(Poster 79) Trends in Local Hormonal Therapy Use: Merative™ MarketScan® Databases Analysis

Objectives: Genitourinary syndrome of menopause (GSM) is a prevalent condition affecting 15% of perimenopausal and up to 70% of postmenopausal women, yet data suggests that it remains underreported, underdiagnosed, and undertreated. This study aims to evaluate contemporary national trends in local hormonal therapy (LHT) prescription claims among women with GSM in the United States.

Methods: We conducted a retrospective cohort study using a 1% sample of the Merative™ MarketScan® Research Databases to evaluate trends in LHT claims from 2007 to 2022. The cohort included women aged >40 years with at least one year of continuous enrollment in commercial, employer sponsored insurance plans with prescription drug coverage. LHT formulations (e.g. vaginal estradiol creams, tablets, rings, Intrarosa and oral Osphena) were identified via National Drug Codes in outpatient pharmacy claims. We estimated annual LHT claims, stratified by age and US census division. Descriptive statistics were used to summarize prescribing patterns over time.

Results: A total of 19,755 unique women met inclusion criteria. The proportion of enrollees filling > 1 LHT declined from 2.5% in 2006 to 2% in 2022 (p < 0.001), with a peak observed between 2015 (3.02%) and 2018 (2.95%) (Figure 1). The mean age at first LHT prescription was 59 ± 9 years with nearly half (47.8%) filling prescriptions between ages 50-59. The South accounted for the largest proportion of initial LHT prescriptions (40.2%) suggesting regional variation in utilization patterns, followed by with the North Central (21.8%), West (20.2%), and Northeast (16.7%) regions. From 2007 to 2016, the majority of prescription claims were for Estrace and Premarin vaginal creams (25.5% and 25.3%, respectively) and Vagifem tablets (40.7%). However, a shift in this prescribing pattern was observed in 2016–2017 with the introduction of generic estradiol cream and Yuvafem. In 2022, ultra low dose Imvexxy prescriptions comprised 6.2%, while non-estrogen LHT prescription claims for Osphena and Intrarosa accounted for 2.6% and 2.2% respectively (Figure 2).

Conclusions: While LHT utilization among enrolled women briefly increased in 2015, it has subsequently decreased annually from 2018-2022. Despite the availability of new and generic LHT formulations that should address barriers such as medication delivery, cost, and concerns surrounding estrogen use, it appears to underutilized. This suggests persistent challenges in the reporting, diagnosis, and treatment of GSM, as well as potential ongoing issues with hormonal therapy hesitancy and/or access. Further research is needed to identify systems, provider, and/or patient-level barriers and to enhance education on symptom recognition, diagnosis, and management.
Figure 1: The percent of vaginal estrogen usage per year among women 40 years or older enrolled in a commercial, employer sponsored insurance plan based on data from a 1% sample of the Merative™ MarketScan® Research Databases.
Figure 2: Number of prescription claims by year from 1% sample of the Merative™ MarketScan® Research Databases for each group of local hormonal therapy.