Increases In Drug
Prescription Rates
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Tuesday, July 9, 2002
For More Information Contact:
Janet Firshein, 301-652-1558 or
Jon Gardner, Health Affairs, 301-656-7401, ext. 230



Increased Prescribing Linked To More Older Patients, More Multiple Conditions, New Drug Choices, Medical Payment And Delivery Systems, And Direct Marketing To Consumers

Washington, D.C. – At a time when Congress is struggling to create a viable prescription drug benefit and consumers are increasingly worried about drug costs, a new study shows that physicians are prescribing medications to their patients at a far greater rate than they did just two decades ago. In fact, the prescription rate rose 34 percent between 1985 and 1999, from 109 to 146 prescriptions per 100 visits, according to a federal study released today in the journal Health Affairs.

The increase in drug mentions (including prescription drugs, over-the-counter preparations and immunizations) cuts across all age groups and all physician specialties except general surgeons, cardiologists, and dermatologists. The study reveals that the largest increase was found for psychiatrists, whose drug mention rate jumped from 82 to 178 drugs per 100 visits. This is largely attributable to an increased use of antidepressants - at least eight new antidepressant drugs have been introduced since 1987.

"The study data show that there are a number of reasons why prescription rates are soaring," said study author Catharine Burt of the Centers for Disease Control and Prevention. According to the study, if the current drug increase rate continues, drug spending will likely double in the next five years, despite patent expirations for many popular brand name drugs.

Increases in patient age and number of medical conditions by patients seeking care account for about two-thirds of the observed increases in drug prescribing practices. The study data show that from 1985 to 1999, the proportion of visits by patients who were 45 years of age or older increased by one quarter and visits by patients with at least three diagnoses more than doubled.

Changes in drug coverage, drug research and development, faster Food and Drug Administration approval, and increased drug marketing to physicians and consumers are additionally cited as likely contributors to increased use of medications in ambulatory care. The study also shows that physicians were 43 percent more likely to prescribe multiple drugs per patient visit in 1999 than in 1985, after controlling for differences in patient and condition mix in those two time periods.

The study pulls data from the National Ambulatory Medical Care Survey (NAMCS), which has collected patient encounter data periodically since 1973, and annually since 1989. NAMCS is a sample survey of 2,500 to 4,500 office-based physicians conducted by the CDC's National Center for Health Statistics. For this study, Burt analyzed 288,941 patient encounter records.

Increases in medications prescribed were found for all major therapeutic classes, except antimicrobial agents such as penicillins and tretracycline. The prescription rate for this class of drugs actually dropped 12 percent in the study period.

But six areas accounted for 80 percent of the increase in the overall drug mention rate: central nervous system drugs, hormones, respiratory drugs, pain relief drugs, metabolic/nutrients, and cardiovascular-renal drugs. Specifically, the top classes accounting for most of the increase in the overall drug prescription rate at physician office visits were:

• Antidepressants
• Hyperlipidemia drugs
• ACE inhibitors
• Antihistamines
• Calcium channel blockers
• Acid/peptic disorders
• Blood glucose regulators
• Vaccines
• Estrogens

For seniors, the largest increase was found for hematologic agents with a 187 percent jump from 1985 to 1999 from 1.9 mentions to 5.5 mentions per 100 visits. The largest increase for patients ages 45-64, was 109 percent for metabolics, which includes lipid-lowering drugs such as Lipitor. For children, the largest increase was for central nervous system drugs, with the prescription rate rising a whopping 327 percent between 1985 and 1999. According to the study, one of the most frequently mentioned drugs at children's visits in 1999 was Ritalin for treating attention deficit hyperactivity disorder.

"Some might assume that the likely driver of such an increase in prescriptions is an aging population, but our study shows that only about 20 percent of the observed increases can be attributed to this," said Burt. "Other factors – more patients with multiple conditions, new drugs for chronic conditions, increased health insurance and prescription drug coverage, increased focus on managed care including the use of treatment guidelines, and direct-to-consumer advertising – appear to play a role."

New Drugs. FDA approvals for new drugs have doubled since the early 1980s, from an average of about 19 per year to 38 per year in the 1990s. Also, the length of time for approval of new drugs has declined from about 33 months in 1986 to 12 months in 1998. The newer drugs offer doctors more choices in finding medications that best meet the needs of patients, including those with the fewest side effects.

Drug Coverage and Managed Care. Payment sources for physician office visits have changed tremendously since 1985. The NAMCS data show that in 1985, 35 percent of visits were paid for by the patient, in contrast to only 5 percent in 1999. The share of visits paid for by Medicare rose 40 percent and by private insurance or HMO coverage, almost 200 percent. At the same time, the percentage of insured workers with drug coverage rose from 91 percent in 1988 to 99 percent in 1999. In addition, more than half of all Medicare recipients now have some kind of drug coverage from supplemental plans.

Managed care has also likely led to increased use of treatment guidelines, many of which include medication use. For example, treatment guidelines for hypertension include multiple drug regimens in many cases. The same is true for an increased emphasis on pain relief medications.

Direct-to-Consumer Advertising (DTC). Direct mass-media marketing, approved since 1997, is linked to a sharp rise in the number of prescriptions written and overall spending on prescription drugs. The study cites research that shows that doctors wrote 34 percent more prescriptions in 1999 than in 1998 for the 25 direct-to-consumer promoted drugs that contributed most to overall drug spending. They wrote only 5 percent more prescriptions for all other prescription drugs. For example, Pfizer increased DTC advertising for Lipitor six fold between 1998 and 1999 and saw prescriptions increase by 50 percent.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the July/August 2002 issue will be provided free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs, 301-656-7401, ext. 230, or via email, Selected articles from the July/August issue are available free on the journal's Web site,


©2002 Project HOPE–The People-to-People Health Foundation, Inc.


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