Express Scripts Finds Prescription Drug Use Varies Widely Across United States, to Unveil ‘Five-Tier’ Prescription Plan

"Wide variations" exist from state to state in the use of prescription drugs, especially antidepressants and estrogen-therapy drugs, according to a new study from Express Scripts Inc. The Wall Street Journal reports that the St. Louis-based pharmacy benefits manager conducted a random study of 1.3 million people ages 18-64 covered in its health plans. It also conducted a separate analysis of 147,000 children and their drug use (Burton, Wall Street Journal, 6/19). Following are some of the results of the study:

• New York, California, Massachusetts and Colorado residents were prescribed the fewest prescriptions, an average of 7.7 a year, while Kentucky, West Virginia and Ohio residents were prescribed the most, at 11 per year.
• Children in Louisiana, South Carolina and Alabama were "more likely" to be prescribed attention deficit disorder drugs than children in California, Colorado and Nevada (Appleby, USA Today, 6/19). The rate of such prescriptions in Louisiana was 6.5% of all children ages five to 14, while Colorado, the state with the lowest usage of ADHD drugs, had a rate just under 2%.
• Overall antidepressant use was highest in Utah, Maine, Oregon, Washington state and Kentucky, while New Jersey, New York, California and Florida had "low" rates.
• The use of estrogen-replacement drugs by women to combat osteoporosis, Alzheimer's and certain cancers was highest in Arkansas, Oklahoma, Louisiana and Idaho, while New Jersey, New York and Massachusetts women took these drugs at half the rate of the highest states.
• Overall prescription drug spending among Express Scripts members increased 16.9% in 2000, down from the previous year's increase of 17.4%.

Lacking 'Obvious Explanation'
The Journal reports that some of the variations in drug use "are explainable by true health conditions, such as high use of cardiovascular drugs in states with lots of heart disease and obesity, possibly because of smoking, diet and other lifestyle factors" (Wall Street Journal, 6/19). For example, Express Scripts researcher Brenda Motheral said that the number of prescriptions written for heart disease drugs was higher in southern states, where the risk factors for heart disease are greater (USA Today, 6/19). However, other regional discrepancies, including those seen for antidepressants and estrogen-replacement drugs, do not appear to have an "obvious explanation" (Wall Street Journal, 6/19). USA Today reports that the study shows that "well-established" prescription treatments, such as those for diabetes or epilepsy, are more uniform across the country than are "controversial or less well-established" treatments, including estrogen therapy (USA Today, 6/19). The Boston Herald reports that states with the lowest number of drugs prescribed have "high levels" of managed care participation. "There are certainly disincentives on physicians (in HMOs) to being expensive with their care," Dr. Manuel Lowenhaupt, a principal at Deloitte Consulting, said (Powell, Boston Herald, 6/19). Dr. Terry Sullivan, chief medical officer of PacifiCare of Colorado, the state with the second-lowest rate of prescription drug use, noted that 75% to 80% of Coloradans are in managed care plans, a rate that is "one of the highest ... in the country" (Perrault, Denver Rocky Mountain News, 6/19). Click here for the Express Scripts study and additional information. Please note: this link is available to Web readers only.

Five-Tier Rx Plan
In related news, Express Scripts plans to unveil on June 19 a "five-tier" prescription benefits plan for employers that could have patients paying less for generic drugs and more for brand-name drugs, particularly allergy medications. Under the plan, consumers would pay a $3 co-pay for "older" generic medications, "some first-generation antidepressants," beta blockers for heart disease, and diuretics for high blood pressure; $10-$15 for "more expensive generic drugs, such as calcium channel blockers for heart disease"; $20 for preferred brand-name drugs; $35 for non-preferred brand-name drugs; and $50 for drugs that provide "symptomatic" relief, including the allergy drugs Claritin and Allegra. The plan's intent is to encourage customers to switch to lower-cost generic drugs. Many employers already use three-tier plans, and some other benefit management firms call Express Scripts' new "five-tier" proposal "too complicated" and say that it would not be well-received by workers. "The greatest dissatisfaction among employees that we hear about is the switch to three-tier drug plans," Ken Sperling of Hewitt Associates said, adding, "The only thing they know is that the drug they've been taking for three years costs them $35 instead of $10" (Appleby, USA Today, 6/19).