US prescription drug use fell in 2008, study says

NEW YORK – Prescription drug use in the U.S. fell last year, although total spending on drugs increased as prices rose sharply on brand-name products, pharmacy benefits manager Medco Health Solutions said Wednesday.

Medco said the overall decline in prescriptions was the first in a decade. The company, which handles drug benefits covering about 60 million people, said total prescription use was down because few new drugs were launched last year, former blockbuster drugs like Zyrtec became available without a prescription, and some drugs faced safety issues that led to decreased use.

Those factors had a bigger impact on prescriptions than the recession, the company said.

Total spending grew 3.3 percent, Medco said, mainly due to greater use of "specialty" drugs, which often treat chronic or complex illnesses. The strongest growth came from diabetes drugs, and use of specialty treatments for cancer, along rheumatological disease, seizure disorders and antiviral drugs also increased. The average price of brand-name pharmaceuticals rose more than 8 percent in 2008, the fastest increase in five years.

Medco said specialty drug prices are rising more quickly than those for other drugs. Specialty drugs often require special handling that is not needed for other drugs, like refrigeration or protection from light, and many must be administered by a doctor or nurse instead of the patient.

Drugmakers tend to raise the price of a product as the date of its patent expiration approaches. After the key patents supporting a drug expire, generic versions usually reach the market and are available for a fraction of the price.

Several drugmakers cited higher prices in their first-quarter earnings reports. Bristol-Myers Squibb, which makes the anti-clotting drug Plavix, said higher prices were responsible for half its revenue growth in the first quarter of 2009.

Medco projects prescriptions will rise no more than 1 percent in 2009 and in 2010 as well. But it believes higher prices will lift total spending by 3 to 5 percent this year and 4 to 6 percent next year.

Franklin Lakes, N.J.-based Medco is the largest pharmacy benefits manager in the U.S. The company filled almost 800 million prescriptions last year.

Revenue from specialty drugs rose almost 16 percent for the year. Medco said growing use of low-cost generic drugs reduced the growth in total spending: 64 percent of all prescriptions were filled with generic drugs. Medco and other pharmacy benefits managers make a larger profit when generic drugs are substituted for brand-name ones. They encourage health plans to develop ways to increase use of generics and 90-day mail-order prescriptions.

Some drugs that were previously available only with a prescription became over-the-counter in 2008, reducing total prescriptions. The biggest names were Zyrtec, an allergy medication, and the laxative Miralax. Drug use was essentially flat with 2008 if Zyrtec and Miralax are excluded, Medco said.

Prescriptions for people 19 and under grew faster than for any other age group. Medco said that was due to rising rates of diabetes among the young, and more prescriptions for attention deficit disorder and similar problems.

Several billion dollar-selling drugs took hits due to potential safety issues last year. Sales of the diabetes treatment Avandia fell after the Food and Drug Administration added new warnings to its labeling, pointing out concerns about heart problems. Sales of the cholesterol drug Vytorin fell after a study released in January showed it was no better than an older drug, Zocor, at reducing plaque buildup in neck arteries. Zocor is available in generic form for about 80 percent less.

Sales of Amgen's Aranesp and other drugs used to treat chemotherapy-induced anemia have been sliding for two years, since studies connected the drugs to the faster growth of some tumors. Medco said safety issues also affected sales of osteoporosis drugs and hormone replacement therapies, and product recalls hurt sales of migraine and cough and cold therapies.

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Births to unwed moms rising, N. Europe beats US

ATLANTA – The percentage of births to unmarried women in the United States has been rising sharply, but it's way behind Northern European countries, a new U.S. report on births shows.

Iceland is the leader with 6 in 10 births occurring among unmarried women. About half of all births in Sweden and Norway are to unwed moms, while in the U.S., it's about 40 percent.

France, Denmark and the United Kingdom also have higher percentages than the United States, according to the report from the U.S. Centers for Disease Control and Prevention.

The U.S. and at least 13 other industrialized nations have seen significant jumps in the proportion of unmarried births since 1980, said Stephanie Ventura of the CDC's National Center for Health Statistics.

Rates have doubled and even tripled in these countries, according to the CDC report released Wednesday.

"Basically we're seeing the same patterns," Ventura said, noting the trend has accelerated in the last five years.

Experts are not certain what's causing the trend but say there seems to be greater social acceptance of having children outside of marriage.

"The values surrounding family formation are changing and women are more independent than they used to be. And young people don't feel they have to live under the same social rules that their parents once did," said Carl Haub, a demographer at the Population Reference Bureau in Washington, D.C.

But there are differences in how unmarried pregnancies are viewed in different countries.

In the United States, unmarried mothers are more likely to be on their own and — traditionally — they are more likely to be poor and uneducated, experts said.

In northern Europe, men and women more often live together in unmarried, long-term, stable relationships, Haub said. Because of declining birth rates in some European countries, people tend to be more focused on whether the baby is born healthy instead of whether the mother is married, Haub said.

He predicted that the total number of births internationally will decline — that's already happening in some European countries — because of faltering economies. But he expects trends in the percentage of mothers who are unmarried will persist.

The CDC previously has reported on the percentage of U.S. births to unmarried mothers. The new report gathers previously released information from other countries to make an international comparison.

The report shows trends from 1980 to the most recent years available — 2007 for the United States and most of the other countries, but 2006 for six nations.

Japan had the lowest percentage of unmarried births, with 2 percent in 2007, up from 1 percent in 1980.

Increases were much more dramatic in the other countries, with Italy rising from 4 percent to 21 percent, Ireland from 5 percent to 33 percent, Canada from 13 to 30 percent, and the United Kingdom from 12 percent to 44 percent.

The U.S. proportion of unmarried births rose from 18 percent to 40 percent during that period, according to the report.

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On the Net:

The CDC report: http://www.cdc.gov/nchs

(This version CORRECTS U.S. number to 40 percent in last graf.)

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Swine flu fears evident as world's cases top 6,000

MEXICO CITY – In China, mask-wearing police cordoned off more hotels Wednesday, quarantining anyone who came in contact with swine flu patients, no matter how mild their symptoms. Not so in Mexico, where the health secretary encouraged tourists to come relax in their favorite vacation spots despite a growing swine flu caseload.

The global outbreak appears mild, but skittishness is evident. Not long after Switzerland lifted its advisory against travel to Mexico and the United States, the Japanese national women's soccer team canceled a tour to North America, where most swine flu cases have been reported.

And in China, hundreds of people have been quarantined inside hotels, hospitals and homes after they came in contact with several infected plane or train travelers from Canada and U.S. The U.S. Embassy said Americans are among those quarantined.

There are now 33 countries reporting an estimated total of 6,080 confirmed swine flu cases, including 3,009 in 45 U.S. states, 2,446 in Mexico and 358 in Canada. But the death total is relatively low — 65, of which 60 were in Mexico, three in the U.S., one in Canada and one in Costa Rica.

Health Secretary Jose Angel Cordova said Wednesday that Mexico has tested about 9,000 sick people, working through a backlog of samples taken before and after the virus was identified as swine flu — and found that Mexico's dead represents 2.5 percent of confirmed cases, suggesting the virus is not as deadly as intitially feared.

Pneumonia, often brought on by regular seasonal flu, may be much more deadly, Cordova said — killing 9,500 people in Mexico last year. The last death from swine flu was on May 7, he said.

Cordova also addressed Mexico's hard-hit tourism industry, saying there are "very few" cases in tourist destinations — including 7 in Cancun.

"There is no risk for tourists — they can return to these relaxing vacation spots," he said.

There is a danger the virus will mutate into something more dangerous — perhaps by combining with the more deadly but less easily spread bird flu virus circulating in Asia and Africa, according to experts at the U.S. Centers for Disease Control and Prevention.

Another concern is that it will combine with the northern winter's seasonal H1N1 virus. While not unusually virulent, it was resistant to Tamiflu, and health officials worry it could make the new swine flu resistant to Tamiflu as well.

With swine flu still spreading around the globe, the World Health Organization is warning countries to limit the use of antiviral drugs to ensure adequate supplies.

European countries have been using antiviral drugs such as Tamiflu and Relenza much more aggressively than the U.S. and Mexico, administering them whenever possible in an attempt to contain the virus before it spreads more widely.

Officials from EU and Latin American nations, including Mexico, were meeting in Prague on Wednesday to discuss the threat.

A WHO medical expert, Dr. Nikki Shindo, said the U.N. agency thinks antivirals should be targeted mainly at people already suffering from other diseases or complications — such as pregnancy — that can lower a body's defenses against flu.

The CDC also said pregnant women should take the drugs if diagnosed with swine flu — even though the effects on the fetus are not completely known.

Pregnant women are more likely to suffer pneumonia when they catch flu, and flu infections have raised the risk of premature birth in past flu epidemics. A pregnant Texas woman with swine flu died last week, and at least 20 other pregnant women with swine flu have been hospitalized in the U.S., including some with severe complications.

For all these reasons, risks from the virus are greater than the unknown risks to the fetus from Tamiflu and Relenza, said Dr. Anne Schuchat of the CDC.

"We really want to get the word out about the likely benefits of prompt antiviral treatment" for pregnant women, she said.

Mexico now gives Tamiflu to anyone who has had direct contact with a person infected with swine flu, Cordova said. And now that schools are back in session, authorities plan to give it to any children who show symptoms and are suspected of being infected.

In Mexico's Baja California state, on the U.S. border, 5,689 children were turned away from schools when classes resumed because they had symptoms like runny noses, headaches or sore throats, the state education department reported Tuesday.

Swiss pharmaceuticals company Roche Holding AG announced it was donating enough Tamiflu for 5.65 million more people to WHO. A further 650,000 packets containing smaller doses of the drug will be used to create a new stockpile for children.

Mexican authorities had enough Tamiflu for 1 million people at the start of the outbreak and have received more, building reserves of 1.5 million courses.

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Medicare won't cover 'virtual colonoscopy'

WASHINGTON – Medicare won't pay for the so-called virtual colonoscopy procedure, concluding Tuesday that there's inadequate evidence to support the cheaper, less intrusive alternative to the dreaded colonoscopy.

Some experts had hoped that popularizing the X-ray procedure would boost screening for colon cancer, the country's second leading cancer killer. Screening to spot early cancer or precancerous growths has resulted in fewer deaths over the last two decades.

But in a decision posted on its Web site, the Centers for Medicare and Medicaid Services said that the test does not qualify for Medicare coverage. The memo noted that the procedure is performed on people without symptoms and cannot, in itself, rid a patient of precancerous growths, like a regular colonoscopy can.

Medicare does cover regular colonoscopies, in which a long, thin tube equipped with a small video camera is snaked through the large intestine to view the lining. Any growth can be removed during the procedure.

CT colonography, also known as virtual colonoscopy, is a super X-ray of the colon that is quicker, cheaper and easier on the patient, but involves radiation. Both procedures involve preparation to clean out the bowels.

The Medicare memo notes that the virtual colonoscopy has shown better precision in detecting larger polyps than smaller ones.

There's been some division of opinion in the medical community over the virtual colonoscopy. Some doctors question its utility since, if a polyp is found, a regular colonoscopy would typically have to follow, anyway.

Others support it, saying it can result in early cancer detection. The American Cancer Society recommends it as an alternative to a regular colonoscopy.

A concern for Medicare officials, according to their decision Tuesday, was the effectiveness of the procedure for the Medicare population — people 65 and older — as opposed to younger patients. More data is needed to answer that, Medicare said.

The U.S. Preventive Services Task Force opted last fall not to give its stamp of approval to the virtual colonoscopy, citing the risk of radiation among other factors. Medicare said it took that decision into account in reaching Tuesday's determination, which is final.

Some private insurers cover the virtual procedure but others don't. Colonoscopies cost up to $3,000 while the X-ray test costs $300 to $800.

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On the Net:

Centers for Medicare and Medicaid Services: http://www.cms.hhs.gov/

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