September 19

Kids are "hot ticket" in Rx drug market

Subject: Kids are “hot ticket” in Rx drug market

Date: Thu, 19 Sep 2002 17:39:52 -0400

According to MEDCO Health, which manages prescription drug plans, the records of 500,000 children under age 19 reveal that: “Kids have surpassed senior citizens as the hot ticket in the prescription drug market… Spending on prescription drugs for infants, children, adolescents and young adults has increased by 85% during the last five years.”

Indeed, children have become the testing and dumping ground for the drug industry and irresponsible doctors who put children at risks of harm by prescribing drugs without medical need. For example, ADHD has not even been established as a bone fide medical disorder– as demonstrated by the failure of experts to reach a consensus about either the ADHD diagnosis criteria or treatment approach. Yet, according to MEDCO, the treatment cost of ADHD has increased by 122% over the past four years.

Another example that lacks medical justification is a 660% increase in spending to treat heartburn and other gastrointestinal disorders in children.

Public health policymakers should consider the following: How many children will suffer from acquired chronic illnesses as a result of aggressive drug based treatment that is being provided without medical justification? How will future generations judge those who allowed children’s welfare to be sacrificed to increase industry’s profit margins?

Below are reports by Reuters and The New York Times. ~~~~~~~~~~~~~~~~~~ Prescription Drug Use Rising Fastest Among Kids September 19, 2002, Reuters

Kids have surpassed senior citizens as the hot ticket in the prescription drug market.

While people over 50 are the largest drug market, Medco Health said in its annual survey released on Thursday that an increasing number of children are taking prescription drugs, making them the fastest growing prescription users in 2001.

Dr. Robert Epstein, Medco’s chief medical officer, said more aggressive treatment and diagnosis of allergies and asthma, as well as higher-cost antibiotics, have led to higher drug spending for the pediatric market.

Spending on prescription drugs for infants, children, adolescents and young adults has increased by 85% during the last five years, said Medco, which manages prescription drug plans covering 65 million people and operates a mail order pharmacy.

“We are concerned that many medical conditions we are treating in children not only require multiple medications now, but may be precursors to chronic diseases such as cardiovascular disease, diabetes and chronic respiratory ailments–conditions that will require a lifetime of drug therapy,” Epstein said.

According to the 2002 Medco Drug Trend study, which reviewed the prescription drug use of half a million people under age 19, younger patients are taking 34% more medications than they were five years ago, based on days of therapy.

For the under-19 age group, drug trend–the one-year rise in prescription spending per patient–was 28% in 2001, compared to 23% in the 35-49 age group, and less than 10% in the 65 and older age group. The rise in spending was attributed to an increase in the cost of drugs and the introduction of new and more effective therapies, said Medco, which is a subsidiary of drug giant Merck & Co. Inc.

Members of Medco’s pharmacy benefits management programs that are over 65, however, take 12 times more medications than younger populations, the company’s survey found. Patients under 19 account for only 5% of drug spending, Medco said.

While asthma, allergies and anti-infective drugs were key drivers behind the increased drug spending, the cost of treating attention deficit-hyperactivity disorder (ADHD) increased by 122% over the past four years.

Spending on proton pump inhibitors to treat heartburn and other gastrointestinal disorders in children has increased by 660% over the past five years.

“Some of the issues we associate with adulthood are moving backwards to children,” Epstein said, noting increased rates of obesity and diabetes in children. “It’s a phenomenon of how American children are living today.”


Epstein said doctors have become more aggressive in treating asthma over the past 10 years, leading to the increased spending on drugs such as Merck’s Singulair and GlaxoSmithKline Plc.’s Advair. Medco said spending on treatments for allergies and pediatric asthma increased by 211% over the past five years.

Medco cited National Center for Health Statistics data that the number of pediatric emergency room visits has declined, especially in the respiratory category.

“The paradigm five or ten years ago for a lot of parents was to wait until the child wheezes enough to take him to the emergency room,” said Epstein, who noted that using the asthma drugs is more preventative.

Spending on antibiotics over that period has increased by 42%, but the number of prescriptions written has declined. The spending increase resulted from doctors prescribing newer and stronger products that cost more, Epstein said.

Physicians and parents have become increasingly concerned that the overuse of antibiotics diminishes their effectiveness, Epstein said. Also, viruses, such as the common cold, do not respond to antibiotics.

“Antibiotics are not for every one and parents don’t need to get them every time a child has a cold,” Epstein said. THE NEW YORK TIEMS Children’s Use of Prescription Drugs Is Surging, Study Shows By SHERYL GAY STOLBERG

ASHINGTON, Sept. 18 — Prescription drug use is growing faster among children than among the elderly and baby boomers, according to a new study that says spending on prescription medicines for pediatric patients has increased by 85 percent over the past five years.

The figures are drawn from an analysis by Medco Health Solutions, a pharmacy benefits management company and subsidiary of Merck, the pharmaceutical concern. Each year, Medco examines its own data to spot trends in prescription drug spending.

The research, scheduled to be made public on Thursday, did not find that children take more medicine than adults. In fact, said Dr. Robert Epstein, Medco Health’s chief medical officer, children accounted for just 5 percent of prescription drug expenditures.

But in examining prescription drug use among 500,000 children under age 19, Dr. Epstein did find that more young people are taking medicine today than five years ago and are taking drugs for longer periods.

“This was the first time that we have noticed that the pediatric age group trend was beating all the other age groups,” said Dr. Epstein, who took a close look at pediatric prescribing as part of the company’s annual look at drug-use trends.

Experts, including Dr. Epstein, attributed the rise in spending to several factors. First, certain conditions, including asthma and allergies, as well as hyperactivity, are being diagnosed more frequently and treated more aggressively than ever before. In addition, the overall cost of medicines is going up; Dr. Epstein said 30 percent of the rise in spending was attributable to an increase in drug prices.

Dr. Epstein said the percentage of children taking prescription medicines for allergies had nearly doubled, to 11.7 percent in 2001-2002 from 5.9 percent in 1997-98.

The use of antibiotics, however, has “flattened out,” he said, remaining steady at about 34 percent of children each year.

Steven Findlay, director of research at the National Institute for Healthcare Management, a nonprofit organization that tracks prescription drug spending, said he was not surprised by the findings.

“We’re seeing, for the last 5 to 10 years, everyone acknowledges more use of medications across the board in kids,” Mr. Findlay said.

Dr. Epstein found that 48.9 percent of children took one or more prescription medications within the past year compared with 45.7 percent five years ago. The average length of time children spent on medication also increased, to 51 days in the past year from 38 days five years ago.

Over the past several years, the Food and Drug Administration has been pressing pharmaceutical companies to test their medicines in children, and the Bush administration recently reauthorized a program giving drug companies six-month patent extensions for conducting such tests.

Mr. Findlay said the Medco findings provided further justification for that policy, adding that the trends in pediatric drug use were cause for concern.

“I think it warrants close watching by physicians, by parents groups, public interest groups, consumer groups and even pharmaceutical companies,” he said. “Everyone is concerned that we have begun to use pills, which were originally designed and tested in adults, in children more and more. That has a different set of risks.”

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