Update on Psychotropic Drug Prescribing in the United States: 2014–2015

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Our February, 2011 editorial in these pages analyzed psychotropic drug prescribing patterns in the United States for calendar year 2009.1 This analysis included data on numbers of outpatient retail prescriptions for individual psychotropic drugs and drug classes, along with information on costs and expenditures. The principal data source at that time was “SDI/Verispan, VONA.” The information was provided to and subsequently published on an annual basis by Drug Topics, and included listings of the top 200 prescription drugs, with separate lists for generic and brand-name drugs, and rankings according to number of prescriptions as well as dollar sales revenue.
More than 5 years have elapsed, and we have updated our analysis of psychotropic drug prescribing patterns, anticipating that the landscape might have changed in significant ways. New drug entities have become available, many brand-name drugs have become generic, and some drug entities have been approved for new indications or with new dosage forms. Over the same time interval, the corporate landscape has also changed, and the extensive listings described above are no longer available. More limited listings can be obtained via sources such as Statista.com, Medscape.com, Drugs.com, and IMS Health, but none is comparable to what was available for our previous review.
For the present analysis, we identified two potential sources of outpatient retail prescription data: Symphony Health Solutions Corp., and ClinCalc.com/DrugStats. Symphony covers calendar year 2014, and ranks the top 200 drugs by number of prescriptions. ClinCalc ranks the top 300 for a 12-month period from mid-2014 to mid-2015. The two sources provide similar but not identical prescription numbers for individual drugs, with Symphony estimates being on average 26% higher than those from ClinCalc. Because ClinCalc included more drugs in their ranking, we used this source for our subsequent analysis. The ClinCalc data comes from the annual Medical Expenditure Panel Survey (MEPS), a survey conducted by the Agency for Healthcare Research and Quality, a federal agency. All data is publicly available at no cost on the MEPS web site.
Neither ClinCalc nor Symphony provides data on expenditures or sales. To acquire cost information, we used Data-Rx.com, which gives retail costs of all marketed brand-name and generic prescription drugs. We assumed that a typical prescription contained 100 dose units, and calculated total expenditures for that drug as the product of number of prescriptions multiplied by the cost of the typical prescription. In our earlier analysis, this calculation method yielded expenditure estimates that were close to the actual expenditures available at that time from the data base.1
With only 2 exceptions (vilazodone and lurasidone), all drugs on the list were available as generics, and most of those continued to be obtainable as the original brand names as well (Table 1). The lower generic cost was used for the expenditure estimates, and we calculated a brand/generic cost ratio when both were available. Note that we did not include stimulants, analgesics, anticonvulsants, or GABAergic drugs (gabapentin, pregabalin) in the analysis, and no information was available on drugs that did not fall into the top 300. Among drugs not represented on the list are newer agents (suvorexant, vortioxetine, paliperidone, and others), as well as older drugs (clozapine, chlordiazepoxide, triazolam, lithium, monoamine oxidase inhibitors, and others).
Total psychotropic drug prescriptions for the target one-year period were just under 380 million. Of these, only 3.2 million (0.8% of the total) were accounted for by the 2 brand-name drugs; the rest were generic (Tables 1 and 2). Consistent with our previous report1 and data from other sources,2 antidepressants accounted for 58% of all prescriptions (Fig. 1). Anxiolytics, hypnotics, and antipsychotics accounted for 22%, 15%, and 5% of prescriptions, respectively.
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