Prescriber Specialty Involvement in Medicare Patients With Chronic Hepatitis B

Abstract

Chronic hepatitis B (CHB) is a major cause of liver-related morbidity and mortality in the United States. Patients with CHB require long-term antiviral treatment and consistent follow-up, but often face numerous barriers to accessing care and medications. In this study, we used the Medicare Part D database and the Rural-Urban Continuum code to explore specialty and geographic characteristics of healthcare providers that manage Medicare patients with CHB. Between 2013 and 2021, more than 7000 prescribers prescribed over 2.4 million 30-day prescriptions of these CHB therapies, of which 2 million (85%) were in metropolitan counties. The number of 30-day prescriptions increased by 5.4% annually. The number of prescriptions by GI increased by 12.5% a year and prescriptions by APPs increased by 12.2% a year, while prescriptions by ID decreased by 14.0% annually. In non-metropolitan counties, APPs experienced -5% APC between 2013 and 2021, and PCPs experienced -12.5% APC between 2016 and 2021. In this study, we found that there has been a noticeable shift in the specialties prescribing medications for patients with hepatitis B. Gastroenterologists and APPs became significantly more involved as prescribers. The increase in APP management of patients with CHB is a welcoming development, especially in light of the physician workforce shortage. It is important to create solutions such as co-management to ensure that patients with CHB receive consistent care without further contributing to supply-demand mismatch in gastroenterology.