Practice patterns of reflux medication prescriptions in otolaryngology compared to other specialties.

OBJECTIVES/HYPOTHESIS: To describe the trends in proton pump inhibitor (PPI) prescription rates and durations and compare them to those of H2-receptor antagonists (H2RAs) between 2013 and 2016 in otolaryngology, gastroenterology, and family practice, following the increasing publications on PPI adverse effects and inappropriate prescribing.

STUDY DESIGN: Retrospective review of publicly available Medicare Part D prescribing data.

METHODS: PPI and H2RA prescription and beneficiary data were obtained through the Centers for Medicare and Medicaid Services website. For prescription rates, 30-day fill counts were analyzed nationally and regionally per 10,000 Medicare members. Days supply per beneficiary was examined to show average prescription durations. Results were compared between otolaryngology, gastroenterology, and family practice. Medication-related economic burden per year was calculated based on reported drug cost.

RESULTS: From 2013 to 2016, PPI 30-day fill counts remained stable, whereas H2RA prescription rates increased by up to 62% per 10,000 Medicare beneficiaries. The South consistently prescribed two to three times as much antireflux medication as the lowest prescribing region over time and across all three specialties. The days supply per beneficiary remained stable and ranged from an average of 128 to 203 days depending on the specialty. Antireflux medication-related healthcare cost decreased steadily.

CONCLUSIONS: Despite numerous publications describing a multitude of adverse events and inappropriate prescribing patterns of PPIs in the past decade, prescription rates and durations per beneficiary have remained stable in the fields of otolaryngology, gastroenterology, and family practice. Additionally, H2RA prescriptions have increased from 2013 to 2016.

LEVEL OF EVIDENCE: NA Laryngoscope, 130:321-327, 2020.