Trends and current drug utilization patterns of Medicaid beneficiaries

Health Care Financing Review, Spring, 2006 by Terry R. Lied, Julio Gonzalez, Wendy Taparanskas, Tejas Shukla

Table 1 Medicaid Drug Reimbursements and Utilization: Calendar
Years 1994-2003

Year     Number of         Amount          Mean          Number of
       Prescriptions     Reimbursed    Reimbursement     Enrollees
       (In Millions)   (In Billions)     (Dollars)     (In Millions)

1994      332.9            $8.435          25.34           40.5
1995      330.1             8.994          27.25           41.4
1996      340.1            10.606          31.18           41.2
1997      340.5            11.575          33.99           41.6
1998      350.2            13.587          38.80           41.4
1999      368.1            16.177          43.95           44.3
2000      404.8            19.989          49.38           44.3
2001      476.7            25.351          53.18           47.2
2002      520.7            29.639          56.92           51.0
2003      573.1            34.298          59.85           53.6

Year        Mean
       Prescriptions
       (Per Enrollee)

1994       8.2
1995       8.0
1996       8.3
1997       8.2
1998       8.5
1999       8.3
2000       9.1
2001      10.1
2002      10.2
2003      10.7

NOTE: Reimbursements are not net of rebates and average about 20
percent.

SOURCES: Centers for Medicare & Medicaid Services: Data from the
Medicaid Drug Rebate Program, State Drug Utilization Files, 1994-2003
and projected figures for 2002-2003 from the Office of the Actuary.

Table 2
Mean Prescription Reimbursements, Medical Consumer Price Index (MCPI),
and Constant 2003 Dollars: Calendar Years 1994-2003

                       Percent Change        Mean Prescription
                      Mean Prescription        Reimbursement
Year   MCPI    MCPI     Reimbursement    (In Constant 2003 Dollars)

1994   211.0   4.55         6.51                  35.68
1995   220.5   4.31         7.01                  36.72
1996   228.2   3.37        12.63                  40.61
1997   234.6   2.73         8.26                  43.06
1998   242.1   3.10        12.37                  47.61
1999   250.6   3.39        11.72                  52.11
2000   260.8   3.91        10.98                  56.24
2001   272.8   4.40         7.16                  57.92
2002   285.6   4.48         6.55                  59.20
2003   297.1   3.87         4.91                  59.85

NOTE: Reimbursements are not net of rebates which average approximately
20 percent.

SOURCES: Centers for Medicare & Medicaid Services: Data from the
Medicaid Medicaid Drug Rebate Program, State Drug Utilization Files,
1994-2003; U.S. Department of Labor Statistics, Bureau of Labor
Statistics, Consumer Price Index, various releases. Data from the MCPI
base year 1982-1984.

Table 3 Top 40 Drugs (In Payments) Versus All Other Drugs: Calendar
Years 1994-2003

                        Top 40 Drugs

            Prescriptions           Reimbursement
          Number     Percent      Total      Percent
Year   In Millions    Total    In Billions    Total    Mean

1994      65.1         20         $2.90        34       45
1995      63.2         19          3.26        36       52
1996      57.1         17          3.72        35       65
1997      59.9         18          4.30        37       72
1998      61.2         17          5.13        38       84
1999      67.6         18          6.57        41       97
2000      81.6         20          8.80        44      108
2001      99.2         21         11.21        44      113
2002     107.9         21         13.04        44      121
2003     113.3         20         14.86        43      131

                        All Other Drugs

                          Reimbursement
       Prescriptions      Total
Year    In Millions    In Billions   Mean

1994      267.8           5.54        21
1995      266.9           5.73        21
1996      283.0           6.89        24
1997      280.6           7.28        26
1998      289.0           8.46        29
1999      300.5           9.61        32
2000      323.2          11.19        35
2001      377.5          14.14        37
2002      412.8          16.60        40
2003      459.8          19.44        42

NOTES: The top 40 drugs were different for each year and were based on
the top reimbursement amounts for each year. Reimbursement not net of
rebates which average approximately 20 percent.

SOURCES: Centers for Medicare & Medicaid Services: Data from the
Medicaid Drug Rebate Program, State Drug Utilization Data Files,
1994-2003.

Table 4
Medicaid Prescriptions, Reimbursements, and Mean Reimbursements, by
Drug Group: Calendar Year 2003

                                 Prescriptions

                                           Percent   Reimbursements
                                            Total
Group                           Number     Number        Amount

Central Nervous System        81,693,758    14.3     $7,302,883,398
 Drugs
Cardiovascular Agents        102,503,877    17.9      4,128,003,330
Anti-Infective Agents         46,509,187     8.1      3,403,663,558
Analgesics and Anesthetics    62,775,245    11.0      2,853,284,118
Respiratory Agents            60,786,865    10.6      2,837,901,907
Endocrine and Metabolic       54,556,435     9.5      2,778,079,944
 Drugs
Gastrointestinal Agents       38,926,954     6.8      2,712,783,203
Neuromuscular Drugs           33,125,583     5.8      2,427,417,306
Hematological Agents          15,938,287     2.8      1,706,717,130
Topical Products              31,933,433     5.6      1,237,125,236
Miscellanous                   3,305,209     0.6        561,514,396
 Psychotherapeutic and
 Neurological Agents
Stimulants/Anti-Obesity/       6,709,833     1.2        520,613,909
 Anorexiants
Genitourinary Products         8,045,177     1.4        466,983,390
Antineoplastic Agents          1,982,937     0.3        428,876,536
Biologicals                      243,546     0.0        320,850,341
Nutritional Products          18,096,550     3.2        245,085,656
Miscellaneous Products         1,374,319     0.2        239,355,331
Other / Unknown                4,563,315     0.8        127,164,366
Total                        573,070,510   100.0     34,298,303,061

                                Reimbursements

                                        Percent Total
Group                           Mean    Reimbursement

Central Nervous System         $89.39       21.3
 Drugs
Cardiovascular Agents           40.27       12.0
Anti-Infective Agents           73.18
Analgesics and Anesthetics      45.45        8.3
Respiratory Agents              46.69        8.3
Endocrine and Metabolic         50.92        8.1
 Drugs
Gastrointestinal Agents         69.69        7.9
Neuromuscular Drugs             73.28        7.1
Hematological Agents           107.08        5.0
Topical Products                38.74        3.6
Miscellanous                   169.89        1.6
 Psychotherapeutic and
 Neurological Agents
Stimulants/Anti-Obesity/        77.59        1.5
 Anorexiants
Genitourinary Products          58.05        1.4
Antineoplastic Agents          216.28        1.3
Biologicals                  1,317.41        0.9
Nutritional Products            13.54        0.7
Miscellaneous Products         174.16        0.7
Other / Unknown                 27.87        0.4
Total                           59.85      100.0

NOTE: Reimbursements are not net of rebates which average approximately
20 percent.

SOURCES: Centers for Medicare & Medicaid Services: Data from the
Medicaid Drug Rebate Program, State Drug Utilization Files, 1994-2003.

Figure 3
Medicaid Reimbursement Top 40 Drugs Versus All Other Drugs: Calendar
Years 1994-2003

       Top 40   All Other

1994    2.90      5.54
1995    3.26      5.73
1996    3.72      6.89
1997    4.30      7.28
1998    5.13      8.46
1999    6.57      9.61
2000    8.80     11.19
2001   11.21     14.14
2002   13.04     16.60
2003   14.86     19.44

Note: Tebale made from bar graph.

NOTES: The top 40 drugs were different for each year, and were based on
the top reimbursement amounts. Reimbursements are not net of rebates
which average approximately 20 percent.

SOURCE: Centers for Medicine & Medicaid Services: Data from the
Medicaid Drug Rebate Program, State Drug Utilization Data Files,
1994-2003.

Table 5 1998 Versus 2003 Top 40 Drugs Reimbursed Medicaid Drugs

                               1998

                       Number        Total           Mean
Brand Name             Drugs     Reimbursement   Reimbursement

Zyprexa              2,276,790    $562,255,761       247
Risperdal            2,914,311     407,339,230       140
Prozac               3,088,185     299,155,014        97
Depakote             2,808,609     227,442,176        81
Zoloft               3,160,016     226,911,158        72
Paxil                3,057,445     208,509,344        68
Clozaril             1,867,551     187,891,909       101
Prevacid             1,575,421     177,163,267       112
Pepcid               2,354,149     176,984,931        75
Vasotec              2,842,655     137,999,358        49
Procardia XL         2,049,366     135,389,319        66
Buspar               1,607,224     135,210,908        84
Norvasc              2,254,978     122,891,451        55
Zocor                1,189,240     111,966,133        94
Augmentin            1,957,215     106,825,432        55
Neurontin              927,655     101,846,541       110
Lipitor              1,417,372     101,199,268        71
Cardizem CD          1,754,772     100,450,323        57
Glucophage           2,069,422      96,828,503        47
Cipro                1,523,052      94,478,131        62
Claritin             1,495,141      87,944,615        59
Combivir               175,026      84,314,625       482
Zerit                  352,360      81,128,161       230
Biaxin               1,400,690      80,185,791        57
Pravachol              972,898      79,556,848        82
Epivir                 375,364      79,464,974       212
Ultram               1,762,731      77,380,982        44
Dilantin             2,696,242      75,136,196        28
Rocephin               247,980      71,704,599       289
Crixivan               183,526      70,677,577       385
Clonazepam           1,805,129      70,394,581        39
Albuterol Sulfate    2,697,067      66,305,260        25
Procrit                105,829      64,993,980       614
Depo-Provera           245,399      64,540,905       263
Mevacor                679,206      63,586,053        94
Diflucan               726,750      61,627,007        85
Serostim                12,981      60,082,536     4,629
Relafen                898,158      59,056,101        66
Duragesic              404,654      56,431,658       139
Imdur                1,255,057      55,340,151        44
Total               61,187,616   5,128,590,757        84

                              2003

                    Number        Total            Mean
Brand Name          Drugs     Reimbursement    Reimbursement

Zyprexa           5,575,396   $1,698,198,937        305
Risperdal         6,132,470    1,130,277,222        184
Prevacid          6,133,410      806,836,095        132
Seroquel          3,951,706      742,006,685        188
Lipitor           7,240,817      646,116,815         89
Neurontin         4,856,503      589,110,235        121
Zoloft            5,753,583      482,160,123         84
Celebrex          4,481,097      472,957,967        106
Zocor             3,793,548      468,237,418        123
Plavix            3,468,018      399,779,462        115
Oxycontin         1,428,041      380,161,247        266
Depakote          3,364,296      370,191,388        110
Protonix          3,604,819      369,064,123        102
Advair Diskus     2,411,127      334,408,830        139
Norvasc           5,641,549      325,959,523         58
Singulair         3,741,466      320,500,997         86
Duragesic         1,380,473      297,297,793        215
Paxil             3,379,653      293,857,055         87
Actos             1,956,198      293,309,712        150
Effexor XR        2,533,564      290,443,444        115
Nexium            2,101,010      278,196,514        132
Topamax           1,460,040      277,094,679        190
Procrit             320,230      251,044,645        784
Synagis             214,574      248,050,452      1,156
Wellbutrin SR     2,404,534      236,637,149         98
Celexa            3,037,985      229,223,574         75
Avandia           1,873,077      228,074,346        122
Vioxx             2,501,180      222,351,537         89
Ambien            3,274,251      222,176,648         68
Aricept           1,662,705      214,685,493        129
Abilify             646,640      194,910,804        301
Pravachol         1,609,773      191,149,058        119
Zyrtec            3,675,637      184,105,280         50
Recombinate          12,125      174,539,186     14,395
Levaquin          2,272,755      173,671,975         76
Fosamax           2,342,540      171,316,197         73
Combivir            287,707      169,004,965        587
Lamictal            763,264      167,394,730        219
Omeprazole        1,327,012      161,198,649        121
Geodon              705,226      153,797,029        218
Total           113,319,999   14,859,497,981        131

NOTE: Reimbursements are not net of rebates which average approximately
20 percent.

SOURCES: Centers for Medicare & Medicaid Services: Data from the
Medicaid Drug Rebate Program, State Drug Utilization Data, 1998 and