National trends in psychotropic medication prescribing before and during the COVID-19 pandemic

•The number of patients with dispensed psychotropic medications declined during the early months of the pandemic but experienced a significant growth in later periods.•The number of psychotropic medications dispensed declined during the early months of the pandemic but experienced a significant growth in later periods.•Average days supply of psychotropic medications dispensed increased significantly throughout the pandemic.•Commercial insurance remained the primary payer for psychotropic medication throughout the pandemic.•There was a significant increase in the number of prescription fills covered under Medicaid. The early months of the COVID-19 pandemic saw a decline in psychotropic medication use; however, little is known about how this trend evolved as the pandemic progressed and how it varied across different payers in the United States. Using a national multi-payer pharmacy claims database and adopting a quasi-experimental research design, this study examines trends in psychotropic medication prescriptions dispensed from July 2018 - June 2022. The study finds that the number of patients with dispensed psychotropic medications and the number of psychotropic medications dispensed declined during the early months of the pandemic but experienced a statistically significant growth in later periods compared to the pre-pandemic rate. Average days supply of psychotropic medications dispensed increased significantly throughout the pandemic. Commercial insurance remained the primary payer for psychotropic medication during the pandemic, but there was a significant increase in the number of prescription fills covered under Medicaid. This implies that public insurance programs played an increasing role in financing psychotropic medication use during the COVID-19 pandemic.