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 states		Bottom 5 states
State	Utilization	State	Utilization
West Virginia	1.63	Colorado	0.77
Kentucky	1.47	California	0.81
Tennessee	1.47	Montana	0.87
South Carolina	1.47	Idaho	0.87
Mississippi	1.44	Vermont	0.90
Antihyperlipidemic medications
Top 5 states		Bottom 5 states
State	Utilization	State	Utilization
Kentucky	0.55	New Mexico	0.28
Rhode Island	0.55	Colorado	0.29
Maine	0.53	Idaho	0.29
Ohio	0.51	Alabama	0.32
West Virginia	0.51	Montana	0.32
Antiasthmatic drugs
Top 5 states		Bottom 5 states
State	Utilization	State	Utilization
Rhode Island	0.50	Mississippi	0.16
New Hampshire	0.37	Arkansas	0.17
Maine	0.34	Louisiana	0.19
Michigan	0.33	South Carolina	0.19
Ohio	0.33	Florida	0.19
Antidepressants
Top 5 states		Bottom 5 states
State	Utilization	State	Utilization
Utah	1.11	New Jersey	0.39
Maine	1.03	New York	0.44
Oregon	0.86	California	0.47
Washington	0.83	Florida	0.50
Kentucky	0.79	Alabama	0.54

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