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.