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Evolution of postmenopausal hormone therapy between 2002 and 2009

Ettinger, Bruce MD1; Wang, Sharon M. PharmD, MS2; Leslie, R. Scott MPH2; Patel, Bimal V. PharmD, MS2; Boulware, Michael J. PhD3; Mann, Mark E. BS4; McBride, Michael BA4

doi: 10.1097/gme.0b013e31823a3e5d
Original Articles

Objective The results of the Women’s Health Initiative led to a sharp decline in postmenopausal hormone therapy use. Subsequently, treatment guidelines were revised to recommend hormone therapy at the lowest effective dose for the shortest possible duration. The objective of this analysis was to assess trends in nationwide hormone therapy prescription claims from 2002 to 2009.

Methods This study was a retrospective database analyses of pharmacy claims from MedImpact Healthcare Systems Inc. Data from women with claims for oral or transdermal hormone therapy were analyzed to assess trends in hormone therapy claims, including route of administration, dose, and physician specialty.

Results By the end of 2002, the total number of hormone therapy claims dropped approximately 30% from 2002 second quarter claims. This trend continued during the next 7 years, and by 2009, hormone therapy claims were reduced by more than 70%. The proportion of low--dose oral claims rose fourfold, whereas the proportion of standard/high-dose claims decreased 30%. The proportion of claims for transdermal formulations more than doubled, and the proportion of claims for low-dose transdermal hormone therapy increased 10-fold. Although reductions in overall claims, routes of administration, and dose categories were similar between physician specialties, obstetrician/gynecologists prescribed transdermal hormone therapy nearly twice as often as all other types of providers.

Conclusions Since the publication of the Women’s Health Initiative results, there has been a sustained decrease in hormone therapy claims. The proportional use of low-dose oral and transdermal formulations has increased, but as of 2009, claims for these formulations accounted for approximately one in four total hormone therapy claims.

Between 2002 and 2009, 70% fewer hormone therapy prescription claims were received by a large pharmacy benefits management organization. Lower dosage and transdermal hormone therapy options have taken a larger share of prescribed hormone therapy.

From the 1University of California, San Francisco, CA; 2MedImpact Healthcare Systems Inc., San Diego, CA; 3Upsher-Smith Laboratories Inc., Minneapolis, MN; and 4Upsher-Smith Laboratories Inc., Maple Grove, MN.

Received July 20, 2011; revised and accepted September 28, 2011.

Funding/support: Database analyses and manuscript preparation support were funded by Upsher-Smith Laboratories, Inc.

Financial disclosure/conflicts of interest: Dr. Ettinger has served as a consultant to Abbott Laboratories, Théramex, and Upsher-Smith Laboratories Inc. Drs. Wang, Patel, and Leslie are employees of MedImpact Healthcare Systems Inc., which received payment for the presented analyses. Dr. Wang has also received honoraria for presenting a portion of these findings to a managed care advisory board in 2009. Dr. Boulware was a clinical fellow at Upsher-Smith Laboratories, Inc. at the time of the database analysis and has served as a consultant to Upsher-Smith Laboratories. Mr. Mann and McBride are both employees of Upsher-Smith Laboratories, Inc. Michael J. Boulware is an independent consultant; however, he was a fellow at Upsher-Smith Laboratories Inc. at the time of the study.

This text was sponsored by Upsher-Smith Laboratories Inc., which included funding the services of a professional medical writer (Regina Switzer, PhD). The authors are guarantors of this text, which expresses their opinions and conclusions. The authors actively participated in the preparation of this text in line with the principles of the Uniform Requirements of the International Committee of Medical Journal Editors (ICMJE). More specifically, all authors were actively involved in the initial planning of the text and all revisions.

Address correspondence to: Bruce Ettinger, MD, 156 Lombard Street #13, San Francisco, CA 94111. E-mail:

©2012The North American Menopause Society