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Sleep Deprivation Driving Drug Use and Cost: New Research Finds Increased Use of Prescription Sleeping Aids

PR Newswire | October 17, 2005

* Number of Younger Adults (age 20-44) on Sleeping Medications Doubled in Four Years
* Children 10-19 Increased use of sleeping aids by 85 percent

For many Americans a good night sleep is just a pillow away, but the number of people -- including children -- who find themselves tossing and turning the night away is increasing. A nationwide analysis released today by Medco Health Solutions, Inc. (NYSE: MHS - News) finds that the most dramatic increases in the use of prescription sleeping aids are among younger adults and school-age children.

According to the research, the number of adults aged 20-44 using sleeping medications doubled from 2000 to 2004, and rose by 85 percent for children from 10-19. The increase in spending on these medications was highest for 10-19 year olds -- up 223 percent; younger adults showed a 190 percent spending spike over the four-year period. The analysis reviewed prescription drug claims of 2.4 million Americans between 2000 and 2004.

"Although the elderly are still the most frequent users of sleeping aids, the evidence found in this study shows that younger adults and children are starting to use these medications with even greater frequency," said Dr. Robert Epstein, chief medical officer for Medco. "With several new medications that treat sleep disorders coming to the marketplace in the next three years, we anticipate that this trend will continue to accelerate."

A supplemental analysis of the same patients looked at the concurrent use of both prescription sleeping aid medications and drugs used to treat attention deficit/antihyperactivity disorder (ADHD) during the first six months of 2004. Children ages 10-19 showed the highest dual usage in these two therapeutic categories at 15 percent, followed by the 20-44 age-category at nearly 4 percent.

"One of the potential side-effects of drugs to treat ADHD is insomnia. Therefore, for some, the additional use of medications to assist in sleeping is something one might anticipate," said Epstein. "The number of people in our analysis that have concomitant use in these two therapeutic classes is significant and warrants continued research, especially since these two conditions are accelerating at similar rates and among similar demographic audiences."

Additional Research Findings:
* Females are far more likely to use sleeping aids than males. In 2004,
there were 37 percent more girls ages 19 and under, 58 percent more
women ages 20-64, and 36 percent more women 65 and over taking sleeping
medications than their male counterparts.
* In 2004, the highest prevalence of adults under 65 on sleep medications
was seen in a portion of the central region of the U.S., which includes
Kentucky, Tennessee, Alabama and Mississippi, while higher percentages
of children (19 and under) were prescribed sleeping pills in the
mountain states including Idaho, Montana, Wyoming, Nevada, Utah,
Colorado, Arizona and New Mexico than in any other area of the nation.
* Although adults over 64 have the highest rate of sleeping-medication
use, they showed the lowest increase in prevalence from 2000 to 2004 --
only a 16.5 percent change over that time, 84 percent lower than the
increase seen in adults 20-44.

A Sleepless Nation

According to the National Institutes of Health (NIH), more than 70 million people in the U.S. may be affected by a sleep problem and, for 60 percent of them, it's a chronic disorder. There are significant gender differences when it comes to sleeping problems, with women being twice as likely as men to have trouble sleeping, which is reflected in the prescription data.

Common sleep disorders include insomnia, sleep apnea, and restless leg syndrome. Menopause and perimenopause are also frequently associated with sleep impairment in women. Sleep deprivation and disorders cost the nation $15 billion in health care expenses and $50 billion in lost productivity each year, according to United States Surgeon General.

Treatments for sleep disorders include both over-the-counter and prescription medications, as well as behavioral interventions. Americans filled more than 35 million prescriptions for sleeping pills in 2004, spending $2.1 billion on these medications. Although drug therapy may be beneficial for short-term improvement and long term use may be needed in some cases, the American Academy of Family Physicians cautions that long-term use of many psychotropic or sedative-hypnotic drugs may cause adverse reactions and may actually impair return to normal sleep. A combination of medication and behavioral interventions is often more effective than either approach alone for those with chronic insomnia.

A 2003 study published in the Journal of Pediatrics found that 75 percent of practitioners surveyed reported recommending a non-prescription sleeping aid and 50 percent had actually prescribed one for their pediatric patients during a six-month period. In addition, the study found that the likelihood of prescribing sleep medications was two-to-four times greater for those physicians who treated children with ADHD.

Managing Cost in Sleeping Medication Use

Three new sleep medications introduced in 2005 are the first of other additional hypnotics that will be coming to market in the next few years. These new products, some with better data supporting long-term use and improved safety profiles, are expected to address some of the problems associated with older sleep aids and as a result are being approved for longer-term use. These single source products could significantly increase costs of hypnotics. T. Rowe Price Health Sciences Fund predicts that the market for sleep drugs will more than double to $5 billion by 2010.

One factor that may help keep costs down despite these new products is that the most popular sleep medication currently on the market (zolpidem) is expected to be available as a generic in late 2006.

To help manage the growth in both use and spend associated with hypnotics, Medco provides its clients with a number of cost-saving solutions within their plan design. The company uses nationally recognized clinical guidelines and an independent Pharmacy and Therapeutics Committee of medical experts to determine drug classes that can be used as first-line courses of therapy. In many cases, there may be lower-cost medications that should be tried first before moving to newer, more expensive brand-name drugs. Prior authorization rules can be put in place to assure that the most appropriate treatment is being prescribed to meet the needs of the patient -- avoiding waste and cost. Daily dosage and duration of therapy management can help reduce costs, while providing an increased level of safety, by helping to ensure that an appropriate and cost-effective medication dosage or dosage form is prescribed for the correct duration.

About Medco

Medco Health Solutions, Inc. (NYSE: MHS - News) is a leader in managing prescription drug benefit programs that are designed to drive down the cost of pharmacy healthcare for private and public employers, health plans, labor unions and government agencies of all sizes. With its technologically advanced mail-order pharmacies and its award-winning Internet pharmacy, Medco has been recognized for setting new industry benchmarks for pharmacy dispensing quality. Medco serves the needs of patients with complex conditions requiring sophisticated treatment through its specialty pharmacy operation, which became the nation's largest with the 2005 acquisition of Accredo Health. Medco, the highest-ranked prescription drug benefit manager on Fortune magazine's list of "America's Most Admired Companies," is a Fortune 50 company with 2004 revenues of $35 billion. On the Net:

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward- looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this presentation should be evaluated together with the risks and uncertainties that affect our business, particularly those mentioned in the Risk Factors section of the Company's Annual Report on Form 10-K filed with the Securities and Exchange Commission.

Last modified October 17, 2005