(333) TRENDS IN PHOSPHODIESTERASE TYPE 5 INHIBITOR PRESCRIPTIONS AND COST: MEDICARE ANALYSIS 2017-2021

Abstract Introduction Phosphodiesterase Type 5 (PDE5) inhibitors are the first line treatment for erectile dysfunction. While urologists commonly prescribe these medications, patients may also receive them from their primary care providers. Cost of medication also highly varies depending on insurance, location, and pharmacy type, which may impact prescribing behavior. Objective We aimed to examine prescribing patterns and cost of PDE5 inhibitors in the United States over time, specifically comparing urologists to non-urologists. Methods The 2017-2021 Medicare Part D Public Use File was used to identify prescribers of PDE5 inhibitor medications including sildenafil, tadalafil, and vardenafil. The number of claims and total annual expenditure for each medication for all prescribers, non-urologists, and urologists were analyzed from 2017 to 2021. Results Sildenafil was the most commonly prescribed PDE5 inhibitor each year, comprising 70.6% of claims in 2021 (Table 1). From 2017 to 2021, sildenafil claims increased from 282,809 to 456,709. Tadalafil prescriptions decreased each year, with 278,773 claims in 2017 and 189,303 claims In 2021. Vardenafil was the least prescribed medication each year. Urologists consistently prescribed more tadalafil than sildenafil each year, however there was a trend towards decreased tadalafil and increased sildenafil prescriptions (Fig. 1). Total annual expenditures for all medications steadily decreased from $444 million in 2017 to $143 million in 2021 (Table 2). Conclusions There was a rise in overall claims accompanied by a drastic drop in cost for PDE5 inhibitors over the 5 year period in the Medicare Part D database. Specifically, claims for sildenafil increased, while claims for tadalafil decreased. Additionally, claims from non-urologists increased each year, while claims from urologists remained relatively stable. Urologists most commonly prescribed tadalafil while non-urologists most commonly prescribed sildenafil. Vardenafil prescriptions remained low over time. We suspect that usage of these medications increased as a result of decreasing costs. However, online access options, direct to consumer advertising, and patient comfortability with seeking treatment may play a role as well. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Endo Pharma, Fellow, Posterity Health, HIMS, WIN fertility, Haleon.