Millions of Senior Citizens Given Drug Over Doses - Twice As Many As 1999

Potential for confusion and errors compounded: -- one in four seniors sees four or more physicians, -- one in three uses four or more different pharmacies

May 28, 2003 - The number of senior citizens subjected to a potentially dangerous over-medication has more than doubled since 1999, as more prescription drugs are prescribed by more doctors and filled at more pharmacies than ever before, according to data released May 21 by Medco Health Solutions, Inc., the nation's leading provider of pharmacy healthcare services.

In 2002, approximately 7.9 million medication alerts - including millions of cases of "over" dosing -- were flagged by Medco Health's targeted senior drug utilization review (SDUR) system, more than twice the approximately 3.4 million alerts detected in 1999 for the more than 6.3 million seniors covered by Medco Health who filled prescriptions.

Of the 7.9 million alerts in 2002, roughly 2.2 million situations involved exceeding the clinically recommended dose for a senior age 65 and older, and approximately 2.4 million involved prescribing a drug that is clinically inappropriate in the elderly and may lead to harm. More than 3 million other situations involved interactions between two or more medications.

"Not every alert posted is cause for alarm. However, we frequently find incidents with anti-anxiety medications and sleep aids that are prescribed at too high a dose for seniors, which can in turn cause confusion and falling. In addition, we often see concurrent use of blood thinners and aspirin-like drugs which can cause bleeding; and we find many patients being prescribed both beta agonists for lung issues and beta blockers for the heart, which may cancel each other out or lead to a worsening of one or both conditions," said Dr. Robert Epstein, chief medical officer, Medco Health. "The good news is that advances in the SDUR system have caused the identification of a higher number of alerts and in many cases has lead to a change in therapy that is safer for the patient. Conversely, there are millions of uninsured seniors that do not have the 'safety net' provided by pharmacy benefit mangers, which are often the last line of defense in recognizing and alerting healthcare providers to potential medication mishaps."

Also, while the data does not provide insight to the absolute cost burden these incidents are inflicting on the healthcare system, the Journal of the American Pharmaceutical Association reported in 2001 that drug-related issues result in a total cost of more than $177 billion annually, of which senior "over"dosing is a contributing factor.

"This research underscores the critical need for an integrated view of prescription drug treatment across multiple providers," said Dr. Epstein. "These large numbers are due, in part, to the expansion of a patient's healthcare team to include primary care physicians, multiple specialists and pharmacists. The data raises our awareness about the need for better communication between healthcare providers and obtaining and maintaining complete medication histories so that changes in therapies can be made, when appropriate, as patients age and are prescribed additional drugs."

To illustrate more clearly how complex the seniors' drug arena has become, Medco Health reviewed the prescription drug therapies of more than 650,000 senior patients aged 65 or older in conjunction with its 2003 Drug Trend Report and found:

• One in four seniors sees four or more physicians, however, nearly one in ten seniors was prescribed medications by six or more different doctors in 2002

• One in three used four or more different pharmacies and one in seven seniors used five or more pharmacies to fill prescriptions last year

• One in four seniors took a narcotic for more than 30 days, and nearly one in 10 took more than three different narcotics in 2002

• On average, the amount of money spent yearly on prescription medications for one senior is equivalent to the amount spent on a typical family of four.

The complex web of multiple physicians and multiple pharmacies is compounded by the fact that, among seniors covered by Medco Health who take medications, the average senior receives 25 prescriptions annually. The leading types of medication categories being taken by this age group includes high blood pressure, antibiotics, cholesterol lowering agents and non-narcotic pain relief.

"The senior population has unique and special characteristics when it comes to their pharmaceutical care. Clearly it is becoming increasingly difficult for patients and physicians to track appropriate prescription medication use," said Epstein. "However, by using integrated technology platforms, we alert physicians and pharmacists daily to potential overlaps in therapies, interactions and dosage issues, which can prevent potential harm or even deadly medication mishaps."

These issues are not solely those of the senior sector. In 2002, Medco Health's rigorous drug utilization review (DUR) program, along with its SDUR program, examined each of the 548 million prescriptions ordered by and dispensed to the 62 million people the company serves and secured millions of therapy changes for issues ranging from drug-drug interactions, excessive dosages and prescription duplication. DUR is just one of many programs and tools used by Medco Health to ensure high quality pharmaceutical for patients, while helping to moderate cost. Increased use of generic drugs, home delivery services and formulary compliance are several other key drivers outlined in Medco Health's recently issued 2003 Drug Trend Report.

Drug Trend Drivers Shifting Gears

Nationally, 2002 drug trend, the percent increase in spending on prescription drugs, was projected to be 14.3 percent, according to the Center for Medicaid and Medicare Studies (CMS) formerly known as HCFA. However, in collaboration with its clients and using innovative techniques, Medco Health has effectively managed drug trend among its clients to 12.9 percent, representing the fourth consecutive year Medco Health has reduced drug trend for its clients. The 2003 Drug Trend Report reveals some notable and interesting shifts in drug trend drivers across all demographic groups. Among the findings:

• Drug price inflation increased 33% in 2002 over 2001, contributing the largest portion of drug trend in 2002 and outpacing traditional trend drivers including drug mix (the move to new, often more expensive, therapies), increase in the number of people taking medications and the increase in days of therapy. The unit cost (cost per pill) accounted for approximately 64% of drug trend in 2002, up from approximately 41% in 2001.

• Spending on specialty pharmacy drugs increased by roughly 40% in 2002. In fact, if specialty drugs represented a specific category of medication, it would represent the fifth largest category of drug spend in 2002, and the third largest driver of drug trend.

• As the diabetes epidemic continues to grow, costs for therapy and supplies may rise significantly; the latest insulins are approximately 42% more expensive on a cost-per-day basis.

• For the second consecutive year, the children's age category, 0-19, had the highest overall drug trend increase at 16.4%, with seniors 65 years and older next in line at 14.8%. Children still rank lowest in drug spend at approximately $12 per member per month, with seniors highest at approximately $118 per member per month.

The Medco Health Solution

Medco Health works closely with its many clients to develop optimal plan designs and formulary solutions, ranging from the widespread adoption of generic medications when appropriate to the development of step therapy programs, to help manage the growing trend in prescription drug spending.

"By applying innovation and creativity to our deep understanding of the prescription drug business, we have proven that prescription drug costs can effectively be moderated while still providing members with the level of care and service they expect," said David Snow, president and CEO, Medco Health.

Among the cornerstones of its drug trend management efforts, Medco Health's Generics First program, the nation's first generic drug sampling and education program, demonstrated a significant jump overall in the generic prescribing rates of physicians participating in the program over prescribing rates of a comparison group of physicians in 2001.

Additionally, Medco Health strongly advocates the use of home delivery pharmacy for patients on chronic medications. During 2002, 82 million were dispensed and delivered to patients using the company's integrated network of 11 home delivery pharmacies including the two largest automated pharmacies, as well as customer-care call center pharmacies and medcohealth.com, the world's largest internet pharmacy.

To identify key indicators of potentially inappropriate use of medications, Medco Health's integrated data management looks beyond just pharmacy claims and examines pharmacy, medical and lab data.

In response to the growing need for specialty drugs, Medco Health recently added a dedicated specialty pharmacy to its clinical Centers of Excellence. By managing the dispensing of specialty drugs within the pharmacy benefit rather than the medical benefit, clients can leverage Medco Health's buying power with manufacturers to reduce the costs of these expensive therapies by as much as 50 percent.

"While we are showing progress in reducing costs, drug trend management requires a concerted effort on the part of plan sponsors, plan members, clinicians and PBMs," said Epstein. "We have at our disposal a number of resources to affect change; however, we all must dedicate ourselves to maximizing those resources for the betterment of the system."

About Medco Health

Medco Health Solutions, Inc., is the nation's leading provider of prescription healthcare services, based on $33 billion in sales in 2002. Medco Health is a wholly owned and independently managed subsidiary of Merck & Co., Inc. (NYSE:MRK) and assists its clients to moderate the cost and enhance the quality of prescription drug benefits provided to about 62 million Americans.