Adalat

Express Scripts reports that its first-quarter 2003 drug trend slowed to 11.3%, compared with 16.9% in the same quarter of 2002. The PBM attributes the deceleration to:

* Increased acceptance and utilization of generic drugs by members;

* A mild flu season, with fewer antihistamines and cough-and-cold remedies used;

* Reduced utilization of estrogen drugs for hormone replacement therapy due to publicity about safety concerns last year.

Of these factors, generic drug utilization has the greatest potential for continued impact on the drug trend, the PBM says. During the first quarter of 2003, 47% of all prescription claims processed by Express Scripts were for generic drugs, up from 43% a year earlier. Greater use of generic drugs reduced the dollar outlay for prescription drugs by 3.2% during the first quarter and, for all of 2002, by 2.1%.

Express Scripts says that brand-name drugs representing $32.3 billion in U.S. sales are due to expire in the next five years, including Monopril, Nolvadex, Cipro and Celexa (see figure 1, page 3).

Despite the impact of generic utilization, the trend in certain categories remained high. Express Scripts said spending on blood pressure medications increased by 10.6% during the first quarter, cholesterol medications rose by 14.1%, and diabetes meds by 14.5%.

For the entire year of 2002, Express Scripts reports prescription drug spending for its clients increased 18.5% to $585.60 per member per year, from $494.20 in 2001. The company forecasts a 15.5% increase in drug spending for 2003.

In its recently released "Drug Trend Report," Medco Health Solutions also cites generic opportunities in the coming years--for those plans that are proactive. Classes to watch include nonsedating antihistamines (NSAs) and selective serotonin reuptake inhibitor (SSRI) antidepressants.

Taking advantage of generic opportunities as they occur is imperative, say PBMs, because other factors will continue to boost spending on prescription drugs. Medco says drugs now in the pipeline may account for up to 40% of the drug trend in the next few years. According to Medco's report, there are some 166 new drug applications awaiting FDA approval, and as many as 111 of them are potential blockbusters--with expected sales of more than $500 million per year.

Information: Steve Littlejohn, Express Scripts, (314) 702-7173; and Anne Smith, Medco Health Solutions, (201) 269-5984.

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