For the first time, a majority of insured Americans are being treated for a chronic medical condition, according to a new report from the pharmacy benefit manager Medco.

In 2007, 51% of insured Americans were taking prescription drugs to treat at least one chronic health problem. Many of these patients are on multiple medications. One-fifth of the population used three or more chronic drug treatments last year, contributing to soaring medical costs and raising concerns about the health of the nation.

"It appears that we have now reached the tipping point where treating chronic diseases and conditions is more common than not," says Dr. Robert Epstein, Medco's chief medical officer. "This data does paint a pretty unhealthy picture of America. But there is a silver lining. It does show that people are receiving treatment, which can prevent more serious health problems down the road."

However, Steve Raetzman, a health care consultant with Watson Wyatt, comments, "[Employers] should be alarmed, and it's only going to get worse because, basically what's happening is, we're all getting older. That's why getting a [better] primary care system is important."

He advises employers to "get more people with chronic conditions to participate in your programs to help them manage their chronic conditions. It's the single best way to control the cost of health care. It does have a return on investment."

Looking ahead

Overall, Medco expects drug utilization to increase by 2% to 3% this year and the same amount in 2009 and 2010. Likewise, it expects drug prices to increase by 4% to 6% this year and the same amount over the next two years.

The relatively low 2% drug trend in 2007 is attributed mainly to savings from use of generics and mail-order pharmacies, Medco researchers assert.

For the future, key trend drivers may include patent expirations; some expected conversions to over-the-counter status; changes in disease prevalence, disease recognition or diagnostic criteria; new drug approvals; new indications for existing drugs; and new combination products, the study notes.

Drugs with U.S. sales of almost $24 billion could lose patent protection in the next three years, opening the door for lower-cost generic versions. Treatments for cancer, infections and central nervous system disorders are the leading areas of new drug development.

Top meds

Diabetes drugs are the top drivers of drug inflation now, recently surpassing lipid-lowering drugs.

Meanwhile, treatments for neurological problems, mental health and pain were the top therapeutic categories contributing to drug spending in 2007, followed by cardiovascular problems and gastroenterology.

Spending declines for lipid-lowering drugs, antidepressants and nonnarcotic pin relievers helped to moderate the overall trend.

Treatments for high cholesterol and high blood pressure were the most commonly used medications overall, with more than 20% of Americans on antihypertensives, and almost 14% on cholesterol-lowering drugs. These also were among the top four medications taken by men ages 20 to 44, whose use of cholesterol-lowering drugs surged more than 80% over a seven-year period.

"Younger people are increasingly being treated for heart-disease-related conditions, such as high cholesterol and hypertension," observes Epstein. "There's no doubt that rising rates of obesity are having a major impact on our health. These chronic conditions are incredibly costly for the nation and will become exponentially so if we're seeing these problems show up at a younger and younger age."

Medco identified narcotic pain relievers, anticoagulant and antiplatelet drugs, and medications used to treat attention deficit hyperactivity disorder as therapeutic classes to watch for rapid spending growth. In contrast, antihyperintensives, ulcer and heartburn drugs, antibiotics and allergy drugs showed relatively slow growth in spending last year.

In the specialty drug category, the top therapeutic areas included autoimmune conditions (26% of specialty drug spending), multiple sclerosis (17.4%), cancer (17.3%) and growth hormone deficiency (6.1%).Overall, specialty drugs account for 11% of total drug spending. Medco does not expect generic equivalents to become available for most of those drugs.

While senior citizens unsurprisingly show the highest prevalence of chronic medication use, younger adults are quickly catching up.

Notably, 48% of women ages 20 to 44 are being treated for a chronic condition, compared to one-third of men their age. Antidepressants are the most commonly used medication among this group, with 16% of women ages 20 to 44 taking them.

This demographic group also claimed the sharpest increases in the number of patients on chronic medications, rising more than 20% between 2001 and 2007, the study indicates.