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Cost of prescription drugs up more than 24.8% since 1996 (Brandeis study): What can we learn?
Volume X, Issue 6
Harold J. DeMonaco, M.S. Director of Drug Therapy Management

The Brandeis University Schneider Institute for Health Policy Research recently released the results of a study conducted along with PCS Health Systems, Inc. examining the cost escalation of prescription drugs. The study was conducted using the prescription claims data of PCS from 1996 through 1999. Here is what they found:

Prescription drug costs increased at an annual rate of 24.8% per year from 1996-1999.
Based on a fixed population (as in a capitated practice model), prescription drug costs increased at an annual rate of 28.8%.
Drugs introduced after 1996 account for about one third of the increase in costs from 1996-1999.
The proportion of patients with prescription drug costs >$2,000 annually has grown four fold, from 1.3% to 5.3% of the population.

Here are the factors and their contribution to the cost escalations according to the study:

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The data demonstrate that more patients are taking more expensive prescription drugs for longer periods of time. Inflation is not a major factor in the cost escalation. Utilization growth is the major driver of cost increases. The 45-64 year old age group is the fastest growing segment of "new users" of prescription drugs, increasing by 7%. Patients over the age of 65 years comprise the group with the fastest rising number of prescriptions from 16 prescriptions per year in 1996 to 23 by 1999.

Here is a list of the drug categories constituting the growth areas:

Gastrointestinal medications (26% annual increase in expenditures)
Anti-arthritics (33% annual increase in expenditures)
Cardiovascular (38% annual increase in expenditures)

As noted in previous editions of Drug Therapy, the elderly are especially hard hit, especially those on fixed incomes.

Here are a few suggestions which should be applicable for all patients:

Prescribe generic members of a class of drugs whenever possible. For example, prescribe naproxen sodium or ibuprofen rather than Daypro.

When prescribing SSRI antidepressants, think about using Celexa (citalopram) as a first-line drug. The majority of patients are managed with about 20mg daily. Celexa is about 25% less expensive than Prozac (fluoxetine). Regardless of which drug is chosen, make certain that you give the drug an adequate trial. See the 3/1/99 edition of Drug Therapy or visit the AHCPR website for additional details. (http://www.ahcpr.gov/clinic/)

Topical nasal corticosteroids are the most effective and least costly way to manage patients with allergic rhinitis who cannot tolerate first-generation antihistamines like Chlor-Trimeton. Second-generation antihistamines such as Allegra and Claritin should only be used as third-line drugs for patients with nasal symptoms. See the 4/1/98 edition of Drug Therapy for additional details

Lipitor (atorvastatin) is the most effective of the HMG-CoA reductase inhibitors and, when based on LDL lowering, is the most cost-effective member of the class. See the 1/1/2000 edition of Drug Therapy for additional details.

Patients should not receive more than 3 months of therapy with Prilosec (omeprazole) or any other antiacid therapy unless a definitive endoscopic diagnosis has been made or that Helicobacter pylori serologic testing has been done. See the 11/1/1998 edition of Drug Therapy for additional details.

Editor’s Note: Special thanks to James Mongan, M.D. for forwarding a copy of the Brandeis study.