Americans Cutting Back on Drugs and Doctor Visits

By Katie Thomas for the New York Times

Patients cut back on prescription drugs and doctor visits last year, a sign that many Americans are still struggling to pay for health care, according to a study released Wednesday by a health industry research group.

The report, issued by the IMS Institute for Healthcare Informatics, said 2011 was also a breakthrough year for the drug industry, which introduced 34 new medicines, the most in a decade, to treat diseases including cancer, multiple sclerosis, hepatitis C and others.

The number of prescriptions issued to patients declined by 1.1 percent compared with 2010, and visits to the doctor fell by 4.7 percent, the report said. Visits to the emergency room, by contrast, increased by 7.4 percent in 2011, an increase that the report’s authors said was linked to the loss of health insurance resulting from long-term unemployment.

Michael Kleinrock, director of research development at the institute, which consults for the drug industry, said his research showed that some people with health insurance at the start of the recession actually increased their visits to the doctor out of fear they were about to lose insurance.

But as the economy has failed to strongly recover, “we’re now seeing more people reset their expectations about how often they will use medicine,” he said.

The study found that older Americans, in particular, used fewer medicines: prescriptions for patients 65 and older declined by 3.1 percent last year. The biggest declines were in prescriptions to treat high blood pressure and osteoporosis, according to the report. Mr. Kleinrock said older Americans appeared to be rationing their care as they struggled to pay rising bills on fixed incomes.

“We’re reaching a tipping point where patients will actually take that increased cost and use less medicine,” he said.

Older Americans used fewer prescription drugs even as their out-of-pocket costs fell, the study found. The total out-of-pocket spending on medicines dropped to $9.7 billion, from $11.5 billion in 2010, for those enrolled in the Medicare Part D prescription drug program, available to people 65 and older.

The average co-payment for Medicare Part D recipients fell by $2.66, to $23.31. The report attributed the lower costs to Medicare Part D drug subsidies that began taking effect in 2010 as part of the new health care law.

Leigh Purvis, a senior strategic policy adviser who studies drug prices for the AARP, noted that the drugs that older patients seemed to be cutting back on, including those to treat high blood pressure and cholesterol, “are drugs where you don’t necessarily develop symptoms when you stop taking them.” As a result, she said, some patients may view such drugs as expendable.

She also noted that while the overall cost had decreased as more Americans took generic drugs, the prices for brand-name drugs had jumped in recent years, driving up costs for people with medical conditions that require them to take drugs without a generic equivalent.

Even as fewer Americans were using prescription drugs, the opposite was true for young adults aged 19 to 25. Prescriptions for those patients rose by 2 percent compared with 2010, a change that Mr. Kleinrock said was because the health care law allowed adult children under 26 to be covered by their parents’ health care plan.

The federal government has estimated that 2.5 million people have taken advantage of that benefit, which took effect in September 2010. The IMS study found that the biggest increases among young adults were for antidepressants and drugs to treat attention deficit hyperactivity disorder.

The report also found that several important new medicines were introduced in 2011, including those that improve care for people with hepatitis C, multiple sclerosis and several types of cancer. All told, the report found, the new treatments could help an estimated 2.5 million people who are newly diagnosed with medical conditions each year, and about 20 million people who currently live with the diseases.