Medicare prescribing trends: Lots of pain in Alabama

Majority of states have a statin as the most commonly prescribed Medicare drug, but Alabama’s collective pain level apparently exceeds that of the other 49 states.

Researchers at examined government Medicare prescribing data to establish what the most commonly prescribed medications are. The vast majority of states – 44 – had Atorvastatin, used to treat high cholesterol, as the most commonly prescribed medication.

Alabama, however, did not. The top Medicare drug there was surprisingly hydrocodone-acetaminophen, an opioid pain reliever that is commonly sold under the brand name of Vicodin. It is most commonly prescribed to relieve moderate to severe pain. In 2020, the report states that there were 837,529 Medicare Part D claims filed in Alabama for hydrocodone-acetaminophen – or one claim for every resident age 65 or older. The number of actual recipients was less than 200,000, and the study author says that the reason claims outnumber beneficiaries four-to-one may be recurring prescriptions for pain patients or abuse.

The total cost for all these pain killers in Alabama was almost $17 million. The CDC ranks Alabama number one as the highest prescribing state in the nation for opioid pain reliever prescriptions, and the study points out that a Blue Cross Blue Shield study found that 16.4 per 1,000 members were diagnosed with an opioid disorder in Alabama in 2016, double the national average. The study also notes that in 2018, HHS reported Alabama had the highest proportion of beneficiaries receiving opioids through Medicare Part D (44%).

Mississippi had the second highest opioid prescription rate in the HHS report, but the top drug in the study was Amlodipine, a hypertension medication. Similar to Alabama, there are an excess number of claims for this drug, with 600,215 claims for Amlodipine filed in 2020, or more than one each for every over-65 person in the state. These prescriptions were given to about 130,000 beneficiaries, but the study author notes that there is no history of abuse of Amlodipine, so the high number is a bit puzzling.

Mississippi is tied for the highest rate of hypertension in the nation, with 44% of the adult population being diagnosed with it, and also has the highest death rate from it (28%). The total cost to Medicare for these prescriptions was slightly more than $3 million.

The other four outlier states – Arizona, Montana, South Dakota, Wyoming – saw Levothyroxine as the most prescribed Medicare drug, according to the study. The drug is used for the treatment of hypothyroidism.

In total, residents of the four states filed 1.2 million claims for the drug in 2020, or about two claims for every three elderly residents, costing Medicare about $28 million, according to the report. There isn’t any clear evidence as to why these four states appear to have a greater rate of hypothyroidism.

For the rest of the states – 44 – Atorvastatin held the top spot, according to the study. It is the most prescribed drug nationwide, and there were 57.1 million claims in Medicare Part D for it across the U.S., or one for each of the nation’s 48 million beneficiaries. The total cost to Medicare was about $850 million in 2020.

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