Rx patterns complicated by regional variation

California and New York may be the nation's most populous states, but they and other big states, like Florida, New Jersey, Minnesota and Massachusetts, placed at or near the bottom in per capita prescription drug use, according to St. Louis-based pharmacy benefit manager Express Scripts. The company measured per capita prescription drug use, across the nation, using a random sample of commercially insured members (age 18 to 64) of its pharmacy benefit plans.

New York's drug utilization rate was 7.7 prescriptions per year, as were the rates for California, Massachusetts and Colorado, putting all four states at the bottom of the list. Florida, New Jersey and Minnesota showed rates of 8.2, 8.2 and 8.1, respectively.

Topping the list of states with high prescription drug use were Kentucky, West Virginia and Ohio, where per capita prescription drug use among Express Scripts members exceeded 11 prescriptions per year. Louisiana was a close fourth at 11.0 prescriptions per member per year, and Texas was not far behind at 10.5.

"Such wide regional variation adds an entirely new dimension to an already complex pharmacy landscape," said Barrett Toan, chief executive officer of Express Scripts. "We suspect the explanation lies in physician prescribing habits and the health status of a state's population, but consumer preferences may also play a role. At Express Scripts, we have already embarked on further research to explain the geographic variation in drug use."

Therapeutic fluctuations

Express Scripts researcher Brenda Motheral noted that geographic patterns of prescription drug usage by adults also fluctuated across therapy classes. Notable findings, adjusted for age and gender, included:

•Â Higher rates of antidepressant use in Utah, Maine, Oregon and Washington.

•Â Higher rates of cardiovascular medication use in the South (West Virginia, Kentucky, Tennessee, South Carolina, Mississippi and Louisiana).

•Â Higher rates of antidiabetic medication use in West Virginia, Texas, North Carolina, Utah and Ohio.

•Â Lower rates of asthma medication use in the South (Mississippi, Arkansas, Louisiana and South Carolina).

•Â Lower rates of antihyperlipidemic medication use in New Mexico, Colorado, Idaho, Alabama, Montana and California.

•Â Lower rates of estrogen use among women in Northeastern states, such as New Jersey, New York and Massachusetts. 

Among children in the 5-to-14 age category, use of medications to treat attention deficit hyperactivity disorder varied by a factor of 3.3 across states in 2000. Louisiana had the highest prevalence of use, with South Carolina and Alabama rounding out the top three. Western states, including Colorado, California and Nevada, demonstrated the lowest prevalence of use.

Observed Motheral: "Our findings regarding ADHD medications highlight the controversy and uncertainty surrounding both the diagnosis and the use of psychostimulants in the treatment of ADHD in children." PR