A Bitter Pill to Swallow

A new study shows Louisiana residents popping more prescription pills than any other state. A new study shows that the number of Americans with at least one prescription has increased from 67 percent in 2000 to 74 percent in 2006. Not surprisingly, Louisiana, a regular bottom-dweller in health care studies, ranks among the top states with the highest incidence of consuming certain prescription drugs. In fact, this state has the dubious distinction of being the No. 1 state overall for the greatest prevalence of usage for 2006.

According to researchers at Express Scripts, a pharmacy benefits manager providing services to more than 55 million members, Louisiana is in the upper echelon of states with the greatest per capita increase in spending for seven major therapy classes — antihyperlipidemics (high cholesterol), antidiabetics, antihypertensives (high blood pressure), gastrointestinal medications, antidepressants, analgesics/anti-inflammatories and estrogen. The study, called “Geographic Variation Trends in Prescription Use: 2000 to 2006,” shows that consumers in this state spent $154 per person more for prescription drugs in 2006 than they did in 2000, which translates to about $215 million in additional spending just for GI, hypertension, lipid, diabetes and antidepressant medications.

The 2006 study tracked 3 million random Express Scripts members aged 18 to 64. In 2000, the survey randomly sampled 2.2 million consumers. Databases consisted of administrative pharmacy claims by members enrolled in commercially insured plans through an employer, not Medicare or Medicaid. “We take our eligibility file of everybody who is enrolled with us and determine how many of them actually use the prescription benefit during the year,” explains Emily Cox, Ph.D., senior director of research at Express Scripts. “So the research is based upon claims data and not self-report.”

In general, the report shows that the South had a higher prevalence of cardiovascular, diabetes and GI medications. Louisiana was among five states with the largest increase in antihypertensive medications, which can be traced to the rise in national obesity rates. According to the Centers for Disease Control and Prevention’s “U.S. Obesity Trends 1985-2004,” seven of the nine states with obesity prevalence rates of more than 25 percent were in the South, including Louisiana. “We can’t say that the rising obesity is causing the increased drug use, but it is certainly highly correlated,” Cox observes, “because we do know from state-level obesity rates from the CDC that states in the South have much higher obesity rates, which is certainly driving overall prescription utilization.”

But this isn’t the only reason for increasing prescription use. Another factor affecting the growth in these drugs is the boom in drug-to-consumer advertising. This ad blitz increased from $2.8 billion in 2000 to more than $4 billion in 2005. “Certainly, that has increased consumers’ awareness of prescription drugs and, also, studies that have shown that it has increased the likelihood of members asking for drugs,” Cox says. “But, there is also a likelihood that physicians are more likely to prescribe drug therapy more quickly if a patient is diagnosed with hypertension or maybe another condition where, five or 10 years ago, they may have said, ‘You know what? Let’s try diet and exercise first, and see how that works.’ But, our data can’t really answer that question specifically. However, it certainly is indicating that there a number of factors driving this overall increased use.”

Over-the-counter medications are not typically included in these studies. Today, consumers are purchasing more OTC agents, including non-sedating antihistamines such as Clarinex and stomach medications like Pepcid AC. “These would actually drive down the likelihood of [prescription] use,” Cox says. “And, we’ve seen that in specific therapy classes, but we didn’t really see that in the specific therapy classes that we evaluated.” Louisiana also ranked in the top five states for increased prevalence of antidepressants. Nationwide, usage increased by 33 percent from 2000 to 2006, from about 11 percent to 14 percent. But Louisiana had the highest increase during this period, with about 6 percent more Express Scripts members taking an antidepressant medication in 2006.

Several local physicians and other health care officials contacted for this story either declined to comment or did not return calls for comment.

One theory for this increase in use is the impact of Hurricane Katrina. A year after the hurricane, California-based International Medical Corps, one of the nation’s largest emergency response agencies, found that survivors living in temporary trailers in Louisiana and Mississippi were 15 times more likely to commit suicide than people in the rest of the country. International Medical Corps also found that the rate of depression within these trailer parks was seven times the national average. This finding is especially troubling in light of the new study led by Irving Kirsch of the University of Hull (England), concluding that antidepressants work no better than placebos, except in severely depressed patients. On the bright side, this could mean that depressed people can improve without medications, relying instead on therapy, exercise and other non-medical treatments. Kirsch wasn’t alone in his findings; CNN medical correspondent Sanjay Gupta, reporting last week on this latest study, said that an aggregate of all recent published and unpublished studies on antidepressants show they are ineffective in most patients. “About 82 percent of the time, the improvement that you seek from antidepressants can actually be duplicated by a placebo,” he said. “That is a sugar pill. A pill that has no specific medicinal qualities.”

Another surprising finding was that Louisiana still ranks at the top for estrogen use. While consumers’ ingestion of estrogen dropped nationwide by over half since 2000, mainly in response to government-backed studies showing that it fuels certain cancers, Louisiana retained the highest prevalence of use for this therapy in 2006. Estrogen use did decrease in this state from about 10.48 percent in 2000 to 6.32 in 2006. However, it did not decline as much as other states, particularly in the Northeast and the West. In general, southern women continued to use this hormone replacement therapy more than those in other parts of the country. “It’s a really interesting finding that deserves a different type of research, where you are going to some survey research or focus groups or something to try to understand this a little bit better,” says Cox. “Every state decreased in utilization, but some states did not react as dramatically as others did.”

And while consumers across Louisiana are popping more pills than ever before, they’re also paying more for them, as costs for prescriptions in Louisiana continue to skyrocket. In addition to seeking out other options outside of medication, Cox recommends that consumers take a more active role in their prescription management, suggesting they ask physicians and pharmacists about generic or lower-cost alternatives. “If residents find themselves in a situation with chronic disease that they need treatment for, I would be encouraging them to talk to their doctor and pharmacist about ways they can save money through using lower-cost alternatives.”