Utilization of Medicines Decreased in 2011

Compared with a year earlier, spending on medicines in the United States increased by 0.5% in 2011 to $320 billion. However, the overall per capita utilization of medicines and the per capita retail prescription usage declined last year. Meanwhile, there were 34 new molecular entities launched in 2011, the most in 10 years and 10 more than were launched in 2010. The new therapies were for several disease classes, including cancer, multiple sclerosis, hepatitis C, and cardiovascular conditions. The results, detailed in The Use of Medicines in the United States: Review of 2011 from the IMS Institute for Healthcare Informatics, also indicated that the weak economy continued to have an impact on people’s healthcare utilization. Total office visits and nonemergency department hospital visits declined in 2011 by 4.7% and 0.1%, respectively, but emergency department admissions increased 7.4% as patients lost health insurance or delayed visits to doctors until their conditions worsened. Michael Kleinrock, director of research development at the institute, said that the most anticipated event in healthcare heading into 2011 was the expiration of Lipitor® (atorvastatin) in November. Still, he said the expiration of the top-selling drug in the United States “was far from the defining moment of the year” in the industry. “The year was characterized by the continuation of several trends, the most impactful being the continued weak economy and its impact on patients’ healthcare choices,” Mr. Kleinrock said during a webcast in early April. “But we did see important transformations in the healthcare system that really will be harbingers of future change as we watch the next few years—transformative new medicines in an array of new therapy areas, indicating the [research and development] pipeline is alive and well and perhaps will be able to deliver those breakthrough therapies that we all want and hope for. We also saw important changes in usage, again perhaps linked to the economy and to the ever-rising healthcare costs that patients are experiencing.” The report also found that the Patient Protection and Affordable Care Act (ACA) has had an impact. Most notably, people between 19 and 25 years of age had a 2.0% increase in the number of medicines used per person, which coincided with the provision in the ACA that children can remain on their parents’ health insurance plans until they turn 26. All other age categories had a decline in medication use, and the overall use of medicines per person fell 1.1%. The largest drop occurred in the ≥65 years of age category, which had a decline of 3.1% after a decline of 2.7% in 2010. In prior years, seniors’ use of medicines increased by an average of 4%, according to the report’s authors. The decline occurred although total out-of-pocket spending for Medicare Part D decreased from $11.5 billion in 2010 to $9.7 billion in 2011 and the average copayment for Medicare Part D fell from $25.97 in 2011 to $23.31 in 2010. Mr. Kleinrock said as the population ages, seniors may be becoming healthier and may be using fewer medications than they did in the past. However, he said the biggest decline in medication usage in 2011 was for hypertension medications, which are most commonly used by seniors. He suggested seniors may be worried about their financial situations and may be more hesitant to fill their prescriptions. Although generics accounted for 80% of prescriptions in 2011, Mr. Kleinrock was encouraged by several drugs launched last year and said there were “a number of transformative breakthroughs.” The 34 drugs could be appropriate for 2.5 million newly diagnosed people each year plus 20 million people who already have the diseases, according to IMS. Mr. Kleinrock described Incivek® (telaprevir) and Victrelis™ (boceprevir) as 2 of the most important recent developments in the industry. Both are protease inhibitors to treat patients with hepatitis C.