Impact of Wealth on Rx Utilization

Jun 20, 2013
A new study from Express Scripts shows the highest income individuals use prescription drugs 1.5x more than the lowest income group.

With apologies to F. Scott Fitzgerald, the very rich are different when it comes to prescription drugs.

That’s according to a recent study by Express Scripts that looked at 6 million people whose prescription-drug benefits were covered by commercial health insurance from 2010 to 2012. The study, presented recently at the annual meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in New Orleans, investigated the relationship between income, age and the use of prescription drugs to determine variation by income level and age group.

Wealthy Spend Most on Healthcare

The study found that the highest overall annual healthcare expenditures and prescription-drug use came from the wealthiest groups – those with incomes $150,000 and greater. For prescription-drug use, this pattern was especially apparent in children and young adults, with the highest income group using prescription medications more than 1.5 times more than the lowest income group (measured as days’ supply of medication). The latter is somewhat counterintuitive, as many studies have shown that poor health and poverty are correlated. This correlation is likely to be true but does not seem to play out in the use of prescription medications.

Top Drugs Differ Among Income Groups

Which drugs were used also differs by income. When comparing the top 10 therapy classes in terms of utilization, the lowest income group was the only one in which pain and inflammation medications were in the top 10 and contraceptives were not. In the wealthiest group of patients, prescription allergy medications and drugs used to treat infections were in the top 10. Prescriptions used to treat seizures and those used for pain were pushed out of the top 10 for the wealthiest groups.

Top ten therapy classes in four income groups 

One interesting finding: As income rises, utilization for antidepressant drugs and contraceptives increases – perhaps because wealthier persons have access to more aggressive screening and diagnosis for depression and possibly greater motivation to plan pregnancies. Conversely, as income declines, the use of medications to treat high blood pressure and high cholesterol increase.

The study suggests that in our society, consumption of healthcare may approach that of ordinary goods: rising as income rises.

Utilization Rises as Recession Eases

However, growth in utilization during the period 2010 to 2012 was higher in the lower income-level groups. This suggests that the recession of 2007 to 2008 might have taken a greater toll on the household budgets of lower income groups and that actual demand is increasing as economic conditions improve.

In summary, even among a commercially insured population with equal access to prescription medication coverage, utilization varies with income.

Utilization in days supply 

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