(072) PRESCRIBING PATTERNS AND COST OF HORMONE THERAPIES AMONGST ISSWSH PROVIDERS
Authors: Chapalamadugu M , Paulsen O , Chapalamadugu K , Barnett R , Quaile H , Rubin R , Yee A 
Published: December 2024

Abstract

Introduction
Vaginal estrogen is commonly used to treat vulvovaginal disorders and genitourinary syndrome of menopause (GSM). Systemic hormone replacement therapy (HRT) is an evidence-based treatment for menopause and female sexual dysfunction. Insurance coverage for topical estrogen and HRT is highly variable and remains inaccessible for many patients. Compounded medications are an alternative that some prescribers turn to, despite inconsistency in quality, safety, and prices.

Objective
This study aims to examine prescribing patterns of ISSWSH providers of various hormonal and non-hormonal topical therapies, HRT, and cost of these medications.

Methods
A fourteen-item survey was distributed to ISSWSH providers via online platforms including social media. Participants were asked about medical education background and specialty, practice location, topical vaginal HRT (i.e., estrogen, estrogen and testosterone) and non-hormonal therapy (i.e., capsaicin, gabapentin) prescription practices, the most common diagnoses for which they prescribe these medications, systemic hormone therapy prescription practices, and counseling on cost-saving programs. Pharmacies used by respondents were surveyed regarding monthly cost of the compounded medications mentioned above. All data was de-identified prior to analysis. Descriptive statistics were performed in SPSS.

Results
Of the fifty-five responses collected, a majority of participants (51%) are ob-gyn providers and 22% are urology providers. The remaining participants are providers of internal medicine, family medicine, midwifery, urogynecology, and functional medicine. A majority are designated MD, DO, or equivalent (49%), and 45.5% are advanced practice providers (NP or PA). Notably, 100% of participating family medicine providers (n = 8) report prescribing estrogen-containing systemic therapies, compared to ob-gyns (89%) and urologists (58%). Systemic testosterone is prescribed most often by urologists. Numerous providers report prescribing topical estrogen and testosterone: 50% being family medicine, 67% urologists, 67% midwives, 71% ob-gyns, and 100% of urogynecologists. Prescribing patterns for non-hormonal topicals vary. Gabapentin and valium appear to be most common in ob-gyn practices (43% each). Valium is also commonly prescribed by urologists, family medicine providers, and urogynecologists. According to the results, internal medicine providers rarely prescribe non-hormonal options. From the 37 pharmacies we contacted, the median monthly cost of compounded vaginal hormone therapy was $55.00. The median monthly costs of non-hormonal topicals, including topical gabapentin, diazepam suppository, topical diazepam, topical capsaicin, and baclofen, are $55.00, $56.00, $73.00, $58.50, $62.00, and $56.00, respectively. Our data reveals that 91% of participants report counseling patients on cost-saving programs such as GoodRx, Mark Cuban Cost Plus Drugs.

Conclusions
Hormone therapies are prescribed at high rates by providers within the ISSWSH community; however, the types of therapies prescribed and prescription frequency vary greatly. Counseling regarding cost-saving methods shows to be promising; however, patients do not usually expect to pay cash. Atorvastatin is the most commonly taken medication in the US, and the average monthly copay is $2.48, which is drastically different from the median $60.00 monthly cost we found for hormonal and non-hormonal therapies aimed at vulvovaginal disorders and GSM. Future directions for this project include correlating prices with zip codes to examine geographical trends in medication cost.

Disclosure
No.