• Lianlian Lei, Julie Strominger, Ilse R Wiechers, H Myra Kim, Frederic C Blow, BohnertAmy S BASBCenter for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.Department of Anesthesiology, University of Michigan, A, Lillian Min, Sarah L Krein, and Donovan T Maust.
• Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
• J Gen Intern Med. 2021 Dec 1; 36 (12): 368936963689-3696.

BackgroundThere has been a reduction in BZD prescribing in the Veterans Affairs (VA) health care system since 2013. It is unknown whether the decline in VA-dispensed BZDs has been offset by Medicare Part D prescriptions.ObjectivesTo examine (1) whether, accounting for Part D, declines in BZD prescribing to older Veterans remain; (2) patient characteristics associated with obtaining BZDs outside VA and facility variation in BZD source (VA only, VA and Part D, Part D only).DesignRetrospective cohort study with mixed effects multinomial logistic model examining characteristics associated with BZD source.PatientsA total of 1,746,278 Veterans aged ≥65 enrolled in VA and Part D, 2013-2017.Main MeasuresBZD prescription prevalence and source.Key ResultsFrom January 2013 to June 2017, the quarterly prevalence of older Veterans with Part D filling BZD prescriptions through the VA declined from 5.2 to 3.1% (p<0.001) or, accounting for Part D, from 10.0 to 7.7% (p<0.001). Among those prescribed BZDs between July 2016 and June 2017, 37.0%, 10.2%, and 52.8% received prescriptions from VA only, both VA and Part D, or Part D only, respectively. Older age was associated with higher odds of obtaining BZDs through Part D (e.g., compared to those 65-74, Veterans ≥85 had adjusted odds ratio [AOR] for Part D vs. VA only of 1.8 [95% highest posterior density interval (HPDI), 1.69, 1.86]). Veterans with substance use disorders accounted for few BZD prescriptions from any source but were associated with higher odds of prescriptions through Part D (e.g., alcohol use disorder AOR for Part D vs. VA alone: 1.9 [95% HPDI, 1.63, 2.11]) CONCLUSIONS: The decline in BZD use by older Veterans with Part D coverage remained after accounting for Part D, but the majority of BZD prescriptions came from Medicare. Further reducing BZD prescribing to older Veterans should consider prescriptions from community sources.© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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