Contact: Steve Littlejohn


Depression Treating Drugs Lead Record Setting Pharmacy Benefit Cost Rise Total Increase Lower When Pharmacy Benefit Actively Managed

ST. LOUIS, June 29, 1999 -- America's growing use of depression-treating drugs like Prozac, Zoloft and Paxil made antidepressants the biggest contributors to a record-setting pharmacy benefit cost increase of 16.8 percent last year, according to a study by the country's largest independent pharmacy benefit manager, Express Scripts, Inc.

Not everyone was hit by the full cost increase. "Plan sponsors that successfully navigated the challenging pharmacy landscape were able to cut the cost increase in half by actively managing their pharmacy benefit to encourage the use of lower cost but equally effective and safe drugs," said Barrett Toan, chief executive officer of Express Scripts.

For consumers, the cost increases mean they will pay a bigger share of the expense in the form of higher copayments ranging from $5 for generic drugs to $25 or more for selected, single source brands. Employers and other pharmacy benefit plan sponsors currently pay as much as 80 percent of a prescription's cost which can amount to more than a hundred dollars each in some cases.

Plan sponsors used carefully constructed formularies, three tier copayments and other approaches to control costs and maintain access to pharmacy benefits despite the discovery of more innovative drugs, faster FDA approvals and more widespread direct-to-consumer marketing, according to Toan.

Last year's annual per member cost -- on an average wholesale price (AWP) basis before copayments, discounts and active management -- was $329.48 up from $282.48 in 1997. New drugs introduced since 1992 accounted for 35.6 percent or $117.55 of the 1998 pharmacy benefit cost. A single prescription for a post-1992 new drug cost an average of $72 in 1998.

The unmanaged AWP cost increase was the largest reported by Express Scripts since 1993, when the company began monitoring drug cost and utilization trends among its members, which now number 47 million. Another increase of more than 16 percent is expected this year. On average, 7.7 prescriptions were written last year for each pharmacy benefit recipient, up from 7.4 in 1997.

Toan attributed the growing popularity of antidepressant drugs, to "greater public awareness and acceptance of depression as a disease and the availability of easier to dose, less toxic, better tolerated medications like selective serotonin reuptake inhibitors and selective norephinephrine reuptake inhibitors."

Drugs used to treat depression accounted for $4.76 of last year's $47.35 average increase in per member per year drug costs. These drugs are expected to account for more of the pharmacy benefit dollar than any other class of drugs by the end of 1999, according to Express Scripts.

Antidepressant drugs are now the second most used class of drugs, just behind blood pressure controlling antihypertensive drugs like ACE inhibitors. Antidepressant use increased 11.9 percent last year from 0.37 to 0.42 prescriptions per year. Use of antihyperintensive drugs increased 9.7 percent from 0.43 to 0.47 prescriptions per year.

The study also found usage growing for drugs that control high blood pressure, combat diabetes, lower cholesterol, treat digestive problems, and open sinuses. Drug prices are higher across the board, too. In 1998, prices for all but one of the nation's 50 most prescribed drugs increased -- many several times and often by double digits. Overall, price increases alone accounted for nearly a third of last year's benefit cost growth, the first time price inflation has played such a prominent role in driving up the total pharmacy benefit cost.

Toan cautioned that there is "no panacea for stemming the rise in prescription drug costs, not even tiered copayments." He noted that copay levels should not be set so high as to dissuade members from having essential prescriptions filled or refilled, a situation that could result in emergency or inpatient admissions. The levels at which copayments are set must take into account the family income of covered membership and the types of drugs that require high copayments.

"The key element of having a successful drug plan benefit is to have a balance of cost and quality management which focuses on appropriate utilization," said Toan. To supplement cost management approaches, Toan pointed to programs that promote the appropriate use of drugs by looking at prescription drugs within the context of overall health resources expended to treat a specific disease. He also cited the growing popularity of disease management, an approach that encompasses the comprehensive management of a patient with a specific disease.

Released in St. Louis today at a national conference of employers, managed care organizations and other pharmacy benefit plan sponsors, the Express Scripts Drug Trend Report is a one-of-a-kind study based on large samples of 8.8 million plan members in 1998 and 7.2 million in 1997.

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 copy of the 1998 Express Scripts Drug Trend Report as an Adobe Acrobat PDF file (633K) is available to the media via email by contacting Steve Littlejohn at 314-290-2024 or A media teleconference will be held at 11 am CDT, Tuesday, June 29, 1999. The conference call phone number will be 888-857-6929, access code 719626.)


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