Lin, HW

Lin, SJ

Pickard, AS

Shaw, JW

Tsai, HH

Wittenberg, RD

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PHP33 HERB/DIETARY SUPPLEMENT AND PRESCRIPTION DRUG USE TRENDS AMONG US ADULTS, 1999-2004 

days at intensive care unit. The incremental cost per bed-day
saved was R$419,66. CONCLUSION: The NAGIS(c) model of
managed high cost patient, called Case Management Program is
cost-effective where the incremental cost per bed-day saved is
$419,66, and its return of investment is highly positive.
PHP31
DRUG PROXIES FOR IDENTIFYING SPECIFIC DIAGNOSES IN
MEDICARE PART D
Livengood KB, Harada A, Gong S, Stockl K, Le L, Zhang S
Prescription Solutions, United Health Group, Irvine, CA, USA
OBJECTIVE: The purpose of this analysis was to develop a
method for identifying Medicare Part D members with cardio-
vascular disease using medication proxies. METHODS: A binary
matrix was created from cardiovascular medication prescription
claims for Medicare Part D MAPD and commercial members
from the ﬁrst quarter of 2007. The binary matrix was subjected
to factor/principal component analysis. The maximum valued
factor loading for each of the generated components were then
used to create a member/factor loading matrix. This matrix was
used to derive beta coefﬁcients, from logistic regression, to cal-
culate a member’s probability of having hypertension, CAD, or
CHF. RESULTS: One-hundred and twelve factors were produced
over 696,471 members prescribed cardiovascular medications.
Different probability thresholds were evaluated to determine the
sensitivity and speciﬁcity for the identiﬁcation method. The
threshold probabilities ran from >0.30 to >0.975. As the thresh-
old probabilities increased, sensitivity/speciﬁcity for hyperten-
sion, CAD, and CHF ran from 0.99/0.50–0.50/0.99, 0.61/0.91–
0.50/0.99, and 0.63/0.96–0.50/0.99, respectively. A similar result
was produced using maximum score coefﬁcients resulting from
the principal component analysis. CONCLUSION: Although
this approach to identifying members with medication proxies
appears to separate members with and without certain cardio-
vascular conditions, it tends to exclude members at the cost of
minimizing erroneously identiﬁed members.
HEALTH CARE USE & POLICY STUDIES—Drug Use
PHP32
WHAT’S DRIVING PRESCRIPTION COPAYMENTS?
Cox E1, Svirnovskiy Y2
1Express Scripts Inc, Saint Louis, MO, USA, 2Express Scripts, Saint
Louis, MO, USA
OBJECTIVE: Some contend that prescription copayment
increases reﬂect a disproportional shifting of costs to members
while others believe that copayments are simply keeping pace
with rising prescription costs. To better understand the drivers of
prescription cost sharing, this analysis examines recent trends
in member copayments relative to total prescription costs.
METHODS: The study is a retrospective descriptive analysis of
prescription claims data for a sample of commercially-insured
members enrolled with Express Scripts between 2002 and 2006.
Plan sponsors included in the analysis offered integrated prescrip-
tion coverage within an employer-based market (no Medicare or
Medicaid). For each year, the data represent prescription claim
activity for over 18 million members. Total per-prescription costs
were calculated as the sum of the discounted ingredient cost,
dispensing fee, administrative fees and any applicable tax divided
by the number of 30-day equivalent prescriptions. Average
member per-prescription cost was calculated as the total member
cost divided by the total number of 30-day equivalent prescrip-
tions. Costs were calculated separately for generics, preferred
brands and non-preferred brand-name prescriptions. RESULTS:
From 2002 to 2006 the average total per-prescription cost
increased $10.23 or 20.5% while the average member per pre-
scription copayment increased by $1.70 or 14.3%. The propor-
tion of total costs paid by members decreased from 24% in 2002
to 23% in 2006. Per-prescription member costs increased by
10% for generics, 25.7% for preferred brands and 58.6% for
non-preferred brands. CONCLUSION: These ﬁndings suggest
that plan sponsors are not shifting a greater proportion of costs
to members, nor is member cost share keeping pace with rising
prescription costs. Actual per-prescription member cost share
increased at a modest rate, inﬂuenced by increased generic use
which grew from 42% in 2002 to 58% in 2006.
PHP33
HERB/DIETARY SUPPLEMENT AND PRESCRIPTION DRUG USE
TRENDS AMONG US ADULTS, 1999–2004
Lin HW1, Pickard AS2,Wittenberg RD1,Tsai HH3, Lin SJ1, Shaw JW1
1University of Illinois at Chicago, Chicago, IL, USA, 2College of
Pharmacy, University of Illinois at Chicago, Chicago, IL, USA, 3China
Medical University,Taichung,Taiwan, Changhua City, Changhua County,
Taiwan
OBJECTIVE: The aim of this study was to evaluate trends in the
use of herbs and dietary supplements (HDS) in relation to pre-
scription drug (Rx) use, as well as their individual use, among US
adults from 1999–2004. METHODS: Data were abstracted from
the 1999–2000 and 2003–2004 cycles of the National Health
and Nutrition Examination Survey (NHANES). HDS included
herbs, vitamins, minerals, and other supplements. Trends in HDS
and/or Rx use were examined based on stratiﬁed characteristics
(i.e., sociodemographics, insurance coverage, health care visits
during the preceding year, chronic conditions). Sampling weights
were adjusted to allow for the pooling of data from multiple
waves. RESULTS: Overall, the proportion of HDS users
increased from 51.2% during 1999–2000 to 53.0% during
2003–2004, while that of Rx users increased from 49.9% to
55.6% over the same period. Between 1999 and 2004, the pro-
portion of HDS-only users decreased while the proportion of
people who only used Rx increased. The concomitant use of HDS
and Rx increased for most subgroups, except for those who had
an annual household income less than $14,999 or greater than
$65,000, and who had never have health care visits during the
preceding year. CONCLUSION: Trends suggest that concomi-
tant HDS and Rx use increased over the period of observation in
the general US population. Further research is needed to inves-
tigate the outcomes of concurrent HDS and Rx use.
PHP34
PRINCIPAL COMPONENTS ANALYSIS OF DRUG UTILIZATION
AND EXPENDITURETRENDS FOR MAJORTHERAPEUTIC
CLASSES IN U.S. MEDICAID PROGRAMS
Jing Y1, Nguyen K1, Guo JJ1, Fan H2, Li X1, Kelton CM1
1University of Cincinnati, Cincinnati, OH, USA, 2Covance Inc, Sun
Prairie,WI, USA
OBJECTIVE: Drug expenditures have been increasing much
faster than spending on other medical services and have become
burdensome for state Medicaid programs. This study was to
analyze the trends of Medicaid drug utilization and expenditures
across all major therapeutic classes and to identify their similari-
ties and differences. METHODS: Quarterly Medicaid reim-
bursed drug prescriptions and dollar amounts for each drug were
extracted from the national claims data from the Centers for
Medicare & Medicaid Services for 1991 through 2004. Expen-
ditures were aggregated across all drugs in 64 different therapeu-
tic classes, providing 64 different time series of length 56 quarters
A38 Abstracts


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PHP33 HERB/DIETARY SUPPLEMENT AND PRESCRIPTION DRUG USE TRENDS AMONG US ADULTS, 1999-2004

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