001). In 2013, the ratios of 75th-to-25th percentile HRM use rates across HRRs were 1.42 (MA-PDs) and 1.31 (PDPs). HRRs with the highest HRM use rates were: Casper, WY (21.8%), Waco, TX (16.1%), Tuscaloosa, AL (15.8%), Lubbock, TX (15.7%), and Redding, CA (15.5%) (MA-PDs); and Lawton, OK (19.0%), Tuscaloosa, AL (18.6%), Slidell, LA (18.4%), Oklahoma City, OK (18.1%), and Alexandria, LA (18.1%) (PDPs). Geographic variation in HRM use exists among older adults in Medicare, regardless of prescription drug plans. Areas with high HRM rates may benefit from targeted interventions (e.g., medication therapy management monitoring or alternative medication substitutions) to prevent potential adverse consequences.