Background <p>Oral anticoagulants (OACs) are recommended for stroke reduction in non-valvular atrial fibrillation (NVAF). OAC use has been studied in Medicare populations, but data for younger, commercially insured populations are limited.</p> Objective <p>This retrospective study aimed to describe the geographic variation of OAC use among commercially insured patients with NVAF at high risk of stroke (CHA₂DS₂-VASc score ≥&#xa0;2) in the USA.</p> Methods <p>Geographic variation was assessed by 3-digit zip code and race among patients identified from the Komodo Health commercial database with a diagnosis of NVAF between January 1, 2016, and August 31, 2021. Continuous health plan enrollment for ≥&#xa0;12 months before and 12 months after the NVAF diagnosis was required.</p> Results <p>A total of 619,111 patients with NVAF at high risk for stroke were identified, of whom approximately 50% were not treated with OACs. Of the half who received OACs, almost 85% received direct OACs (DOACs) and 15% received warfarin therapy. Overall, the highest untreated rates were observed in the South and West US regions, followed by the Midwest, then the Northeast. The highest DOAC treatment rates were in the Northeast for White patients and in the North and South for Black patients. The highest warfarin treatment rates were in the upper Midwest for White patients and the Midwest for Black patients.</p> Conclusions <p>This study may help guide the identification of areas to target interventions to improve treatment rates and confirm prior findings of geographic and racial variations of OAC use in NVAF.</p>