Prescription Drugs and the Elderly

8/27/10)- This year's comparative drug pricing report from AARP showed that the 217 most popular prescription drugs used by older Americans increased by an average retail price of 8.3 percent during the year 2009, which was the largest percentage increase since 2004, a year in which the Consumer Price Index rose 3.1%. Please see our item dated 8/26/05 below.

The data from the report showed that over the last 5 years, the retail price for the most popular brand-name drugs increased 41.5%, while the consumer price index rose only 13.3%.

In a survey that had been conducted by the government for its Consumer Price Index, which incidentally included the price for generic drugs as well as brand name drugs, it showed a price increase of 3.4%, which is also far above the rate of inflation for 2009.

The biggest percentage increase for a brand name drug was for Boehringer Indelheim's incontinence drug Flomax, which increased 24.8% even though the patent for the drug expired last year. The generic version of the drug is tamsulosin

The price rose 6% in 2009 to $5.40 a day for AstraZeneca's Nexium. For Plavix from Bristol-Myers the increase was 8.8% to $5.06 a day; for Prevacid from Takeda, the price rise was 7% to $5.50 per day, while 20 mg Lipitor from Pfizer rose 4.1% to $4.03

The Bureau of Labor Statistics report, which included generic drugs showed a 3.4% increase for 2009.

(4/4/10)- Purchases of cholesterol and diabetes prescription drugs by elderly Medicare beneficiaries reached nearly $19 billion in 2007 - about one-fourth of the approximately $82 billion spent for medications for the elderly, according to the latest AHRQ News and Numbers.

(8/26/05)- The results of a recent study that was done by AARP shows that the average prices of dozens of brand-name prescription drugs widely used by elderly Americans have risen more than twice as fast as general inflation for the third year in a row.

The 12-month average increase for the 195 most widely used brand name prescription drugs used by the elderly was 6.7% versus the 3.1% rise in the Consumer Price Index. On the other hand there was only about a 1% increase in the average price of the most widely used generic drugs for the elderly.

110 of the 195 brand name drugs had increases in the first quarter of 2005. For a typical older American who regularly takes three brand-name drugs for a chronic condition, the price for a year's worth of those drugs would probably have increased $866, on average, since 2000, according to the AARP study.

(5/5/05)- About two of every five senior citizens do not take their prescribed medications in the proper amounts either because of cost, bad side effects or because they feel the medications do not really help them. Many elderly people do not believe that they really need the prescribed drug.

The Kaiser Family Foundation and the Commonwealth Fund sponsored the survey that was conducted by a research team at the Health Institute at Tufts-New England Medical Center. A survey was mailed to a random sample of 36,901 non-institutionalized Medicare beneficiaries between July 15 and October 7, 2003. Nearly 18,000 responded. Forty-six percent of those who responded said that they took five or more prescriptions daily

About 25% of those who responded said that they were forgoing taking the medication because of cost. Just about the same percentage answered the survey by saying they did not take their medications because of non-financial considerations. Some of the answers as to why they were not taking the medications included that the medicine made them feel worse, they didn't think the medication was helping or they were already taking too many medications.

(8/28/03)-According to the 2003 report released by Families USA, a Washington based consumer health organization, seniors represent 13 % of the total population and yet they account for about 34 % of all prescriptions dispensed and 42% of all prescription drug spending. "Among Medicare beneficiaries, 90% use prescription drugs during the course of a year, and they pay an average of $2,322 a year for them". Total spending of senior citizens on prescription drugs rose an estimated 44% from 2000 to 2003.

The cost of the 50 most commonly used drugs by the elderly rose by nearly three-and- a half times the rate of inflation from January 2002 to January 2003.

Cost of 5 commonly prescribed drugs for the elderly

Source: Information contained in the report "Enough to Make You Sick: Prescription Drug Prices for the Elderly" from Families USA.

Results from previous Families USA studies also found that drug prices for the top 50 drugs used by older Americans consistently rose faster than inflation. From January 2002 to January 2003 the price for the top 50 drugs used by seniors increased by 6.0 %, while the rate of inflation for the same period, excluding energy increased by only 1.8%.

Of the top 50 drugs used by seniors, 15 are generic drugs. Of these generic drugs, 9 did not increase in price at all during the period from January 2002 to January 2003. Only 3 of the brand name drugs did not increase in price at all, including Prilosec which went off patent recently. "The average annual cost for the generics rose from $348 to $357, while the average annual price for the brands increased from $1,399 to $1,498-an increase of 2.6% for the generics compared to 7.1% for brands".

"Of the 50 drugs used most frequently by seniors, the average annual cost as of January 2003 was $1,439." The report used data from the Pennsylvania Assistance Contract for the Elderly (PACE), which is the largest outpatient prescription drug program for older Americans in the United States. In 2002, 268,005 people were enrolled in the PACE program, and PACE filled 9,144,923 prescriptions."

The Pharmaceutical Research and Manufacturers of America (PhRMA), the trade group for the drug industry recently released some very informative data concerning the work the industry is doing on drugs for the elderly. Their data did not include the studying of the 458 drugs in development and latter stages to treat heart disease, cancer and stroke, which are the three biggest killers of the elderly. The pharmaceutical companies are presently studying 241 possible drugs to treat ailments for the elderly this year compared to 191 possible drugs studied last year. According to statistics from AARP the average American over the age of 75 has more than 11 drugs prescribed yearly.

The drug industry is now studying 26 compounds as possible treatment for Alzheimer's disease, which is up from the 19 that they were studying in 1999. This year the various drug companies have 16 compounds under development for Parkinson's disease compared to the 10 compounds last year. 26 compounds are under development this year for treatment of depression up from 13 last year. For diabetes the numbers are 25 this year up from 19 last year. Among the individual companies Aventis AG (AVE), Sanofi, Eli Lilly, Merck and Novarits have 9 or more potential drugs under development for treatment of the elderly.

The cost for prescription drugs for the elderly continues to escalate at a pace that far exceeds the rate of inflation. We base this conclusion on some interesting projections and forecasts for the Health Care Finance Administration derived from the figures obtained in the Medicare Current Beneficiary Survey (MCBS). The MCBS surveyed 12,000 elderly and disabled Medicare beneficiaries.

The average cost per prescription for an elderly person in 1992 was $28.50 and in 1999 was $42.30, an increase of 48 %. The average number of prescriptions, including refills, rose to 28.5 per senior in 1999, up from 19.6 in 1992. Drug industry officials say that the increase in prescription drug costs has been more than offset by the reduction in expenses that would have been incurred through long hospital stays. The industry further claims that the quality of life for the elderly has been improved tremendously by many of these new medications.

Spending on prescription drugs averaged $387.09 per person in 1999, which was up 17.4 % from the 1998 figure of $329.83 according to figures released by Express Scripts of St. Louis. Express Scripts manages drug benefits for 38.5 million people, of which 9.5 million were used in the study. While the drug companies have been protesting that many of their blockbuster drugs will be coming off patent in the next few years, the figures showed that 41% of the prescription drug spending was attributable to drugs introduced since 1992.

The brunt of the spending increase was borne by elderly women. The average price for a prescription last year rose 18% for women age 70-79 and 20 % for women in the 80 and older category. For men the increase was 9 % for those in the 70-79 category and 11 % in the 80 and above category. Interestingly enough the price for generic drugs rose an average of 7 % last year, and brand name prices rose 5.8 %.

The pharmaceutical industry spent $1.1 billion on television ads in 1999 according to figures from IMS Health. This represented a 70 % increase over ad spending in 1998. The widely advertised anti-histamines Claritin, Allegra and Zyrtec showed the largest percentage increase (18.4 %) in usage. Cholesterol-lowering drugs increased at an 18.1 % figure and anti-depressants increased at an 11.3 % figure. Please keep in mind that these are the prescription drugs most used by the elderly. Drugs that treat chronic conditions such as heart disease, respiratory illness, diabetes and gastrointestinal disorders were identified by the Express Scripts researchers as the leading categories of therapies for drugs used by seniors. Among these top 10 therapies the annual cost of a prescription was more than $400 in 6 of the 10 categories. It was above $500 in 5 of the top 10 categories. The average senior used 29 different prescriptions in 1998, and we do not know what that figure is yet for 1999.

Physicians wrote 2.9 billion prescriptions during 2000, up from 2.7 billion in 1999. This averaged to about 1900 prescriptions per physician per year. Primary Care Physicians accounted for 53% of these prescriptions. The next highest group of specialists, Ob/Gyn, accounted for 6.1% of the prescriptions, followed by Pediatricians at 5.3%, Cardiologists at 3.9% and Psychiatrists at 3.8%. Other specialties account for the rest of the prescriptions. Consumers spent about $103.5 billion on prescription drugs in 1998, and it is estimated they will spend about $121.6 billion on prescription drugs in 1999.

Wholesale Cost per year of therapy for top 15 drugs used by the elderly in 1999

Source: Compiled by PRIME Institute, University of Minn., for Families USA

The number one prescription sales drug for the year 2000 was Prilosec, a treatment for ulcer conditions with over $4.1 billion in sales. Number two was Lipitor, a cholesterol lowering medication with about $3.7 billion in sales. The third in prescription drug sales was Prevacid for treatment of ulcers with sales of about $2.8 billion followed by Prozac the anti-depressant in fourth place with sales of about $2.56 billion. Rounding out the top five was Zocor a cholesterol reducer with sales of $2.2 billion. The next five prescription drugs in order of sales were Celebrex, the anti-arthritic drug with sales of $2.01 billion, Zoloft (depression -sales of $1.89 billion),), Paxil (depression and OCD-sales of $1.8 billion), Claritin (oral antihistamine-sales of $1.67 billion) and Glucophage (oral diabetes-sales of $1.6 billion).

As you will note, three of the top ten are medications used to treat mood swings i.e. depression and two are related to cholesterol lowering. Since only 3.8% of the prescription writing are attributable to psychiatrists, a logical conclusion indicates that primary care physicians (writers of 53% of prescriptions) are widespread prescribers of these medications. It may also indicate that these medications are taken for such long periods of time and cost so much, that their sales just zoom to the top ten. In either case, does the training of primary care physicians alert them to the nuances of depression so that they take into account the various types of depression and prescribe for the individual or just for the prototype category of depression?

Choice of medication is best made after consideration of factors such as type of depression, response to a particular agent, concurrent drug treatment and possible drug interactions, current physical illness, side effect profile of the medication and cost benefit analysis. This would seem especially true in dealing with the elderly. There is no question that the elderly can benefit from inclusion of a drug plan in their health coverage, but it is our hope that more sophisticated planning will go into prescribing these medications. Mapping of the human genome has indicated subtle differences in gene sequencing that may lead to more focal approach to medication development and prescription. The elderly need to be included in any protocols that are being developed.

The chart below lists the top 10 U.S. prescription drug companies by sales for the year ended March 31, 2000:

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"

Allan Rubin and Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated August 27, 2010

To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com

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