Total spending on US medicines fell 3.5% on a real per-capita basis in 2012, and the use of healthcare services overall declined for the second consecutive year, according to a new study from the IMS Institute for Healthcare Informatics.

The report finds that total dollars spent on medications in the US reached $325.8 billion last year, or real per-capita spending of $898, which is a drop of $33 from the previous year.

"That's the first time IMS has ever measured the decline in the 58 years we're been monitoring drugs," Michael Kleinrock, the IMS Institute's director of research development, told the Associated Press.

Underlying drivers for the overall decline in US healthcare service use last year include fewer patient visits to office-based physicians, fewer non-emergency admissions to hospitals and outpatient facilities, and a less severe flu season in the early part of this year, says IMS.

Also, patent expiries during the year contributed $28.9 billion to the reduction in medicines spending - their largest-ever impact as millions of patients accessed lower-cost generic versions of additional medicines.

Insured US patients also paid higher deductibles, co-pays and co-insurance for their overall healthcare last year, although prescription drug co-pays for most patients were down. At the same time, new transformative medicines because available to treat a large number of diseases for which patient populations are small or strictly defined, says the IMS Institute.

"The cost curve for medicines was clearly bent in 2012, for better or for worse," commented Murray Aitken, the Institute's execute director.

"To some extent, this is a harbinger of more efficient use of our healthcare resources, but it also reflects a decline in utilisation that may be the result of under-treatment and an imbalance between prevention and care. On the eve of the most transformative period in US healthcare, understanding the drivers of this cost-curve reduction is critical to effectively addressing the long-term implications," Mr Aitken added.

Included among the report's key findings are:

- changes in the utilisation of healthcare services and medicines: the number of patient visits to US doctors' offices fell 0.9% in 2012, a lower level of decline compared with the previous two years. Outpatient treatment and non-emergency room admissions were also down slightly, and the only increase was seen in emergency room admissions, which were up 5.8% for the year. The use of medicines per person also declined, by just 0.1%, which was partly the result of a milder season for coughs, colds and flu during the initial months of 2012;

- healthcare costs and spending on medicines: the total cost of medicines declined 3.5% on a real per-capita basis to $325.8 billion last year. In addition to lower utilisation of branded drugs, the primary drivers for this were: the increased availability of lower-cost generic drugs, which now account for 84% of all prescriptions written in the US; the moderating impact of price increases; and lower spending on recently-launched medicines. Healthcare costs remain heavily concentrated among relatively few patients suffering from multiple chronic conditions, cancer or other "specialty" diseases. In the case of the commercially-insured US population under the age of 65, 5% of members incurred 51% of total healthcare costs by using more than $15,684 of healthcare services per person last year;

- patient payment for healthcare and medicines: patients with insurance are paying high deductibles and higher co-pays or co-insurance, with nearly 20% of insured people now enrolled in a consumer-driven health plan. Average out-of-pocket costs for the commercially-insured population aged under 65 reached $1,146 in 2012, which is a 30% jump compared to 2011 and is entirely the result of higher deductibles. Meantime, the average pharmacy benefit co-pay declined by $2 to $121 during the year, while patients filled 72% of all retail prescriptions with a co-pay of $10 or less; and

- transformations in disease treatment: US patients gained access to 28 New Molecular Entitles (NMEs) during 2012. They include seven designated by the Food and Drug Administration (FDA) as orphan drugs for rare diseases, plus a novel oral therapy for rheumatoid arthritis, a treat for cystic fibrosis that is set to improve life expectancy significantly for patients with a specific genetic mutation, and an inhaled antipsychotic. Nine new cancer treatments were also introduced - the most in more than a decade - including a breakthrough for the treatment of basal-cell carcinoma.