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MEDIA CENTRE
Retail Prescriptions Grow at Record Level in 2003
Cholesterol-lowering medications fastest growing drug class
Montreal, Quebec, March 25, 2004 - IMS Health's annual review of prescribing and diagnoses trends reveals 2003 was a record year in the growth of retail prescriptions filled by Canadians. There were over 361 million prescriptions filled in Canadian retail pharmacies in 2003 (excludes hospitals). Retail prescriptions grew 7.9% over 2002, the largest annual increase during the last decade (see Table 1).
Table 1 & 2
Last year's retail prescription market totalled $15.9 billion (total retail price*), which represents on average 11 prescriptions per Canadian at an average retail price of $44 per prescription (see Tables 2 and 3).
* Includes cost of drugs plus any mark-ups and pharmacists' dispensing fees.
Table 3
What are Canadians prescribed?
Cardiovasculars remain the most prescribed class and are followed by
Psychotherapeutics, which includes anti-depressants (see Table 4; see Table 14
for definitions of classes).
Table 4
Hormones, the third highest-prescribed class in Canada, is the only top class to
experience a significant decrease in 2003. Following the results of the Women's
Health Initiative study released in 2002, prescriptions for the hormones
estrogen and progestin fell approximately 25% in 2003 when compared to one year
earlier. The study suggested that long-term use (more than four years) of
combined hormone replacement therapy (estrogen plus a progestin) increases a
woman's risk for heart disease and breast cancer.
Once again, Cholesterol-lowering agents remain the fastest growing of Canada's 10 leading therapeutic classes, growing almost 18 % in each of the last two years. The leading prescribed medication in 2003 was the cholesterol-reducer, Lipitor® (see Table 5).
Table 5
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Family physicians** busier than ever
It follows that Canadian physicians were just as busy in 2003 as their
health care colleagues in pharmacy, especially those in family practice. There
were 309 million visits made to office-based*** physicians last year and a
family physician/general practitioner was seen in 73% of these visits. Of the
more than 361 million retail prescriptions filled in Canadian retail pharmacies
in 2003, 80% of all prescriptions**** (new prescriptions and refills) were
written by family physicians (see Table 6). Family physicians comprise about
half of the approximately 57,000 doctors in Canada (27,500).
Table 6
"Managing prescribing and therapeutics by family physicians is difficult in
many respects," says Dr. Mark Kazimirski, a physician in family practice in
Windsor, Nova Scotia, who suggests there might be ways to help family physicians
manage information. "Most doctors don't have an electronic medical record
to manage the vast amounts of information necessary. This would include an
up-to-date patient profile, a drug interaction data base, and a decision support
tool, that is, a tool indicating which drug to use for a particular clinical
situation." Dr. Kazimirski adds it is a particularly difficult issue to
manage in the elderly. "We also don't measure
outcomes of our pharmacological interventions, so we are not able to learn from
our experiences."
Family physicians wrote approximately 9,597
prescriptions per physician (new prescriptions and refills). They were
surpassed by internal medicine specialists, who wrote an average of 11,528
prescriptions. Dermatologists were the next most active prescribers with an
average of 6,546 prescriptions.
Depression fastest rising diagnosis
Who and what were physicians treating? Approximately 60%
of the visits made to office-based physicians resulted in a recommendation*****
for a medication. Canadians aged 40-64 were responsible for 38% of all
visits in 2003 and continue to drive the growth in visits. Women outnumbered men
in every age group except for visits made by those under 10.
As would be expected, the most prescribed classes of medication are in line with
the most common diagnoses. The most common diagnosis in 2003 was hypertension
(20.3 million diagnoses), followed by depression (9.3 million diagnoses) and
diabetes (8.7 million) (see Table 7). Hypertension has been the main driver of
patient visits in Canada for the last decade.
Table 7
** Includes general practitioners.
*** Physicians seeing patients in private offices.
**** Includes prescriptions written by all licensed prescribers, e.g., nurse
practitioners and dentists.
***** A medication was recommended to a patient and may have resulted in a
prescription.
Depression continues to be Canada's fastest rising diagnosis made by
office-based physicians (excluding hospitals). Visits for depression increased
just over 60% since 1995. Canadians aged 40 to 64 were responsible for 57% of
all visits for depression in 2003. Those aged 20-39 made up 28%, while those
aged 65 and over made up 10% of visits. Young Canadians, 19 and younger, made up
about 5% of all visits for depression in 2003. An anti-depressant was
recommended in approximately three-quarters of visits made by those 19 and
younger.
Summary of Demographics for depression
Ages 40-64 - 57 per cent of total
Ages 28-39 – 28 percent of total
Ages 65 and over – 10 % of total
Ages 19 and younger – 5 percent
Visits for hypertension and for high cholesterol are also growing significantly
- both have increased 50% since 1995, followed by diabetes visits, which
increased 34% during the same period (1995-2003).
Brand and generic drug usage
Two out of every five prescriptions filled in pharmacies are for a generic
product (see Table 8). Generic drugs were responsible for almost 50% of the
growth in the number of retail prescriptions dispensed in 2003. In terms of
dollar value, generic manufacturers account for about 16% of the $13 billion
worth of medications purchased by retail pharmacies (wholesale dollars),
reaching $2.07 billion in 2003 and growing 18.5% over the 2002. Brand
manufacturers, which accounted for about $11 billion of retail pharmacy drug
purchases, grew at about 11% in 2003. Hospitals purchased only $0.13 billion
worth of generic medications last year and $1.41 billion of brand medications.
Generic drugs capture the majority of retail pharmacy prescriptions for anti-infectives,
analgesics and about 90% of diuretics.
Table 8
The country's leading generic manufacturer, Apotex, is ranked sixth among Canada's top pharmaceutical companies with $722 million in sales to retail pharmacies and hospitals (see Table 9). The ten largest pharmaceutical companies in Canada, as measured by sales into pharmacies and hospitals of prescriptions drugs, accounted for more than 47% of total sales in 2003.
Table 9
Purchases by Internet pharmacies more than double in 2003
In 2003 the volume of Canadian internet pharmacy (the practice of selling
prescription medicines to U.S. residents through Canadian internet pharmacies)
reached $566 to $605 million, more than double the 2002 estimate of $251
million. The figures measure the purchases of internet pharmacies at wholesale
Canadian prices and exclude foot traffic - U.S. residents crossing the border to
purchase medications in Canadian pharmacies.
Looking at the practice using American retail prices, IMS Health estimates
that Americans would have spent $1.1 billion U.S. to purchase these medications
in their own country (this figure includes Americans crossing the border to fill
their prescriptions in Canadian pharmacies).
Latest quarterly estimates by IMS Health show internet pharmacy sales decreasing
8% in the fourth quarter of 2003, compared to the previous quarter. The
highest quarterly growth was recorded in the first three months of 2003 when
sales grew 39% over the previous quarter. Early growth figures for 2004 show
internet sales growing 7.2% in January compared to December of last year.
Manitoba accounts for 44% of internet pharmacy sales. (See Tables 10 and 11.)
Table 10 & 11
The top classes of medications comprised 84% of all internet pharmacy sales in
2003 (Table 12), with Cholesterol-lowering medications accounting for the
largest portion (19%), followed by Cardiovasculars with 16% and Anti-spasmodics
with 9%.
Table 12
Brand medications launched in 2003
There were 19 new brand medications launched in Canada last year - excluding
line extensions and generic versions of brand-name drugs. Table 13 ranks the ten
leading medications launched in 2003 by sales into Canadian hospitals and retail
pharmacies (wholesale dollars). The top-selling new drug of 2003 is the
cholesterol-reducer Crestor® with over $30.7 million. A new anti-arthritic, the
COX-2 inhibitor Bextra®, was the second highest-selling new drug last year with
$17.2 million. Cialis®, the first erectile dysfunction disorder medication to
be introduced since Viagra® (1999), was launched in Canada in November of last
year and is ranked tenth with $1.6 million.
Table 13
About IMS
IMS HEALTH Canada, a health information company, supplies the Canadian
pharmaceutical and health care stakeholders with data and analysis on disease
patterns, treatment trends,
physician practice preferences and estimates of prescriptions dispensed. In
operation for over 40 years, IMS HEALTH, Canada is a subsidiary of IMS HEALTH
Inc., world leader in health information solutions with operations in over 100
countries. www.imshealthcanada.com.
For information contact:
Sue Cavallucci
IMS HEALTH, Canada
(514) 428-60
Table 14
