Prescribing Trends of Loop Diuretics Among Medicare Beneficiaries in the United States (US) from 2021-2023

Abstract

Purpose: Heart failure (HF) remains a leading cause of hospitalization and healthcare expenditures in the US, with volume overload being the primary indication for loop diuretics. The American Heart Association (AHA) lists furosemide, torsemide, and bumetanide as the most commonly prescribed loop agents. Furosemide has the poorest bioavailability (47-64%) and shortest half life (0.5-2 hrs). Torsemide offers more reliable absorption (~80%) and longer half life (~3.5 hrs). Bumetanide has high bioavailability (55-89%), but shorter duration (4-6 hrs). Despite these alternatives, furosemide remains dominant. This study evaluated recent national prescribing trends and relative utilization of these diuretics.

Methods: Medicare Part D data of loop diuretic prescribing was obtained from the 2021–2023 Centers for Medicare and Medicaid Services “Part D Prescribers by Geography and Drug” files. Analysis included furosemide, torsemide, and bumetanide across all 50 states and the District of Columbia. For each state and year, total prescription claims and beneficiaries were extracted. Prescribing rates were standardized as claims per 100 beneficiaries to account for population differences. National totals were calculated by summing state claims. Proportional prescribing was determined annually to assess relative utilization. Analyses were descriptive and did not adjust for comorbidities, prescriber variation, or indication.

Results: Between 2021 and 2023, furosemide dominated prescribing. In 2021, there were 23.3 million furosemide claims (5.72 per 100 beneficiaries; state range 3.70-9.53). Torsemide had 2.3 million claims (0.60 per 100) and bumetanide 2.0 million claims (0.44 per 100). In 2022, furosemide declined slightly to 22.6 million claims (5.28 per 100), while torsemide increased modestly to 2.5 million (0.62 per 100), bumetanide remained stable ( 2.0 million claims; 0.43 per 100). In 2023, furosemide remained steady at 22.8 million claims (4.94 per 100), with minimal change in torsemide (2.7 million claims; 0.60 per 100) and bumetanide (2.1 million claims; 0.44 per 100). Across all years, furosemide accounted for more than 80% of loop diuretic prescriptions.

Conclusion: Between 2021 and 2023, furosemide represented the majority of Medicare Part D loop diuretic prescribing with limited uptake of torsemide or bumetanide despite reported pharmacologic advantages. National patterns remained stable over time. Claims data lack clinical context and adjustment for patient factors. Future studies should evaluate whether diuretic selection aligns with evidence based practice by linking prescribing patterns to HF outcomes like readmissions.