N.C. Medicaid Drug Costs Reflect National Trend.

DENVER -- Whopping increases in Medicaid prescription drug expenditures in North Carolina provide insight into physician prescribing trends that may be broadly applicable elsewhere, Dr. Kenneth Fink said at the annual meeting of the Society of Teachers of Family Medicine.

Between 1998 and 2000, prescription expenditures under the North Carolina Medicaid program rose by 27% annually Three trends accounted for the $287 million increase:

* The ranks of state Medicaid beneficiaries grew by more than 70,000 individuals, explaining $41 million of the $287 million rise.

* Prescribing frequency increased. On average, each North Carolina Medicaid enrollee filled 13 prescriptions in 1998, 14.2 prescriptions in 1999, and 15.5 prescriptions in 2000. This accounted for $103 million worth of the overall increase. Billing data showed that the increased frequency of prescribing wasn't due to a greater patient visit rate or to physicians addressing more health problems per visit.

* A rise in the average cost per prescription-from $39 in 1998 to $49 in 2000--was the most rapidly growing factor, accounting for half of the $287 million increase in prescription expenditures, said Dr. Fink, a family physician and Robert Wood Johnson Foundation Clinical Scholar at the University of North Carolina, Chapel Hill, and a member of the state's Medicaid drug utilization review board.

The increase in average cost per prescription appeared to stem mainly from a change in prescribing patterns that favored more expensive drugs. Six drugs-Prilosec (omeprazole), Zyprexa (olanzapme), Risperdal (risperidone), Prevacid (lansoprazole), Celebrex (celecoxib), and Claritin (loratadine)-accounted for more than 25% of the total increase in Medicaid prescription expenditures.

Prilosec was the program's most expensive drug in 2000, costing the state more ...