MULTIPLE NSAID PRESCRIPTIONS IN A MEDICARE MANAGED CARE POPULATION
Karl R Barnum, Albert I Wertheimer, Alan Morrison, and Walter L Straus

OBJECTIVE: To describe the use of multiple nonsteroidal antiinflammatory drugs (NSAIDs) and the cost implications in a Medicare managed care population.

DESIGN: Retrospective analysis of prescription drug database records.

SETTING: Three Medicare managed care plans in the West and South.

PATIENTS: The population consisted of 22,544 patients who filled prescriptions for one or more different nonaspirin NSAIDs during a six-month period beginning March 1, 1998.

MAIN OUTCOME MEASURE: Prescriptions for nonaspirin NSAIDs, misoprostol, proton-pump inhibitors, sucralfate, and analgesic drugs.

RESULTS: A total of 12.6% of individuals filled prescriptions for two different NSAIDs, and 2.3% filled prescriptions for between three and five different NSAIDs. As the number of NSAIDs increased from one to five, there was a decrease in the generic:brand-name ratio from 4.3:1 to 0.93:1, an increase in the total days' supply from 39 to 310 days (for the 180-d period), an eightfold increase in the coprescription of misoprostol, a twofold increase in coprescription of analgesics, and an increase in payments per person for all NSAIDs and listed coprescribed drugs from $51.67 to $403.00.

CONCLUSIONS: A small subset of individuals in Medicare health plans fill prescriptions for multiple NSAIDs, concomitant with increased use of brand-name drugs, increased coprescription of misoprostol and analgesics, and increased drug costs. Healthcare providers should scrutinize this population and consider whether alternative therapeutic approaches might be appropriate.

J Pharm Technol 2001;17:44-8.