The share of nonphysician clinicians prescribing antipsychotics for Medicare Part D beneficiaries increased between 2013 and 2023, according to a study published March 25 in JAMA Network Open.
The study was conducted by researchers from the University of Texas Health Science Center at Houston. During the study period, prescriptions written by psychiatrists and primary care physicians declined annually by 3.2% and 2.6%, respectively, while prescripting by advanced practice nurses and physician assistants increased by 11.8% each year.
The share of prescriptions from psychiatrists fell from 48.4% to 32.4%, and primary care physicians’ share fell from 33% to 23.8%. Meanwhile, the share from advanced practice registered nurses and physician assistants rose from 13.8% to 39.6%.
Researchers said the shift reflects workforce changes, including a shortage of psychiatrists and Medicare opt-out rates of around 8% for the speciality. Total antipsychotic claims increased from 22.4 million to 24.1 million over the decade, while the rate per enrollee declined from 0.63 to 0.46.
The study did not include detailed information on prescribing patterns, such as days’ supply, duration of treatment or whether medications were prescribed as needed or for daily use. It is unclear whether nonphysician clinicians were more or less likely to prescribe antipsychotics compared to physicians.
The findings also suggest expanded roles for nonphysician clinicians in settings such as nursing homes, where about 15% of Medicare enrollees over age 75 receive antipsychotics compared to 3% of community-dwelling adults.
At the Becker's Fall Behavioral Health Summit, taking place October 20–22 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
