The expanding role of nurse practitioners in prescribing for medicare beneficiaries

BACKGROUND: Nurse practitioners (NPs) play a major role in delivering primary and chronic care to Medicare beneficiaries, making their prescribing patterns an important area of study. PURPOSE: This study examined national trends in NP prescribing under Medicare Part D from 2013 to 2022, focusing on overall prescribing volume, prescriptions per Medicare beneficiary, and condition-specific prescribing patterns compared with physicians and physician assistants. METHODS: We conducted a retrospective analysis of the Centers for Medicare and Medicaid Services Medicare Part D Prescribers dataset from 2013 to 2022. Trends in total prescriptions, prescriptions per Medicare beneficiary, and prescribing by provider type were analyzed. Condition-specific analyses focused on cardiovascular, neuropsychiatric, and endocrine conditions, comparing prescribing patterns across provider groups. RESULTS: Total Medicare Part D prescriptions increased modestly between 2013 and 2022, while prescriptions per Medicare beneficiary declined. During this period, NP prescribing increased substantially, accounting for 15.6% of all Part D prescriptions by 2022, while the proportion attributed to physicians decreased. Cardiovascular, neuropsychiatric, and endocrine medications represented nearly 60% of NP prescriptions. Across these clinical areas, NP prescribing increased alongside stable or modest changes in specialist prescribing, indicating redistribution of prescribing responsibility rather than an increase in prescribing intensity. CONCLUSION: Nurse practitioner prescribing for Medicare beneficiaries expanded markedly over the past decade, particularly within key chronic disease categories. IMPLICATIONS: These findings point to the expanding role of NPs in medication management for older adults and emphasize the need for adequate training and support as they take on a larger share of care for Medicare beneficiaries.