Medication prescribing patterns vary widely between, within states and therapy classes

June 29, 1999

Suggests New Opportunities for Managing Cost, Quality of Pharmacy Benefit

ST. LOUIS, June 29, 1999 -- Where you live plays a big role in how many and which medicines you take according to a study of regional prescription use presented here today by University of Arizona researcher Brenda Motheral, Ph.D., at a national conference of health plans and benefits managers. Conference and study sponsor Express Scripts, Inc. (NASD: ESRX), is the nation's largest independent pharmacy benefit manager.

According to Motheral, some states have consistently higher or lower prescription use than other states, certain therapy classes have greater variability than others and individual states have unique patterns of high and low use within specific therapy classes. Her study is the first publicly reported analysis of regional prescription use that is based solely on recipients of pharmacy benefits and that adjusts for age and copayment rates as factors that could influence variation.

"This study of regional prescription variation is part of Express Scripts ongoing exploration of the rapidly changing pharmacy landscape. Based on this study and other Express Scripts studies we expect to develop new pharmacy benefit management approaches that enhance quality and improve cost control for pharmacy benefit plan sponsors and throughout the nation," said Barrett Toan, chief executive officer of Express Scripts.

Motheral analyzed prescription use patterns among 68,000 recipients of pharmacy benefits managed by Express Scripts in nine states -- California, Nevada, Louisiana, Missouri, Illinois, Tennessee, North Carolina, Ohio and Michigan -- where previous national data on pharmaceutical use had shown variation. However, these national data were not adjusted for age or copayment and did not account for who paid for the prescription, such as a benefit plan, Medicare, Medicaid, or a private payer.

The University of Arizona researcher found that prescription use varied from a low of 5.03 prescriptions per member per year in Nevada to a high of 11.38 prescriptions per member per year in Louisiana. Among therapy classes, the widest variation between the states studied was found with cholesterol and blood pressure lowering drugs and antihistamines. The least variation was found with diabetes drugs, estrogens and antirheumatics.

"Variation in the use of heart-related medications was one of our most surprising findings because we thought the existence of generally accepted treatment guidelines would have minimized regional variation," said Motheral.

Using antihypertensive blood pressure drugs as an example, she noted that prescription use varied widely not only between states but also within states. On a state level, antihypertensive use ranged from a low of 0.28 prescriptions per member per year in Nevada to 0.98 prescriptions per member per year in Louisiana. However, within most states examined, antihypertensive use ranged just as widely between zip codes. For example, the lowest antihypertensive use within one Illinois zip code was 0.11 prescriptions per member per year compared to antihypertensive use of 1.1 prescriptions per member per year in the highest utilizing Illinois zip code.

Why prescription use varies between and within states, even among recipients of pharmacy benefits, requires further study, said Motheral. She explained that the variation could be due to physician practice styles, patient preferences, and/or still-to-be-determined underlying factors other than age or copayment levels.
Express Scripts, Inc., is the nation's leading independent full-service pharmacy benefit management (PBM) and specialty managed care company. Through facilities in seven states and Canada, the company serves thousands of clients throughout North America, including managed care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans.

The company provides fully-integrated PBM services, including network claims processing, mail-order pharmacy services, benefit design consultation, drug utilization review, formulary management, disease management, medical and drug data analysis services, medical information management services, which include provider profiling and outcome assessments, through its Practice Patterns Science, Inc. subsidiary, and informed decision counseling services through its Express Health Line SM division. The company also provides non-PBM services, including infusion therapy services through its IVTx subsidiary and distribution services through its Specialty Distribution division. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at

(MEDIA NOTE: A media teleconference will be held at 11 am CDT, Tuesday, June 29, 1999. The conference call phone number is 888-857-6929, access code 719626. The conference call will be simulcast on the Internet at URL address is case sensitive.)

Kupper Parker Communications

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