(081) ACCESSIBILITY AND PRESCRIBING PATTERNS OF HORMONE THERAPIES AMONGST ISSWSH PROVIDERS
Authors: Paulsen O , Barnett R , Trowbridge P , Prabhu S , Contractor M , Wallace M , Quaile H , Rubin R , Yee A 
Published: June 2024

Abstract

Introduction
Vaginal estrogen is a common topical therapy 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 may be inaccessible for many patients. Compounded medications are an alternative that some prescribers turn to despite inconsistency in quality, safety, and prices.

Objective
To examine prescribing patterns of ISSWSH providers of various hormonal and non-hormonal topical therapies, HRT, and strategies of increasing patient access to 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 hormone replacement therapy (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. All data was de-identified prior to analysis. Descriptive statistics were performed in SPSS.

Results
Fifty-five responses were collected. Of these, 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). Interestingly, 100% of participating family medicine providers (n=8) report prescribing estrogen-containing systemic therapies, compared to ob-gyns (89%) and urologists (58%). Systemic testosterone was 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. Additionally, our data reveals that 91% of participants report counseling patients on cost-saving programs like GoodRx, Mark Cuban Cost Plus Drugs, and others.

Conclusions
In conclusion, topical and systemic hormone therapies are prescribed at high rates by family medicine, ob-gyn, urogynecology, and urology providers within the ISSWSH community. However, the types of therapies prescribed vary greatly. Counseling regarding cost-saving methods shows to be promising, suggesting that patients are receiving these therapies at the most affordable rate. Further examination of pharmacy-level practices, patient refill trends, and direct medication costs will help to better describe and address patients’ barriers in acquiring treatment options.

Disclosure
No.