Clinicians in the South are more prone to prescribe red-flagged, high-risk medications (HRMs) such as barbiturates and alpha blockers for elderly patients than their colleagues elsewhere, according to Medicare Part D data for 2014, released by the government last week.
The drugs considered high risk by the Centers for Medicare & Medicaid Services (CMS) are derived from a list maintained by the nonprofit Pharmacy Quality Alliance. This group, in turn, relies on recommendations from the American Geriatrics Society on drugs that persons 65 years of age and older should avoid because the risk for adverse events is high, and safer drugs may be available.
The list also includes vasodilators for dementia, long-duration sulfonylureas for type 2 diabetes, the antithrombotic ticlopidine (Ticlid, Roche), skeletal muscle relaxants, and first-generation antihistamines.
The national average for prescribing HRMs is 0.86 claims per elderly beneficiary, according to CMS. In a swathe of Southern states from Arkansas to North Carolina, the rate of HRM prescribing was 1.09 to 1.31 claims per beneficiary, or 27% to 52% higher than the national average. States with the lowest HRM prescribing rates were in the far West, the upper Midwest, and New England.