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Antihypertensives, Antidepressants, Antihyperlipidemics Top 2001 Drug Use

Kate Traynor

Americans filled an average of 10.6 prescriptions per person last year, an increase of 6.3 percent compared with 2000, according to the Express Scripts 2001 Drug Trend Report.

Most-used drugs. Using data from 3 million covered health plan members, the Missouri-based pharmacy benefits manager (PBM) reported that antihypertensive agents were the most widely used drugs last year, followed by antidepressants and antilipemics.

Overall use of antilipemics grew by 16 percent in one year, fueled by a 15-percent increase in the number of people taking this class of products. The report credited the increased use of antilipemics to last year's revision of the American Heart Association and American College of Cardiology guidelines (PDF) for the secondary prevention of myocardial infarction, which urges greater use of antilipemic drugs.

In the weeks and months following the Sept. 11 terrorist attacks, there was a "rapid escalation in the numbers of prescriptions filled for antianxiety medications." According to the report, last year's 3-percent increase in the use of these products was not limited to the Washington and New York City areas, but occurred throughout the United States.

Use of generics. The report noted that the drug industry is "in the middle of the largest patent expiration cycle in its history," which may ultimately increase the use of generic versions of patented products.

Less than a month after the introduction of a generic version of Prozac, Eli Lilly & Co.'s fluoxetine product, 81 percent of Express Scripts's mail-order prescriptions for the brand-name antidepressant had been converted to the generic fluoxetine product. Among antihypertensive drugs, the report said, more than 75 percent of prescriptions for enalapril, doxazosin, and terazosin were filled with generic products last year. The expected introduction later this year of a generic version of AstraZeneca L.P.'s omeprazole product, Prilosec, may likewise prompt switches to generic omeprazole.

Another widely prescribed drug that may soon face generic competition is Schering Plough Corp.'s loratidine product, Claritin. But the issue of generic displacement of the brand-name antihistamine is complicated by Schering's recent decision to seek approval of a nonprescription version of the product. The report noted that if the Food and Drug Administration (FDA) approves Schering's application to market nonprescription Claritin before the drug's patent expires in December, the agency cannot allow the marketing of identical prescription versions of the drug, whether generic or branded.

An FDA advisory committee recently recommended that the agency allow Procter & Gamble to market a nonprescription 20-mg omeprazole tablet. But the advisory committee asked that the product be approved for a narrower indication than the prescription drug, a factor that could limit use of the product. According to Andrx Corp., which has received FDA approval to market a generic version of Prilosec, the nonprescription tablet's formulation is not a true substitute for enteric-coated Prilosec or the Andrx AB-rated equivalent of the product.

Public perceptions. Included in the report is data from a survey of 1,145 adults who received health insurance coverage through an employer or a union last year.

Some 40 percent of the survey respondents said they were confused by information available to them on health and related issues. Half of those surveyed said they rely most heavily on a pharmacist for drug information, and 62 percent said they obtain drug information from a physician.

Ninety-eight percent of survey respondents said their health insurance coverage included a prescription-drug benefit, and 97 percent said that benefit was at least somewhat important to them. But when asked to allocate a hypothetical $100 among medical benefits, pension benefits, paid leave, and pharmacy benefits, the respondents allotted the least amount overall to the pharmacy benefits. Respondents who were between 55 and 64 years old allocated more money toward pharmacy services than to paid leave.

Ninety-five percent of those surveyed said consumers should pay a portion of their prescription costs. On average, the respondents said consumers should be responsible for about 21 percent of the cost of a prescription.