Benzodiazepine Prescribing by State
Twelve years of Medicare Part D data, 2013–2024. Who is prescribing less, who is prescribing more, and what that means if you are trying to come off.
The headline: benzodiazepine prescribing in Medicare Part D fell 12.9% between 2013 and 2024 — from 39,449,069 claims a year to 34,355,606. That is a real decline, but a slow one: 12.9% over twelve years, and 7,175,026 people still filled a benzodiazepine prescription in 2024. The national figure also hides the states moving the other way — in New York, prescribing rose 15.1% over the same period.
The national trend
| Year | Claims | Patients |
|---|---|---|
| 2013 | 39,449,069 | 8,277,984 |
| 2014 | 42,734,620 | 8,526,373 |
| 2015 | 44,161,842 | 8,775,155 |
| 2016 | 43,981,347 | 8,705,047 |
| 2017 | 42,323,342 | 8,474,011 |
| 2018 | 40,226,272 | 8,114,588 |
| 2019 | 38,352,234 | 7,674,349 |
| 2020 | 37,563,688 | 7,279,304 |
| 2021 | 36,015,337 | 7,194,645 |
| 2022 | 35,125,395 | 7,110,677 |
| 2023 | 34,391,495 | 7,062,858 |
| 2024 | 34,355,606 | 7,175,026 |
Which benzodiazepines
Three drugs account for most of it. Alprazolam alone is 34.1% of all benzodiazepine claims in the programme.
Where prescribing fell fastest
Steepest declines
- Mississippi-38.9%
- Arizona-33.5%
- West Virginia-31.5%
- Oklahoma-31.3%
- Alabama-30.3%
Against the trend
- New York+15.1%
- New Hampshire+12.4%
- New Jersey+3.6%
- Maryland+3.2%
- Connecticut+2.9%
Every state
Sorted by change since 2013. “Fills per patient” is the average number of benzodiazepine prescriptions filled per person per year — a measure of intensity that does not depend on how big the state is.
| State | Claims 2024 | Fills/patient | Since 2013 |
|---|---|---|---|
| Mississippi | 276,786 | 4.96 | -38.9% |
| Arizona | 428,385 | 3.74 | -33.5% |
| West Virginia | 326,398 | 6.02 | -31.5% |
| Oklahoma | 325,735 | 4.92 | -31.3% |
| Alabama | 676,876 | 5.46 | -30.3% |
| California | 2,377,297 | 4.23 | -29.3% |
| New Mexico | 129,179 | 4.39 | -28.4% |
| Maine | 169,086 | 4.6 | -28.2% |
| Oregon | 295,875 | 3.78 | -25.9% |
| Michigan | 1,110,988 | 4.45 | -25.6% |
| Washington | 422,277 | 3.86 | -24.2% |
| Kentucky | 660,545 | 5.83 | -24% |
| Tennessee | 1,017,315 | 5.78 | -23.5% |
| Ohio | 1,206,858 | 4.88 | -23.4% |
| Wisconsin | 554,889 | 4.61 | -23.1% |
| Vermont | 73,449 | 4.72 | -19.5% |
| Nevada | 224,038 | 4.46 | -19.2% |
| Virginia | 709,922 | 4.51 | -19.1% |
| Hawaii | 60,067 | 3.82 | -18.8% |
| North Carolina | 1,354,252 | 4.91 | -18.4% |
| Colorado | 333,226 | 3.9 | -17.2% |
| Pennsylvania | 1,765,580 | 4.92 | -15.7% |
| Indiana | 744,145 | 5.05 | -15.1% |
| Texas | 1,920,091 | 4.49 | -13.8% |
| Minnesota | 378,247 | 4.47 | -13.2% |
| Alaska | 28,017 | 3.61 | -12% |
| Delaware | 102,142 | 4.03 | -11.2% |
| Montana | 97,749 | 4.84 | -9.6% |
| Wyoming | 32,049 | 4.16 | -9.6% |
| Missouri | 842,704 | 5.14 | -9.4% |
| Arkansas | 467,080 | 5.33 | -9% |
| Louisiana | 672,102 | 5.17 | -7.4% |
| Iowa | 369,891 | 5.18 | -7.2% |
| North Dakota | 70,652 | 4.55 | -6.9% |
| Florida | 3,544,578 | 4.83 | -6.7% |
| Georgia | 1,011,913 | 4.68 | -5.8% |
| Utah | 213,718 | 4.57 | -5.8% |
| South Dakota | 84,482 | 4.87 | -5.4% |
| Kansas | 320,168 | 4.92 | -5% |
| Idaho | 142,308 | 4.08 | -4.5% |
| Nebraska | 204,678 | 5.16 | -2.6% |
| Illinois | 1,191,074 | 4.68 | -1.7% |
| Massachusetts | 1,040,617 | 5.16 | +0.1% |
| District of Columbia | 33,184 | 3.25 | +0.4% |
| Rhode Island | 184,889 | 5.34 | +1% |
| South Carolina | 748,024 | 4.98 | +2.5% |
| Connecticut | 471,543 | 4.55 | +2.9% |
| Maryland | 426,055 | 4.21 | +3.2% |
| New Jersey | 1,048,023 | 4.63 | +3.6% |
| New Hampshire | 187,183 | 4.39 | +12.4% |
| New York | 1,786,935 | 4.45 | +15.1% |
The decline is not coming from prescribers stopping
Of 21,900 psychiatric prescribers with benzodiazepine claims in 2024, 3,005 cut their prescribing by at least half since 2019 — but 3,564 increased theirs by at least half. More prescribers grew their benzodiazepine prescribing than shrank it.
That is the most useful thing in this dataset, and it reframes the national decline. Total claims are falling, but not because the prescribing population is converting to deprescribing — the aggregate is moving while individual practice is polarising. Whether you meet a prescriber who is winding benzodiazepines down or one who is writing more of them is close to a coin flip, and it depends far more on which individual you see than on the national trend. Per-state tables of individual prescribers and their five-year change are on each state page.
Psychiatry, psychiatry & neurology, geriatric psychiatry, neuropsychiatry and addiction medicine only. Primary care writes a large share of benzodiazepine prescriptions and is not included in this cohort.
What this means if you are tapering
A falling national number is, on balance, good news — benzodiazepines were over-prescribed for decades. But the way a decline gets delivered to an individual patient is a separate question, and it is where the harm happens. Prescribers under pressure to reduce their numbers sometimes discharge patients, refuse refills, or impose a fast timeline. That is not deprescribing; it is abandonment, and it is the single most common story behind severe withdrawal.
If your prescriber has proposed a timeline that feels driven by something other than how you are doing, the taper calculator will show you what a gradual schedule actually looks like, and the directory page covers how to find a prescriber who will support one.
Method and limitations
- Source. CMS Medicare Part D Prescribers — by Geography and Drug, data years 2013–2024. US Government work, public domain.
- Drugs included. Alprazolam, clonazepam, lorazepam, diazepam, temazepam, chlordiazepoxide, clorazepate, oxazepam, triazolam, estazolam and flurazepam. Midazolam and remimazolam (anaesthesia) and clobazam (primarily anticonvulsant) are excluded.
- Population. Medicare Part D only. This skews heavily toward patients aged 65 and over and excludes commercial insurance and cash-pay entirely. Do not read these as national prescribing totals.
- Suppression. CMS suppresses cells with 10 or fewer claims, so low-volume prescribing is systematically missing.
- Lag. CMS publishes roughly two years behind. 2024 is the most recent year available.
- Claims, not people. One patient filling monthly generates twelve claims. “Fills per patient” is the ratio of the two.
Frequently asked questions
Is benzodiazepine prescribing going up or down?
In Medicare Part D it is going down, but slowly and unevenly. Total benzodiazepine claims fell 12.9% between 2013 and 2024, from 39,449,069 to 34,355,606 a year. Over the most recent five years the change was -10.4%. New York runs against the national trend, where prescribing rose 15.1% over the same period.
Which benzodiazepine is prescribed most?
Alprazolam accounts for 34.1% of Medicare Part D benzodiazepine claims (11,707,497 in 2024), followed by Clonazepam at 25.8% and Lorazepam at 23.7%. Together those three account for 83.6% of all benzodiazepine prescribing in the programme.
Which state prescribes the most benzodiazepines?
By intensity — fills per patient per year — West Virginia is highest at 6.02 fills per benzodiazepine patient, followed by Kentucky (5.83) and Tennessee (5.78). By raw volume the largest states dominate simply because they have the most Medicare beneficiaries, which is why intensity is the more useful comparison.
Does this data cover everyone?
No. It covers Medicare Part D only, so it skews heavily toward patients aged 65 and over and misses commercially insured and cash-pay prescriptions entirely. CMS also suppresses any prescriber-drug combination with 10 or fewer claims, so low-volume prescribing is invisible. It is the largest openly published prescriber-level dataset in the United States, but it is a sample, not a census.
Are psychiatrists prescribing fewer benzodiazepines?
Not uniformly. Of 21,900 psychiatric prescribers with benzodiazepine claims in 2024, 3,005 cut their prescribing by at least half since 2019 while 3,564 increased theirs by at least half. More prescribers grew their benzodiazepine prescribing than shrank it, so the falling national total reflects changes in volume rather than a wholesale shift toward deprescribing. Which prescriber you see matters far more than the national trend.
Why does declining prescribing matter to someone tapering?
Because it explains a common and distressing experience: prescribers are under pressure to reduce benzodiazepine prescribing, and some respond by cutting patients off rapidly rather than tapering them slowly. A falling national number is good public health and can still be delivered badly to an individual patient. Knowing the trend helps you recognise when a proposed timeline is being driven by policy rather than by your symptoms.