JAMA Netw Open. 2026 Mar 2;9(3):e263410. doi: 10.1001/jamanetworkopen.2026.3410.
ABSTRACT
IMPORTANCE: Despite safety warnings, antipsychotics remain commonly prescribed to older adults, particularly those with dementia, and for off-label indications. However, little is known about how prescribing patterns vary by clinician type over time.
OBJECTIVE: To examine trends in antipsychotic prescribing by clinician type among Medicare beneficiaries from 2013 to 2023.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used the Medicare Part D Prescribers by Provider and Drug dataset from 2013 to 2023. Participants included Medicare beneficiaries enrolled in Medicare Part D. Analyses were performed between November 2024 and June 2025.
EXPOSURE: Prescribing clinician type, categorized as psychiatrist, primary care physician (PCP), advanced practice registered nurse (APRN) or physician assistant (PA), or other physician.
MAIN OUTCOMES AND MEASURES: Annual antipsychotic prescription claims, the proportion of claims by clinician type, the number of prescribing clinicians, and the mean number of claims per clinician.
RESULTS: From 2013 to 2023, annual antipsychotic prescription claims decreased from 10.8 million to 7.8 million for psychiatrists (average annual percentage change [AAPC], -3.2% [95% CI, -3.7% to -2.7%]; P < .001) and from 7.4 million to 5.7 million for PCPs (AAPC, -2.6% [95% CI, -3.2% to -2.3%]; P < .001). In contrast, claims prescribed by APRNs or PAs more than tripled from 2013 to 2023, increasing from 3.1 million to 9.5 million (AAPC, 11.8% [95% CI, 10.9%-12.7%]; P < .001). The proportion of prescriptions decreased for psychiatrists (48.4% to 32.4%) and PCPs (33.0% to 23.8%) but increased for APRNs and PAs (13.8% to 39.6%) from 2013 to 2023. These shifts were associated primarily with the expanding number of prescribing APRNs and PAs rather than an increase in the mean number of claims per clinician. Although trends were observed in both rural and urban areas, rural areas experienced larger shifts from PCPs to APRNs and PAs, whereas urban areas experienced larger shifts from psychiatrists to APRNs and PAs.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Medicare Part D data from 2013 to 2023, antipsychotic prescribing shifted from psychiatrists and PCPs to APRNs and PAs, reflecting growth in nonphysician prescribers. These findings suggest evolving roles in antipsychotic medication management and highlight the need for appropriate training for the full range of clinician types who prescribe these medications to Medicare enrollees.
PMID:41879781 | DOI:10.1001/jamanetworkopen.2026.3410
