Generic use reached 84% in 2012, study finds

PARSIPPANY, N.J. — Declining use overall of healthcare services drove down spending on medicines in the United States by 3.5% per capita last year, according to a new study.

The study, by the IMS Institute for Healthcare Informatics, a division of healthcare analytics firm IMS Health, showed total spending on medicines reached $325.8 billion last year, or $898 per capita, down by $33 per capita from 2011. Fewer patient visits to physician offices, fewer non-emergency admissions to hospitals and outpatient centers and a less severe flu season in early 2012 were all factors in the decline, according to the report, titled Declining Medicine Use and Costs: For Better or Worse?

In addition, however, $28.9 billion of the reduction came from expirations of patents covering branded drugs, which IMS called the "largest-ever impact" as patients moved to cheaper generic drugs.

"The cost curve for medicines was clearly bent in 2012, for better or for worse," IMS Institute for Healthcare Informatics executive director Murray Aitken said. "To some extent, this is a harbinger of more efficient use of our healthcare resources, but it also reflects a decline in utilization that may be the result of under-treatment and an imbalance between prevention and care. On the eve of the most transformative period in U.S. health care, understanding the drivers of this cost-curve reduction is critical to effectively addressing the long-term implications."

Higher deductibles paid by insured patients, as well as higher co-pays and co-insurance, as well as declining prescription drug copays for most patients and new medicines to treat a large number of diseases with small or strictly defined patient populations all factored in as well, according to the report.

Per capita medication use declined by 0.1%, partly due to milder cough, cold and flu seasons in the first months of 2012. Meanwhile, use of generics has increased to 84% of all prescriptions, while price increases and lower spending on recently launched drugs have driven spending down as well. Healthcare costs remain concentrated among patients with multiple chronic conditions, cancer and other complex conditions normally treated with specialty drugs; among those with commercial insurance, 5% of those younger than 65 incurred 51% of total healthcare costs, using more than $15,684 per person.

Twenty-eight novel drugs became available in 2012, including seven drugs for rare diseases with orphan drug designations from the Food and Drug Administration and nine new cancer drugs, as well as a new oral drug for rheumatoid arthritis, a treatment for cystic fibrosis expected to significantly improve life expectancy in patients with a specific genetic mutation and an inhalable anti-psychotic.

Nearly 20% of the insured are now in a consumer-driven health plan as insured patients are paying higher deductibles and copays or co-insurance, and average out-of-pocket costs for commercially insured patients younger than 65 reached $1,146, a 30% increase from 2011 and entirely the result of higher deductibles. The average pharmacy benefit copay declined by $2 to $121 in 2012; patients filled 72% of all retail prescriptions with a copay of $10 or less.

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