Benzodiazepine Use among Medicare, Commercially Insured, and Veteran Older Adults, 2013–2017

BACKGROUND/OBJECTIVES Benzodiazepines (BZDs) are widely prescribed to older adults. Although prescribing has declined in the U.S. Department of Veterans Affairs (VA), Medicare introduced BZD coverage in 2013. It is unknown whether declines in the VA have been widespread among older adults in the United States. DESIGN Observational study in traditional fee‐for‐service Medicare, commercial insurance, and the VA. SETTING United States, 2013–2017. PARTICIPANTS Adults aged 55 and older in traditional Medicare (234,290,693 person‐months), commercial insurance (337,827,125 person‐months), and the VA (256,590,369 person‐months). MEASUREMENTS (1) Change in BZD and BZD‐opioid co‐prescribing modeled by Poisson regression over time; and (2) standardized ratios of BZD and BZD‐opioid co‐prescribing, using Medicare as the reference. RESULTS From April 2013 to December 2017, the monthly percentage of adults aged 55 and older who received BZDs fell from 10.4% to 9.3% in Medicare, 6.6% to 6.5% in commercial insurance, and 5.7% to 3.0% in the VA. Monthly BZD‐opioid co‐prescribing over the same time fell from 4.0% to 3.0% in Medicare, 2.3% to 2.0% in commercial, and 2.2% to .6% for the VA. Age‐ and sex‐adjusted rates of decline for BZD and BZD‐opioid co‐prescribing were statistically significant for all systems. Annual BZD rate reductions were .98 (Medicare), .99 (commercial), and .87 (VA; P