PD33-04: Comparison of Medication Prescribing for Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia Among Sexagenarians with Medicare and Private Insurance

Kevin McVary, Lydia Feinstein , Julia B. Ward , Kevin C. Abbott, Tamara Bavendam, Ziya Kirkali, Erline Martinez-Miller, Brian R. Matlaga, Charles Welliver

Introduction: Medication use for lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) increases with patient age. However, little is known about prescribing patterns as men in their 60’s transition from private insurance to Medicare coverage. We characterized differences in LUTS/BPH medication prescribing patterns among a large, national sample of 60- to 69-year-olds.

Methods: As part of the Urologic Diseases in America project, two insurance claims databases were analyzed over the 2006-2013 study period: the Centers for Medicare & Medicaid Services Medicare (CMS) 5% Sample for Medicare beneficiaries and the Optum© de-identified Clinformatics® Data Mart Database (CDM) for privately insured adults. We compared patterns for LUTS/BPH prescription fills between privately insured men aged 60-64 years with LUTS/BPH (N˜38,300 annually) and Medicare beneficiaries aged 65-69 years with LUTS/BPH (N˜28,700 annually). CMS data for 2012 was unavailable.

Results: Prescribing of any LUTS/BPH medication was higher among Medicare beneficiaries (range: 50-55%) than among privately insured men (range: 41-49%), but there was a greater rise in prescribing over time for the privately insured group (17% vs. 5%). The largest difference in medication use was with a-blocker therapy, which was 20% higher on average in the Medicare group (range: 41-45%) compared to the privately insured group (range: 32-38%). Anticholinergic prescribing was uncommon (6% for Medicare vs. 3-4% for private insurance) and remained relatively steady over the study period. 5aRI prescribing increased up to 2010, then decreased in both groups, with a less pronounced decline among Medicare beneficiaries (9% vs. 14%). Tadalafil prescribing was more common in privately insured patients (5-8%) than among Medicare beneficiaries (0.1-3%).

Conclusions: Overall, there was a rise in LUTS/BPH pharmacotherapy for sexagenarians from 2006-2013, with a greater rise among privately insured enrollees relative to Medicare beneficiaries. The decline in 5aRI prescribing correlates to the FDA “black box” warning on finasteride in 2011. Tadalafil coverage was rarely prescribed to Medicare beneficiaries. Source of

Funding: Funded by the NIH via a contract to Social & Scientific Systems.