National long-term trends in benzodiazepine outpatients prescription claims, Medicaid reimbursement, and average reimbursement per prescription in the United States, 2010–2024

BACKGROUND: Research on long-term prescribing and reimbursement patterns for benzodiazepines in the United States remains limited. This study evaluated trends in utilization, expenditures, and average reimbursement per claim of benzodiazepines in the U.S. from 2010 to 2024. METHODS: This observational longitudinal study used data recorded between 2010 and 2024 from the National Medicaid State Drug Utilization database. Utilization was defined as the total annual prescription claims count, expenditure as the annual sum of Medicaid reimbursements, and average gross Medicaid reimbursement per prescription claim as annual expenditure divided by the annual number of prescriptions. Results: Approximately 503 million benzodiazepine prescriptions were recorded, with cumulative Medicaid reimbursement of USD 14.9 billion. Intermediate-acting benzodiazepines were the most frequently utilized, whereas long-acting medications accounted for the largest proportion of Medicaid reimbursement. Annual claims decreased from 46.2 million to 23.9 million, while average reimbursement per prescription increased from USD 17.1 to USD 47.5 over the study period. The largest reported average reimbursement per claim increase was observed for short-acting benzodiazepines, which rose from USD 45.2 in 2018 to USD 183.9 in 2019. CONCLUSION: Benzodiazepine claims decreased significantly between 2010 to 2024, while reimbursement per claim rose significantly. Total Medicaid reimbursement showed no significant net change.