The states where people take the most prescription drugs

Why Miami tops the list

A new Dartmouth Atlas Project study outlines vast prescription variation across the nation, and only about one-third of that variation can be explained by differences in health status.

Miami leads the nation in medications, costs

For the study, researchers used 2010 data from the Medicare Part D program on prescription trends in every state. They found that prescription rates ranged from 63 prescriptions each year for the average beneficiary in Miami to 39 per beneficiary in Grand Junction, Colo.

Researchers acknowledged that some of the disparity is due to the large proportion of seniors in Miami, but they determined that only 31% of the variation can be attributed to the health of the beneficiaries. Moreover, the average beneficiary in Miami spent $4,738 on prescription drugs in 2010, well above the national average of $2,968.

Miami beneficiaries are not just filling more prescriptions: they are also better at adhering to prescription guidelines than the rest of the nation, according to the report.

It found that 78% Miami heart attack survivors reported filling a prescription for beta blockers, and about 76% of diabetic beneficiaries filled a prescription for medications known to reduce blood pressure and prevent kidney disease. Both those rates are far higher than national averages.

"One of the things that's curious about high-spending regions like Miami or McAllen, Texas, or even Manhattan really speaks to this culture … of more aggressive care," says lead author Jeffrey Munson.

What patients, physicians can do with the data

Study co-author Nancy Morden says the findings should motivate patients to learn more about the treatment they are receiving and discuss options with their physician.

"One of the most important things consumers can do is have these conversations with their prescriber: understand why each medication is prescribed; what's the goal of the medication; what the risk and benefit tradeoffs are ... [and] ask about what you're not taking that may be indicated for you and your particular disease state," says Morden.

Munson added that the findings should help physicians too, because often they "don't have a source of feedback to tell them how they're performing relative to their peers, and there isn't an easy way for physicians to know what is the national norm and what is the best care possible" (Dartmouth study, 10/15; Kliff, "Wonkblog," Washington Post, 10/15; Chang, Miami Herald, 10/15).

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