Investor Information

New State-by-State Data Correlates Increase with Rising State Obesity Rates

ST. LOUIS--(BUSINESS WIRE)--Feb. 13, 2008--More U.S. adults are taking prescription drugs than ever before, fueling $12 billion in additional spending during 2006 alone. The number of people with at least one prescription increased from 67% to 74% between 2000 and 2006, according to a new Geographic Variation in Prescription Utilization study by pharmacy benefit manager Express Scripts. The number of prescriptions per person rose to 14.3 from 10.8 in 2000 - a 32 percent jump.

The study correlates the climb in increased spending for antidiabetic and antihypertensive prescription drugs with rising obesity rates. The top five states (West Virginia, Kentucky, Alabama, Mississippi, Louisiana and Arkansas) in the study's ranking of per capita spending increases for drug classes linked to obesity were also the states with the top five obesity rates, according to the U.S. Centers for Disease Control and Prevention.

"The $12 billion in additional spending in 2006 would have been much greater had the nation not increased its use of lower cost generic drugs from 40% to 58% over the intervening years," explains Emily Cox, senior director of research for Express Scripts. "In fact, greater use of generic drugs still has significant potential for managing prescription drug costs. The key will be using an advanced understanding of the consumer to get more people to choose generics."

Conducted within the commercially insured market, the study evaluated overall prescription drug use, analyzing commonly prescribed therapy classes to highlight national and state-by-state trends. Medications from four of the seven therapy classes evaluated are frequently used to treat conditions associated with obesity and related chronic conditions such as high cholesterol, diabetes and high blood pressure. These four therapy classes include antihyperlipidemics, antidiabetics, antihypertensives and gastrointestinal (GI) medications. Also studied were analgesics/anti-inflammatories, antidepressants and estrogen.

The state-by-state analysis found that overall usage and rates of increase varied significantly across geographic regions with the South experiencing the highest utilization and greatest increase in use.

For therapy classes with important safety warnings during the study period - such as estrogen therapy and analgesics/anti-inflammatories (COX-2s) - regional variations in utilization become even more pronounced.

Study Highlights by Therapy Class

Following are overall and state-by-state highlights of study findings:

• The percentage of people with at least one antihyperlipidemic prescription more than doubled in every state examined except for Nebraska, Kentucky, Maine and Utah. Medical guideline changes that lowered the LDL cholesterol levels considered for drug treatments likely drove this dramatic increase. Southern and lower Midwestern regions of the country had the highest rate of use and also some of the greatest increases in the percentage of people with at least one prescription.
• The percentage of people with at least one antidiabetic or antihypertensive prescription and the number of prescriptions per covered individual for both therapy classes increased by more than 75% each with the greatest increases demonstrated in Southern states (Mississippi, Alabama, Georgia and Louisiana). The lowest prevalence was seen in Northeastern (Massachusetts, Maine and New Hampshire) and Western states (Colorado, California and Oregon), respectively.
• Although the percentage of people with at least one GI medication grew at a modest rate of 20%, the number of prescriptions per covered individual rose by 34%. These results suggest that those on medications were more compliant or remained on therapy for longer periods of time. West Virginia, Kentucky, Mississippi and Tennessee topped the prevalence list in this class in both 2000 and 2006.
• The percentage of people with at least one antidepressant rose by nearly 33%, while the number of prescriptions per covered individual grew by 51%. Unlike other therapy classes, no clear pattern of geographic variation was observed. Utah continued as the state with the highest prevalence, followed by Kentucky and Maine.
• Analgesics/anti-inflammatory medication state variations grew for the percentage of people with at least one prescription despite drug recalls in this category. Some states, such as Maine, New Hampshire, Wisconsin, Connecticut and Kansas, saw decreases of over two percentage points, while other states Arizona, Tennessee, Alabama, Florida and West Virginia saw increases of up to two percentage points.
• Overall, the number of people with at least one estrogen prescription dropped by over half, with the impact by state varying considerably. Regional variation increased by over 73% resulting in a five-fold difference in the number of prescriptions per covered individual between New York (1.16) and Louisiana (6.32). The highest rate of use continued to be in Southern and lower Midwestern states (Louisiana, Oklahoma, Kansas, Arkansas and Alabama), while the lowest rate occurred in the Northeast (Pennsylvania, New Hampshire, Massachusetts, New Jersey and New York).

"Significant market forces directly impacting prescription drug usage have occurred over the last five years," explains Cox. "The increases are tied to rising rates of illness and changes in treatment guidelines. However, increases in screening and physicians more likely to choose drug treatment over non-drug treatment (diet and exercise) could also lead to increased use. At the same time, decreases can be tied to high-profile recalls and medical studies questioning the safety of medications for hormone replacement therapy and pain-relievers."

About the Study

The study was an analysis of a random sample of 2.2 million patients in 2000 and three million patients in 2006 enrolled in a commercial (e.g. no Medicare or Medicaid) plan in 2000 and 2006. Express Scripts was the first organization to track and analyze geographic variations in prescription drug use to better understand regional and state-by-state differences in utilization.

The complete study with state by state tables is available at: http://www.express-scripts.com/ourcompany/news/outcomesresearch/ onlinepublications/ (Due to its length, this URL may need to be copied/pasted into your Internet browser's address field. Remove the extra space if one exists.)

About Express Scripts

Express Scripts, Inc. (Nasdaq: ESRX) is one of the largest pharmacy benefit management (PBM) companies in North America, providing PBM services to more than 50 million patients through facilities in 13 states and Canada. Express Scripts serves thousands of client groups, including managed-care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at http://www.express-scripts.com.

CONTACT: Express Scripts, Inc.
Rita Holmes-Bobo, 314-996-0952
rholmesbobo@express-scripts.com

SOURCE: Express Scripts, Inc.