US prices of branded medicines within the traditional therapy classes rose 9.1% last year compared to a 7.4% rise in 2008, while for specialty drugs the increase was 11.5%, up from 2008’s advance of 9.4%, says a new survey.

Overall, US drug spending increased 6.4% last year, a higher rate of rise than in recent years, according to pharmacy benefit management (PBM) company Express Scripts’ latest annual Drug Trend Report, published this week.

“Drug-price inflation for branded products was the single most important factor driving up cost/unit in 2009. Although pricing decisions by pharmaceutical manufacturers depend on many components, manufacturers take advantage of inertia in the market,” the Report comments, adding: “in classes with limited therapeutic competition, manufacturers may believe that plan sponsors will not actively manage drug use through formularies or other trend-management tools, such as step therapy.”

Other trends illustrated in the report are that diabetes treatment was the leading driver of total spending increases in the US traditional drug sector last year, due to high levels of utilisation and cost per prescription, and that spending on viral infection treatments rose around 25%, mainly because of increased use of flu drugs.

The study also reports on new research by Express Scripts which indicates that $163 billion-worth of prescription drug spending is “wasted” in the US every year. Of this total, wastage worth $106 billion results from the medical costs of people failing to take their medicines as prescribed, while $51 billion relates to “missed opportunities” from lower-cost alternatives – both brand and generic – and $6 billion is due to missed opportunities relating to lower-cost options for medicines delivery.

Breaking down behaviour-related waste by therapy class, the Report estimates that, for example, 35.5% of the nation’s annual spending on drugs to treat high cholesterol could be saved as a result of “better behaviour.”

“If we optimized every individual’s behavior relating to prescription drugs, we could achieve savings that in five years would cover the projected costs of the recently-passed national healthcare reform legislation,” said Steven Miller, senior vice president and chief medical officer at Express Scripts.

Meantime, pharmacy provider CVS Caremark has published a study looking at the reasons why some patients who want to take their medications as directed still fail to do so. The study found that:

- 24% of such patients felt that taking prescribed medications interferes with personal priorities like taking care of family members, compromising social aspects of their lives, or that they find it “just another in a long line of chores to keep track of;”
- for 21%, it was because taking their medicine made them feel as though they were losing control of their lives and, sometimes, by stopping their medicine they felt they were resisting authority;
- 16% felt they knew better than their doctors what was good for them, with some believing they should take care of their health through exercise and diet;
- another 16% came to see that they were wary of the health care and pharmaceutical industries and did not want to become dependent on medications or suffer unknown side-effects; and
- 6% did not want to change their personal routines, so they simply put off taking their medications.

Past studies have shown that a quarter of people receiving prescriptions never fill their first prescription, and patients with chronic diseases such as diabetes and coronary artery disease adhere to their ongoing medication regimen for only around half of the time, says CVS Caremark. Non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the US health care system estimated at about $300 billion annually, it adds.