Recent Prescription Drug Spending Trends

Spending on prescription drugs has risen, and is projected to continue to rise more rapidly than overall health care spending. According to the U.S. Department of Health and Human Services1, several factors contributing to THE increase from 2010-2014 can be roughly allocated in these proportions: 10 percent due to population growth; 30 percent due to an increase in prescriptions per person; 30 percent due either to changes in prescribed trends skewing towards higher priced products, or drug price increases that pushed average price increases to exceed general inflation; and 30 percent to overall, economy-wide inflation. Through the All Payer Claims Database (APCD), Virginia has its own source for prescription drug volume.  The chart below shows the top 20 prescription medications by volume. In Virginia, commonly prescribed drugs are generics. The types of drugs most commonly  prescribed are those for high cholesterol and triglycerides (atorvastin and simvastatin), thyroid replacement (levontyroxine sodium), hypertension (lisinopril, amlopidine besylate, hydrochlorthizide), type 2 diabetes/weight loss (metformin), allergies (montelukast sodium, fluticasone propionate, prednisone, alprazolam), pain (hydrocodone, oxycodone/acetaminophen, gabapentin), attention deficit disorder (amphetamine/dextroamphetamine) osteoporosis prevention (vitamin D), mild depression and anxiety (sertraline HCL), and gastroesophageal reflux disease or GERD (omeprazole). The presence of opioids – Vicodin (third) and Percocet (seventeenth) – on the list illustrate how readily available opioids are in Virginia through legitimate sources. The Virginia list shows little variance from a similar list derived from 2014 national data. In that list2, thyroid hormone ranks first, while drugs for hyperlipidemia and GERD round out the top three. Opioids did not crack the top 20 based on the national data. The full list is below:

  • Levothyroxine sodium (Synthroid)- replacement thyroid hormone
  • Rosuvastatin calcium (Crestor) – treats hyperlipidema
  • Esomeprazole (Nexium)- treats GERD
  • Abuterol sulfate inhalation aerosol (Ventiolin HFA)- used for asthma management
  • Salmeterol (Advair Diskus) used for asthma
  • Valsartan (Diovan) – treats hypertension
  • Insulin (Lantus Solostar) (insulin)- used to treat diabetes
  • Duloxetine (Cymbalta)-prescribed for depression or nerve pain
  • Lisdexamfetamine (Vyvanse) ADHD and binge eating disorder
  • Pregabalin (Lyrica) Nerve pain associated with diabetes or other chronic condition
  • Tiotropium (Spiriva Handihaler) -COPD
  • Insulin glargine (Lantus)- prescribed for diabetes
  • Celecoxib (Celebrex)-nonsteroidal anti-inflammatory for chronic pain
  • Aripiprazole (Abilify)- treats bipolar disorder depression
  • Sitagliptin (Januvia)- treats Type 2 diabetes
  • Memantine (Nameda)- treats dementia associated with Alzheimer’s disease
  • Sildenafil (Viagra)- treats erectile dysfunction
  • Tadalafil (Cialis)-  treats erectile dysfunction and enlarged prostate
  • Ezetimibe (Zetia)- prescribed for hyperlipidema
  • Mometasone furoate monohydrate (Nasonex)- treats nasal allergies

So why do the lists differ? The variations are likely due to the nature of Virginia’s APCD. The population reflected in APCD data is largely employed and younger than 65. Many receive health insurance coverage as an employee benefit. As an employed population, those people are likely to have fewer illnesses or conditions that interfere with everyday life. But that younger group experiences acute conditions (infections and traumatic injuries) and early stage chronic disease (hypertension and diabetes) that need to be managed. (6/17)

1 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Issue Brief: Observations on Trends in Prescription Drug Spending. March 8, 2016

2 Top 100 Most Prescribed, Top Selling Drugs. August 1, 2014.

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