The number of Americans using medication to treat attention deficit hyperactivity disorder rose 36% in five years, totaling more than 4.8 million privately insured individuals in 2012, according to a recent report from pharmacy benefit manager Express Scripts.

The data also show that the greatest increase was among women aged 26 to 34. Among this group, usage climbed 85% over the past five years.

“ADHD is no longer a childhood condition,” says David Muzina, M.D., and Express Scripts’ vice president of specialist practice. Up to one-third of children and adolescents with ADHD carry the condition into adulthood and continue to require treatment.

“Some of this increase in treatment with ADHD medications has to do with the surge in diagnoses and treatment in adolescents over the past decade or so, and now those teens are young adults,” says Muzina.

The costs of ADHD medications on a per-member-per-year basis jumped 91% over the five-year study period, from $18.75 in 2008 to $35.52 in 2012, driven primarily by the spike in utilization. The average that plans paid per prescription increased 35.4% to $146.41, while patients’ out-of-pocket costs during the same time period rose only 4.2% to $27.52.

The research looked at de-identified pharmacy claims of more than 400,000 privately insured people under age 65. Other findings include:

  • The percentage of boys ages eight to 12 using ADHD drugs reached 9% in 2012, nearly an 18%-increase since 2008.
  • The southern region of the U.S. has the highest concentration of ADHD medication use, with South Carolina showing the greatest prevalence overall – 14% of 12- to 18-year-olds are on an ADHD drug treatment.

Another contributing factor to the increased use of ADHD drugs is public awareness, says Muzina. “Many adults, more so than 10 or 15 years ago, are aware of attention deficit disorder as something that may be impacting their ability to perform and to work and to focus so more are seeking treatment of symptoms that may, or may not be, ADHD,” he explains.
Some ADHD medication usage may also be the result of overzealous diagnosis and treatment, says Muzina. “Physicians may mistake someone’s subjective reporting of symptoms as a disorder that needs medication and treatment when in fact there are a number of potential other explanations as to why an adult may be having difficulty focusing or concentrating,” he says.

Among adults, women far outnumber men in their use of ADHD treatments, the reverse of childhood trends, where only half as many girls as boys take ADHD drugs. The number of males using ADHD medication plummets after age 18, while women ages 19-25 surpass younger girls’ use of these drugs, 4.4% vs. 3.5% respectively in 2012.

“Girls and young women tend to experience more of the inattentive symptoms of ADHD and less of the hyperactivity that sometime is seen with ADHD in boys and men,” says Muzina. “If you’re a young girl or an adolescent who has trouble focusing and concentrating in school but you’re not disruptive and hyperactive, you may escape the attention of teachers and parents and you’re more quietly experiencing those symptoms. What we may be seeing is [that] as these teens become young adults, the academic and social pressures begin to mount and the symptoms begin to emerge.”

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