Trends in Nasal Spray Prescribing Patterns by Otolaryngologists in the US Medicare Population

Ann Otol Rhinol Laryngol. 2022 Nov;131(11):1185-1193. doi: 10.1177/00034894211060902. Epub 2021 Nov 26.


Objectives: To quantify national and state-level prescribing and cost trends for the 3 most prescribed nasal sprays by otolaryngologists in the Medicare population.

Methods: Through the Centers for Medicare and Medicaid Services (CMS) database and the Kaiser Family Foundation, we retrieved data on Medicare enrollment and on claims and costs of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists from January 1, 2013 to December 31, 2017.

Results: From 2013 to 2017, CMS reimbursed $128.8 million for 5.2 million claims of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists. The national claim rate for fluticasone propionate increased 6.5% per year from 2013 to 2015 and then decreased 4.3% per year from 2015 to 2017 while azelastine HCl and ipratropium bromide consistently increased annually (19.0% and 12.2% respectively) from 2013 to 2017. The cost for fluticasone propionate decreased 33.0% a year from 2013 to 2015 and then increased 5.4% annually to $13.60 per claim in 2017. Azelastine HCl decreased 14.8% annually from $91.30 to $50.23 per claim and ipratropium bromide increased 5.2% annually to $34.78 in 2017. Variations in the claim rate and cost for all 3 nasal sprays were observed in some states.

Conclusions: Otolaryngologists are prescribing azelastine HCl and ipratropium at an increasingly higher rate in the Medicare population, while the rate for fluticasone propionate has been decreasing nationally. Utilization and costs of nasal sprays also vary geographically across the United States.

Keywords: azelastine HCl; fluticasone propionate; ipratropium bromide; medicare; nasal spray.

MeSH terms

  • Administration, Intranasal
  • Aged
  • Double-Blind Method
  • Fluticasone / therapeutic use
  • Humans
  • Ipratropium
  • Medicare
  • Nasal Sprays*
  • Otolaryngologists*
  • United States


  • Nasal Sprays
  • Fluticasone
  • Ipratropium