ST. LOUIS, MO, Special -- Spending on prescription drugs increased a record 17.4 percent last year, with senior citizens 70 years or older seeing the biggest cost increases per prescription. Higher prescription costs and greater drug utilization drove the spending increase, which was less forplan sponsors that actively managed their pharmacy benefits

These are among the findings included in the 1999 Drug Trend Report, released by Express Scripts Inc. at its annual Outcomes Conference.

The company is the nation’s largest independent pharmacy benefit manager, serving more than 38 million Americans

According to the report, the average cost of a prescription rose 9.6percentin 1999, reflecting the effect of higher prices and other factors.* Greater prescription drug utilization and, to a lesser extent, new drugs were responsible for the remainder of the spending increase. The result was a per-member-per-year (PMPY) average wholesale price (AWP) ingredient costof$387.09 in 1999, up from $329.83 in 1998 (AWP does not reflect retail network discounts, mail discounts, dispensing fees and member contributions).Analysis of a sample of the Express Scripts drug trend database showed the average cost of a prescription rising most rapidly for seniors 70 and above - by 14.0 percent in the 70 to 79-year bracket and by 16.4 percent forthose 80 and above.

At the Express Scripts Outcomes Conference, researchers reported on a study of prescription utilization patterns among seniors. Included in the study were more than 52,000 continuously enrolled seniors covered under commercia lplans and over 20,000 enrollees of a Medicare + Choice plan.

The Medicare +Choice plan portion of this study was funded by the Robert Wood Johnson Foundation’s Changes in Health Care Organization and Financing Program. Plan participants aged 65 or older enrolled in commercial health plans used an average of 29 prescriptions per year, more than four times theaverageseven prescriptions per year consumed by those younger than 65.

The per-member-per-year cost difference between the two age groups was even greater: $1,185 vs. $267.Also reported were findings, some of the first using pharmacy claims data ,on how seniors responded to caps placed on their pharmacy benefit. Researchers found that, compared to seniors who did not exceed their prescription caps, seniors who had exceeded their plan’s spending cap were significantly more likely to have stopped taking medicines across the 11therapy categories most utilized by seniors. These categories were predominantly represented by therapies used to treat chronic conditions such as cardiovascular disease, diabetes, and hypothyroidism. The risk of discontinuation was greatest among therapy categories used to treat cardiovascular disease, such as calcium channel blockers, antihyperlipidemics, and beta-blockers. Additionally, researchers found that, for a majority of therapy classes, less than half of those who stopped therapy resumed therapy once the benefit became available again the following year

."Because seniors depend so heavily on prescription drugs, bear some of the highest costs and have such complex utilization patterns, providing them with prescription drug coverage is one of the biggest challenges currently on the pharmacy landscape," said Barrett Toan, chief executive officer of Express Scripts.

"Express Scripts believes there should be a prescription benefit for seniors, either through Medicare or some other initiative, but it should be understandable and simple to administer, and it should encourage cost-effective behavior by the beneficiary," he added. Release of the Express Scripts 1999 Drug Trend Report and the senior prescription utilization study findings came during the company’s annual Outcomes Conference, where more than 700 employer, managed care, medical and pharmacy benefit participants are reviewing the latest developments in the pharmaceutical landscape.