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MANAGED CARE OUTLOOK

Wide variation in pharmacy utilization

On a per-capita basis, prescription drug use in the U.S. is generally highest in the South and Midwest, and lowest in four states with high managed care penetration — California, Massachusetts, Colorado, and New York. These per-member, per-year utilization averages are based on an analysis by Express Scripts, the pharmacy benefit manager, of its commercial population in 2000.

Express Scripts found wide regional variation not only in overall utilization, but in specific classes of medications. Among four classes, the top and bottom five states — in terms of per-member, per-year number of prescriptions filled for each class — are shown in the tables.

Cardiovascular agents
Top 5 statesBottom 5 states
StateUtilizationStateUtilization
West Virginia1.63Colorado0.77
Kentucky1.47California0.81
Tennessee1.47Montana0.87
South Carolina1.47Idaho0.87
Mississippi1.44Vermont0.90
Antihyperlipidemic medications
Top 5 statesBottom 5 states
StateUtilizationStateUtilization
Kentucky0.55New Mexico0.28
Rhode Island0.55Colorado0.29
Maine0.53Idaho0.29
Ohio0.51Alabama0.32
West Virginia0.51Montana0.32
Antiasthmatic drugs
Top 5 statesBottom 5 states
StateUtilizationStateUtilization
Rhode Island0.50Mississippi0.16
New Hampshire0.37Arkansas0.17
Maine0.34Louisiana0.19
Michigan0.33South Carolina0.19
Ohio0.33Florida0.19
Antidepressants
Top 5 statesBottom 5 states
StateUtilizationStateUtilization
Utah1.11New Jersey0.39
Maine1.03New York0.44
Oregon0.86California0.47
Washington0.83Florida0.50
Kentucky0.79Alabama0.54

SOURCE: ATLAS OF PRESCRIPTION DRUG UTILIZATION FOR THE UNITED STATES, EXPRESS SCRIPTS, ST. LOUIS, 2001