Geographical and Specialty-Based Patterns of Dapagliflozin Prescription Among Medicare Part D Providers in Texas, US

OBJECTIVES: Dapagliflozin (Farxiga) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used primarily for the management of type 2 diabetes, heart failure, and chronic kidney disease. This study aims to analyze the prescribing patterns of dapagliflozin among Medicare Part D providers in the state of Texas, US.

METHODS: We utilized the 2022 Medicare Part D Prescriber Dataset to examine the distribution and dapagliflozin prescriptions and the prescriber characteristics. Prescriber locations were designated to be US metropolitan (metro) or nonmetropolitan (nonmetro) areas using Rural-Urban Continuum Codes. The analysis focused on identifying prescriber specialties, the quantity prescribed, and geographical disparities between metro and non-metro areas. All analyses were performed using RStudio (Version 4.4.1).

RESULTS: In 2022, a total of 276,349 dapagliflozin claims were filed covering 499,641 30-day standardized fill counts in Texas. The majority of dapagliflozin (30-day fill) were prescribed by primary care doctors with family practice and internal medicine accounting for 27.2% and 24.4% respectively. However, when considering the quantity (30-day fill) per provider, specialists in endocrinology, nephrology, and cardiology were the top prescribers, averaging 202, 148, and 128 30-day-fills per prescriber as compared to 108 and 83 for internal medicine and family practice. Furthermore, prescribers in metro areas were associated with twice dapagliflozin prescriptions compared to nonmetro areas, averaging 105 vs merely 52 30-day fills per prescriber. This drastic difference persisted in individual specialties as well.

CONCLUSIONS: The study characterized the pattern of dapagliflozin prescriptions among different medical specialties and highlighted a geographic disparity of dapagliflozin prescription between urban and rural areas in the Medicare Part D program in Texas, which ranks No. 1 in rural population in the US. These findings can provide insights to inform policy and potential interventions to address prescribing disparities and improve patient access to dapagliflozin within the Medicare Part D program.