Top 5 Takeaways

  1. High Volume of Prescriptions: In 2021, 6.5 million topical antifungal prescriptions, costing $231 million, were filled for Medicare Part D beneficiaries, equating to approximately one prescription for every eight beneficiaries.
  2. Primary Prescribers: The majority of these prescriptions were written by primary care physicians, nurse practitioners, or physician assistants.
  3. Prescribing Patterns and Costs: Most common prescriptions included ketoconazole, nystatin, and clotrimazole-betamethasone dipropionate, with notable variations in cost per prescription.
  4. Emerging Antimicrobial Resistance: The analysis highlights a concern about the overuse and misuse of topical antifungals contributing to the global emergence of severe antimicrobial-resistant superficial fungal infections.
  5. Need for Judicious Prescribing and Patient Education: The findings emphasize the importance of appropriate prescribing practices and educating patients on the correct use of topical antifungals to combat resistance.

Original Article Author and Citation

Corresponding Author

Jeremy A. W. Gold,

Suggested Citation

Benedict K, Smith DJ, Chiller T, Lipner SR, Gold JA. Topical Antifungal Prescribing for Medicare Part D Beneficiaries — United States, 2021. MMWR Morb Mortal Wkly Rep 2024;73:1–5. DOI:


This MMWR article provides a comprehensive analysis of the prescribing patterns of topical antifungals among Medicare Part D beneficiaries in the United States for the year 2021. The study reveals a significant volume of prescriptions, primarily issued by primary care physicians, nurse practitioners, or physician assistants, and highlights the cost implications of these prescriptions. The report underscores the rising concern regarding the overuse and misuse of topical antifungals, contributing to the emergence of severe antimicrobial-resistant superficial fungal infections.


The study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Medicare Part D, focusing on the volume, rates, and costs of topical antifungal prescriptions. The research identified higher-volume prescribers and compared them with lower-volume prescribers, while also examining the prescription patterns by provider type and region.


The discussion section of the article points out the substantial use of topical antifungals in the United States, despite the challenges of confirmatory testing and accurate diagnosis. It highlights the need for health care providers to utilize diagnostic testing to confirm suspected fungal infections and to educate patients on the proper use of these medications, especially in the context of emerging antimicrobial resistance.


The report concludes with a call to action for more judicious prescribing of topical antifungals and combination antifungal-corticosteroid medications. It emphasizes the importance of diagnostic testing for confirming diagnoses and educating patients on the correct use of these medications, to help control the emergence and spread of antimicrobial-resistant superficial fungal infections.

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