Iowans have increased their use of prescription heartburn medications by 35% over the last three years, according to a new report by Wellmark Blue Cross Blue Shield.Wellmark is Iowa’s largest health insurer and also offers health plans in South Dakota. In order to educate their clients about the high cost of prescription drugs, they publish a series of reports analyzing the use of different classes of prescription drugs. The most recent report details the increase in costs for prescription proton pump inhibitors (PPIs), including Nexium, Prevacid, Prilosec, and Protonix.
South Dakota rates of prescription PPI use, unlike in Iowa, have only increased by 7% over the last three years. Nationwide, 78 patients out of 1,000 use PPIs. Both Iowa and South Dakota are below the nationwide rate, at 70 and 48 patients per 1,000.
Wellmark’s summary of its analysis states, "In the last five years, PPI use by Wellmark members climbed 253 percent…." Furthermore, spending on PPIs increased by 325 percent, more than four times as much as in 1999.
According to the Wellmark Report, there are a number of reasons why the use of prescription PPIs may have increased so drastically in recent years. The FCC loosened standards on advertising for prescription drugs. Drug companies have taken advantage of the decision and are advertising newer, more expensive, drugs, rather than their older medicines that may be as effective. Drug companies have increased their direct-to-consumer advertising by 35% between 1999 and 2002. All of these factors together mean that patients are more aware of the newer prescription options open to them. The advertising has also increased awareness about conditions that may have previously gone untreated.
In addition, very few PPIs are available in a generic format. Of the top PPI medicines, only Prilosec (omeprazole) is available in a generic format. Only 17 percent of PPI prescriptions in Iowa and South Dakota were for the generic omeprazole. While most generic drugs are much cheaper than their prescription counterparts, omeprazole started out at nearly the same cost as brand name Prilosec. In 2004, the price has now dropped by one-third, although usually generics cost at least 40% less than their brand name counterparts.
Although Wellmark does not criticize doctors for overprescribing expensive prescription drugs, the report does state that some patients may be served just as well by generic or over-the-counter medications. Antacids (including Tums and Rolaids) and H2 blockers (such as Pepcid and Zantac) can treat symptoms of heartburn. The report also suggests that patients may keep taking the prescription PPIs for longer than necessary.
