More Americans Are Using More Prescription Drugs

New State-by-State Data Correlates Increase with Rising State
Obesity Rates
ST. LOUIS--(Business Wire)--
More U.S. adults are taking prescription drugs than ever before,
fueling $12 billion in additional spending during 2006 alone. The
number of people with at least one prescription increased from 67% to
74% between 2000 and 2006, according to a new Geographic Variation in
Prescription Utilization study by pharmacy benefit manager Express
Scripts. The number of prescriptions per person rose to 14.3 from 10.8
in 2000 - a 32 percent jump.

The study correlates the climb in increased spending for
antidiabetic and antihypertensive prescription drugs with rising
obesity rates. The top five states (West Virginia, Kentucky, Alabama,
Mississippi, Louisiana and Arkansas) in the study's ranking of per
capita spending increases for drug classes linked to obesity were also
the states with the top five obesity rates, according to the U.S.
Centers for Disease Control and Prevention.

"The $12 billion in additional spending in 2006 would have been
much greater had the nation not increased its use of lower cost
generic drugs from 40% to 58% over the intervening years," explains
Emily Cox, senior director of research for Express Scripts. "In fact,
greater use of generic drugs still has significant potential for
managing prescription drug costs. The key will be using an advanced
understanding of the consumer to get more people to choose generics."

Conducted within the commercially insured market, the study
evaluated overall prescription drug use, analyzing commonly prescribed
therapy classes to highlight national and state-by-state trends.
Medications from four of the seven therapy classes evaluated are
frequently used to treat conditions associated with obesity and
related chronic conditions such as high cholesterol, diabetes and high
blood pressure. These four therapy classes include
antihyperlipidemics, antidiabetics, antihypertensives and
gastrointestinal (GI) medications. Also studied were
analgesics/anti-inflammatories, antidepressants and estrogen.

The state-by-state analysis found that overall usage and rates of
increase varied significantly across geographic regions with the South
experiencing the highest utilization and greatest increase in use.

For therapy classes with important safety warnings during the
study period - such as estrogen therapy and
analgesics/anti-inflammatories (COX-2s) - regional variations in
utilization become even more pronounced.

Study Highlights by Therapy Class

Following are overall and state-by-state highlights of study
findings:

-- The percentage of people with at least one antihyperlipidemic
prescription more than doubled in every state examined except
for Nebraska, Kentucky, Maine and Utah. Medical guideline
changes that lowered the LDL cholesterol levels considered for
drug treatments likely drove this dramatic increase. Southern
and lower Midwestern regions of the country had the highest
rate of use and also some of the greatest increases in the
percentage of people with at least one prescription.

-- The percentage of people with at least one antidiabetic or
antihypertensive prescription and the number of prescriptions
per covered individual for both therapy classes increased by
more than 75% each with the greatest increases demonstrated in
Southern states (Mississippi, Alabama, Georgia and Louisiana).
The lowest prevalence was seen in Northeastern (Massachusetts,
Maine and New Hampshire) and Western states (Colorado,
California and Oregon), respectively.

-- Although the percentage of people with at least one GI
medication grew at a modest rate of 20%, the number of
prescriptions per covered individual rose by 34%. These
results suggest that those on medications were more compliant
or remained on therapy for longer periods of time. West
Virginia, Kentucky, Mississippi and Tennessee topped the
prevalence list in this class in both 2000 and 2006.

-- The percentage of people with at least one antidepressant rose
by nearly 33%, while the number of prescriptions per covered
individual grew by 51%. Unlike other therapy classes, no clear
pattern of geographic variation was observed. Utah continued
as the state with the highest prevalence, followed by Kentucky
and Maine.

-- Analgesics/anti-inflammatory medication state variations grew
for the percentage of people with at least one prescription
despite drug recalls in this category. Some states, such as
Maine, New Hampshire, Wisconsin, Connecticut and Kansas, saw
decreases of over two percentage points, while other states
Arizona, Tennessee, Alabama, Florida and West Virginia saw
increases of up to two percentage points.

-- Overall, the number of people with at least one estrogen
prescription dropped by over half, with the impact by state
varying considerably. Regional variation increased by over 73%
resulting in a five-fold difference in the number of
prescriptions per covered individual between New York (1.16)
and Louisiana (6.32). The highest rate of use continued to be
in Southern and lower Midwestern states (Louisiana, Oklahoma,
Kansas, Arkansas and Alabama), while the lowest rate occurred
in the Northeast (Pennsylvania, New Hampshire, Massachusetts,
New Jersey and New York).

"Significant market forces directly impacting prescription drug
usage have occurred over the last five years," explains Cox. "The
increases are tied to rising rates of illness and changes in treatment
guidelines. However, increases in screening and physicians more likely
to choose drug treatment over non-drug treatment (diet and exercise)
could also lead to increased use. At the same time, decreases can be
tied to high-profile recalls and medical studies questioning the
safety of medications for hormone replacement therapy and
pain-relievers."

About the Study

The study was an analysis of a random sample of 2.2 million
patients in 2000 and three million patients in 2006 enrolled in a
commercial (e.g. no Medicare or Medicaid) plan in 2000 and 2006.
Express Scripts was the first organization to track and analyze
geographic variations in prescription drug use to better understand
regional and state-by-state differences in utilization.

The complete study with state by state tables is available at:
http://www.express-scripts.com/ourcompany/news/outcomesresearch/
onlinepublications/ (Due to its length, this URL may need to be
copied/pasted into your Internet browser's address field. Remove the
extra space if one exists.)

About Express Scripts

Express Scripts, Inc. (Nasdaq: ESRX) is one of the largest
pharmacy benefit management (PBM) companies in North America,
providing PBM services to more than 50 million patients through
facilities in 13 states and Canada. Express Scripts serves thousands
of client groups, including managed-care organizations, insurance
carriers, third-party administrators, employers and union-sponsored
benefit plans. Express Scripts is headquartered in St. Louis,
Missouri. More information can be found at
http://www.express-scripts.com.

Express Scripts, Inc.
Rita Holmes-Bobo, 314-996-0952
rholmesbobo@express-scripts.com

Copyright Business Wire 2008