(P-189) Low Rates of Bone-active Medication Utilization from 2013-2017 by Provider Type for Beneficiaries Aged 65+ with Medicare Part D

Background: Bone-active medications (BAM) effectively delay osteoporosis progression and prevent fractures. Historically, low treatment persistence and drug utilization rates are common among at-risk older adults and are highest after an osteoporotic fracture.

Objectives: To assess the average drug utilization rates for BAM in Medicare Part D provider utilization claims over five-years among five types of providers: geriatric specialists (GERO), generalists, specialists, nurse practitioners (NP), and physicians’ assistants (PA).

Methods: We conducted a retrospective analysis of Medicare Part D Provider Utilization Claims (2013-2017). Providers were included if at least one BAM prescription was reported during the study period for beneficiaries aged 65+. The point prevalence of BAM utilization was modeled with an analysis of response profiles in SAS 9.4 to assess the differences in the mean patterns of utilization over five-years by provider group.

Results: Of the 50,249 providers with beneficiaries over 65 with Medicare Part D, 88.15% were generalists, 5.76% specialists, 1.48% GERO, 2.73% NP, and 1.87% PA. From 2013-2017, overall mean prevalence of BAM utilization in each year were as follows: 5.69%, 7.22%, 7.05%, 6.90%, and 6.82%, respectively. There was a significant difference in the overall patterns of BAM utilization by provider group (F = 12.53, p <.001). PAs and NPs had five-year average BAM utilization rates of 9.02% and 9.20% with no significant changes in their rates of prescribing over time. In contrast, GERO providers and generalists exhibited the lowest average utilization rates over the five-year period: 4.86% and 5.79%, respectively. Specialists had the highest average utilization rate over the five-year period 14.95%, but their utilization rate increased slightly then decreased over the five-year period from 14% in 2013 to 25% in 2015 and to 16% in 2017.

Conclusions: Specialists had the highest average BAM prescribing rate followed by NPs and PAs. Generalists and GERO providers had the lowest utilization rates, and there were no significant increases observed in the overall rates of BAM utilization. From 2013-2017, the results show that BAM utilization was very low and unchanging. Further investigation of BAM utilization should focus on identifying how provider-related factors influence underutilization.