(C-080) Naloxone Prescribing Trends Among Regions and Providers of the United States: Analysis of Medicare Part D Prescriber Data 2013-2022

Background: Naloxone is an opioid overdose antidote that reverses opioid-induced respiratory/central nervous system depression, which is crucial in preventing death. It is important to expand research on the prescribing habits of Medicare patients in the United States (US) as opioid use disorder and opioid-related hospital visits are increasing among patients aged 65 years and older.

Objectives: This study aimed to analyze naloxone prescribing trends to Medicare Part D beneficiaries by geographic region and provider type from 2013 to 2022.

Methods: This project was a cross-sectional, descriptive study analyzing the most recent Medicare Part D Prescriber Public Use File (PUF) which is a public dataset that contains information on prescription drug events incurred by Part D prescription drug plans. All available years of data (2013-2022) were analyzed using SAS (v9.4) and R (v4.4.1). The variables analyzed included prescriber information and prescription drug claims sorted by provider and drug. The naloxone prescribing trends across regions and provider specialties were presented using figures and discussed in the context of state naloxone prescribing laws and recommendations and the opioid epidemic trends.

Results: A total of 17,624 distinct providers prescribed at least one naloxone prescription that was billed through Medicare Part D from 2013 to 2022. The number of providers in this cohort increased yearly, except for a slight decrease in 2020. Nurse practitioners (22%), physician assistants (11%), family practice physicians (11%), internal medicine physicians (10%), and pain management physicians (7%) accounted for the highest number of claims by provider type. Medicare Part D billed 1,323,645 naloxone prescriptions over the study period, with each year's volume increasing (except in 2020). The calculated number of naloxone claims per 1,000 Medicare Part D beneficiaries in each year in each state ranged from 0 to 25. There were considerable differences in claim volumes among the regions of the US with the South and the West having the greatest number of claims.

Conclusions: The increase in naloxone prescriptions billed through Medicare Part D over the 2013 to 2022 period reflects expanded coverage, broader access, and increased awareness of naloxone amongst providers in recent years. Geographic disparities highlight a need to tailor education and policy interventions to improve practices in particular states. Provider differences highlight the critical role of advanced practice providers (nurse practitioners/physician assistants) and general medicine physicians in preventing opioid overdoses among the aging population. These findings are important for future comparative research in drug utilization to inform legislation and strategic recommendations.