Expert Offers Advice on How to Lower Spending on Drugs.

ATLANTA -- Physicians have a tremendous role to play in reining in out-of-control pharmaceutical spending, and much of the job boils down to having an impact on utilization, Dr. Joseph Raduazzo said at the annual meeting of the American College of Physicians-American Society of Internal Medicine.

Total pharmaceutical expenditures rose from $37.7 billion in 1990 to $121 billion in 1999. And although the actual cost of medications has increased at more than double the rate of inflation, most of what's driving the soaring rate of pharmaceutical spending is direct-to-consumer advertising and subsequent increased utilization of drugs.

Case in point: The number of prescriptions per capita increased by 37% between 1992 and 1998, said Dr. Raduazzo of Tufts Managed Care Institute, Boston.

At the same time, the majority of Americans have some form of prescription drug coverage and are actually contributing less in copayments than they did before. A widely unknown fact, he said, is that out-of-pocket expenditures have sharply decreased, from almost 60% in 1990 to less than a third of drug costs in 1998.

The good news is that because utilization is the main culprit, physicians can have an impact.

But for physicians in independent practice associations, that may mean rolling up their sleeves and delving into the nitty-gritty realm of formulary development, he commented.

Dr. Raduazzo suggested the following ways that physicians can have an impact: