US spending on prescription drugs rose by 19% in 2000

Fred Charatan / British Medical Journal 19may01

Florida - Americans spent $132bn (£94bn) on prescription drugs last year, an increase of $20.8bn (18.8%) over 1999. Spending on prescription drugs in the United Kingdom in 2000 was £7bn.

A study by the National Institute for Health Care Management Foundation, a non-profit making, independent group that conducts research on healthcare issues, found that the increase in spending "was attributable in large measure to the rising volume of prescriptions for the top-selling drugs." Researchers at the institute have previously shown that more aggressive marketing by drug companies is contributing to the growth (BMJ 2000;321:783).

The top sellers included the arthritis drug rofecoxib (Vioxx; Merck), the arthritis drug celecoxib (Celebrex; Pharmacia Pfizer), the antiulcer drug lansoprazole (Prevacid; TAP Pharmaceuticals), the cholesterol reducer atorvastatin (Lipitor; Pfizer), and the antidiabetic drug metformin hydrochloride (Glucophage; Bristol-Myers Squibb). The increase in sales of these five drugs alone accounted for a fifth of the entire increase in sales of prescription drugs last year, the study said.

It found that three main factors accounted for the overall rise in spending -- an increase in the number of prescriptions written by doctors (accounting for 42%), a shift towards the use of more expensive drugs (36%), and price increases (22%).

The rapid growth in spending on prescription drugs has pushed up health insurance premiums for individuals and families, has contributed to increases in the cost of health benefits provided by employers, and has driven up the cost of Medicaid, the joint federal and state programme for people on low incomes.

It has sharpened the political debate on new prescription drug benefits for Medicare patients (those aged over 65). President Bush has proposed spending $153bn on drug benefits and unspecified Medicare reforms over the next 10 years. Democrats say that the sum is totally inadequate.

Alan Holmer, president of the Pharmaceutical Research and Manufacturers of America, the main trade association for the drug companies, said, "This report should be hailed as good news" because it means that "more patients are getting more and better medicines." He said that the report confirmed what many patients had discovered for themselves -- that "prescription medicines are the best value in health care today, allowing patients to stay out of the hospital, off the surgery table, on the job, and in the home."

The study can be accessed at www.nihcm.org