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Visit profiles to view data profiles on chronic and disabling conditions and on young retirees and older workers. More than million people — 66 percent of all adults in the United States — use prescription drugs. Utilization is particularly high for older people and those with chronic conditions. Prescription drugs are costly. Advances in new products and technology and increases in utilization — the number of people using prescribed medicines and the number of prescriptions per user — have contributed to increases in overall prescription drug spending. Almost half of the cost of prescription drugs is paid out-of-pocket. Concerns about cost lead some consumers to take less than the prescribed medication. The great majority of adults who have one of five common chronic conditions — diabetes, heart disease, hypertension, arthritis, and cancer — use prescription drugs. For example, 89 percent of people with arthritis and 98 percent of people with diabetes use prescription drugs. People with these conditions fill many prescriptions annually and have significant prescription drug expenditures. Adults with diabetes fill about 4 times as many prescriptions and spend about 4 times as much on prescription drugs as the general population. High prescription drug use may also reflect the fact that people have multiple chronic conditions. The proportion of people using prescription drugs and the amount of prescriptions filled varies by demographic group. Prescription drug use is associated with age, gender, race and ethnicity, income, and health status. For example, prescription drug use increases with age. Three-quarters of those age 50 to 64 use prescription drugs, compared to 91 percent of those age 80 and older. The average number of prescriptions filled also increases with age, from 13 for those age 50 to 64 to 22 for those age 80 and older see Figure 1. Women are generally more likely than men to use prescription drugs. The gap in prescription drug use between men and women is striking for younger populations. Some 40 percent of men and 66 percent of women age 18 to 34 use prescription drugs. Use patterns converge as people get older, however. Similar proportions of men and women age 65 and older are prescription drug users. For example, some 92 percent of men and 90 percent of women age 80 and older use prescription drugs see Figure 2. Prescription drug expenditures are highest for people age 65 and older. Drug expen-ditures are particularly high for the oldest adults. For example, average annual prescription drug expenditures for people age 80 and older are almost 1. People age 80 and older pay even more see Figure 4. Adults pay almost half — 48 percent — of their expenses for prescription drugs out-of-pocket, but persons age 65 to 79 pay 56 percent and those age 80 and older pay 67 percent of their total drug expenditures out-of-pocket. Consumers who have common chronic conditions have substantial prescription drug expenses. Since their total prescription drug expenditures are very high, their total out-of-pocket expenditures are also high. They pay about half of the cost of prescription drugs out-of-pocket. Some people take less medication than prescribed because of the cost. This is a particular problem for more vulnerable populations. For example, among adults who report poor health, about one-fourth percent — of people age 51 to 64 and more than one-tenth — 12 percent — of people age 65 and older say that they have taken less medication than prescribed in the past two years because of the cost. Substantial proportions of people with common chronic conditions also report that because of cost they take less than the prescribed amount of medication see Figure 6. The practice of taking less medication than prescribed may increase overall health care costs if the result is more emergency room visits, hospital admissions, or physician visits. A study of people age 65 and older in eight states reports that a substantial proportion of people, in particular those with low incomes, take less medicine than prescribed. For example, 22 percent of respondents indicate that they had not filled prescriptions one or more times in the past year because of the cost. Some 23 percent say they skipped doses of medication to make it last longer. A substantial proportion of respondents — 21 percent — report that they spent less in the past year on food, heat, or other necessities so they could afford to purchase their medications. The Medicaid program plays an important role in providing prescription drugs for a particularly vulnerable population. All Medicaid beneficiaries have very low incomes and almost one-third report fair or poor health status. Nationally, Medicaid covers 60 percent of prescription drug expenditures, but beneficiaries still must pay about one-third of the cost out-of-pocket. Because the program is state administered, the extent of Medicaid prescription drug coverage varies considerably among states, however. Medicare beneficiaries pay a much higher proportion of drug expenditures — 62 percent — out-of-pocket see Figure 7. For both the uninsured population and Medicare beneficiaries without prescription drug coverage, out-of-pocket drug expenditures may be high if they must pay the full retail price at the pharmacy. The Medicaid program is a significant part of state budgets. Over the past several years, Medicaid spending has grown. Spending on prescription drugs is one factor that has contributed to growth in Medicaid spending. Medicaid spending on prescription drugs grew, on average, by 18 percent between and As states struggle to balance budgets, many have adopted policies to control Medicaid spending for prescription drugs. More than half of states report changes in Medicaid prescription drug policies for fiscal year Many states are negotiating for larger discounts and rebates on their prescription purchases. Another popular strategy is to place some limits on the types of drugs that can be prescribed by requiring prior authorization for prescriptions, using a preferred drug list, or requiring that generic drugs be prescribed. Some policy changes may have a more immediate effect on beneficiaries. These include plans to require new or higher copayments from beneficiaries and rules that limit the number of prescriptions per month that Medicaid beneficiaries may fill. Policy Number of States Negotiating discounts Prior authorization for more prescriptions Use of a preferred drug list New or higher copayments Seeking rebates Requiring use of generic drugs 9. Limits on number of prescriptions per month 6. State budgets under stress: How are states planning to reduce the growth in Medicaid costs? More than 3 million people report using herbal remedies. The great majority of herbal remedy users are women. Herbal drug users tend to be white and to be better educated than the general population. They also are in somewhat better health than the general population see Figure 8. In the Medical Expenditure Panel Survey, total health care expenditures are defined as inpatient hospital and physician services, ambulatory physician and nonphysician services, prescribed medicines, home health services, dental services, and various other medical equipment and services that were purchased or rented during the year. Bruen, B. States strive to limit Medicaid expenditures for prescribed drugs. Safran, D. Neuman, C. Schoen, J. Montgomery, W Li, I. Wilson, M. Kitchman, A. Bowen, and W. Schneider, A. Medicaid: Purchasing prescription drugs. Unless otherwise noted, the data presented in this Profile are from two national surveys of the United States civilian non-institutionalized pop-ulation. The series is supported by a grant from the Robert Wood Johnson Foundation. It is the fifth in the series. Previous Profiles include:. The Center studies the impact of demographic changes on public and private institutions and on the economic and health security of families and people of all ages. A vital component of health care More than million people — 66 percent of all adults in the United States — use prescription drugs. People with chronic conditions depend on prescription drugs The great majority of adults who have one of five common chronic conditions — diabetes, heart disease, hypertension, arthritis, and cancer — use prescription drugs. Who uses prescription drugs? The gender gap in prescription drug use narrows with age Women are generally more likely than men to use prescription drugs. Spending for prescription drugs increases with age Prescription drug expenditures are highest for people age 65 and older. Out-of-pocket costs are particularly high for people with chronic conditions Consumers who have common chronic conditions have substantial prescription drug expenses. Cost affects compliance Some people take less medication than prescribed because of the cost. Some people use herbal remedies More than 3 million people report using herbal remedies. Previous Profiles include: 1. Screening for Chronic Conditions: Underused services 2. Childhood Obesity: A lifelong threat to health 3. Visual Impairment: A growing concern as the population ages 4.