July 2007 

The Top Five Outpatient Prescription 

Drugs Ranked by Total Expense for 

Children, Adults, and the Elderly, 2004 

Marie N. Stagnitti, MPA 

Introduction 

This Statistical Brief provides information on the top five outpatient 

prescription medicines ranked by total expenditures as reported by

households in the U.S. civilian noninstitutionalized (community) 

population in calendar year 2004 for the following three subpopulations: children age 17 and under, adults age 18-64, and the elderly 

age 65 and older. The brief also provides information on average 

total payment and average out-of-pocket payment per purchase for 

the top five drugs for each subpopulation. 

The estimates in this brief are derived from the Household Component of the 2004 Medical Expenditure Panel Survey (MEPS-HC). 

Only prescribed medicines purchases in an outpatient setting are 

included in the estimates. Insulin and diabetic supplies and equipment are included in MEPS prescribed medicines estimates. Overthe-counter medicines are excluded from these estimates as are 

prescription medicines administered in an inpatient setting or in a 

clinic or physician’s office. All differences discussed in the text are 

statistically significant at the 0.05 level. 

Findings 

In 2004, the top five household-reported prescribed medicines when

ranked by annual expenditures for children age 17 and under 

included the following: 

2004 MEPS-HC prescribed medicines: 

Top five prescribed medicines ranked by total expenditures 

for children age 17 and under 

Rank Prescribed

medicine

name

Total

dollars 

(in billions) 

Average 

total 

payment 

per drug 

purchase 

Average 

out-ofpocket 

payment 

per drug 

purchase 

1 Singulair $.68 $86.45 $28.52

2 Concerta $.49 $103.70 $24.59

3 Strattera $.43 $103.31 $22.85

4 Zyrtec $.42 $61.29 $25.60

5 Adderall $.41 $88.10 $22.13

Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #180 

Highlights 

 In 2004, when ranked by 

total expenditures, three 

of the top five drugs for 

children age 17 and 

younger were drugs that 

are commonly used to treat 

attention deficit hyperactivity disorder (ADHD) 

and totaled $1.3 billion: 

Concerta ranked second

with $.49 billion, Strattera 

ranked third with $.43 

billion, and Adderall ranked

fifth with $.41 billion. 

 When ranked by total expenditures in 2004, for 

adults age 18-64, two 

cholesterol reducing medicines ranked first and fourth 

(Lipitor with $4.88 billion 

and Zocor with $2.25 

billion), and two protonpump inhibitors ranked 

second and third (Nexium 

with $2.67 billion and 

Prevacid with $2.42 billion). 

 During 2004 for the elderly 

age 65 and older, cholesterol-reducing drugs ranked

first and second in terms of 

rank by total expenditures 

(Lipitor, $4.35 billion and 

Zocor, $2.44 billion). 

 In 2004, the top five drugs 

when ranked by total expenditures for children age 

17 and under totaled $2.4 

billion and accounted for 

nearly one-quarter (24.2 

percent) of all spending on

prescribed medicines for 

that age group.
In 2004, Singulair, a medicine that can be used to control asthma, ranked first in terms of expenditures at 

$.68 billion. Three medicines that are commonly used to treat attention deficit hyperactivity disorder 

(ADHD) ranked number two (Concerta, $.49 billion), number three (Strattera, $.43 billion), and number 

five (Adderall, $.41 billion), and totaled $1.3 billion. Zyrtec, an antihistamine, ranked fourth at $.42 billion. 

The combined expenditures for the top five drugs totaled $2.4 billion and represented 24.2 percent of the 

$9.9 billion total drug expenditures for children age 17 and younger. 

Zyrtec had the lowest average total payment per drug purchase ($61.29) as compared with the other 

drugs ranked in the top five for children in 2004. The average total payment per purchase for Concerta 

($103.70) was higher than the average total payment per purchase for Singulair ($86.45), Zyrtec 

($61.29), and Adderall ($88.10). The average payment per drug purchase was higher for Strattera than 

for Singulair. 

During 2004, there were no significant differences in the average out-of-pocket payment for any of the top 

five drugs for children when ranked by total expenditures. 

In 2004, the top five household-reported prescribed medicines when ranked by annual expenditures for 

the adult population age 18-64 included the following: 

2004 MEPS-HC prescribed medicines: 

 Top five prescribed medicines ranked by total expenditures 

for adults age 18-64 

Rank Prescribed 

medicine 

name 

Total 

dollars 

(in billions) 

Average 

total 

payment 

per drug 

purchase 

Average 

out-ofpocket 

payment 

per drug 

purchase

1 Lipitor $4.88 $101.34 $30.73 

2 Nexium $2.67 $165.01 $45.22 

3 Prevacid $2.42 $126.72 $32.01 

4 Zocor $2.25 $122.61 $42.74 

5 Zoloft $1.90 $88.49 $29.43 

In 2004, Lipitor, a cholesterol-reducing medicine, ranked first in terms of expenditures at $4.88 billion, and 

another cholesterol-reducing drug, Zocor, ranked fourth at $2.25 billion. Two proton-pump inhibitor drugs 

ranked number two (Nexium, $2.67 billion) and number three (Prevacid, $2.42 billion). Rounding out the 

top five was Zoloft, an antidepressant, at $1.90 billion. The combined expenditures for the top five drugs 

totaled $14.1 billion and represented 12.2 percent of the $115.9 billion of total drug expenditures for 

adults age 18-64. 

The average total payment per purchase for Nexium ($165.01) was higher than the average total 

payment for any other drug in the top five for adults in 2004. The lowest total average payment per drug 

purchase was for Zoloft ($88.49). The average total payment per purchase for Prevacid ($126.72) and 

Zocor ($122.61) was higher than the average total payment for Lipitor ($101.34). 

During 2004, the average out-of-pocket payment per purchase was higher for Nexium ($45.22) and Zocor 

($42.74) than for Prevacid ($32.01), Lipitor ($30.73), and Zoloft ($29.43). There was no significant 

difference in the average out-of-pocket payment per drug purchase for Prevacid ($32.01), Lipitor 

($30.73), and Zoloft ($29.43). 

In 2004, the top five household-reported prescribed medicines when ranked by annual expenditures for 

the elderly population age 65 and older included the following: 
2004 MEPS-HC prescribed medicines: 

Top five prescribed medicines ranked by total expenditures 

for the elderly age 65 and older

Rank Prescribed 

medicine 

name 

Total 

dollars 

(in billions) 

Average 

total 

payment 

per drug 

purchase

Average 

out-ofpocket 

payment 

per drug 

purchase

1 Lipitor $4.35 $107.57 $61.29 

2 Zocor $2.44 $118.24 $61.40 

3 Plavix $1.73 $123.44 $60.68 

4 Norvasc $1.47 $69.52 $37.12 

5 Nexium $1.46 $159.59 $109.12 

In 2004, two cholesterol-reducing medicines, ranked first and second in terms of total expenditures for the 

elderly age 65 and older: Lipitor was first with $4.35 billion, and Zocor was second with $2.44 billion. 

Plavix, an antiplatelet drug, ranked third at $1.73 billion, and Norvasc, a calcium channel blocker, ranked 

fourth at $1.47. Rounding out the top five was Nexium, a proton-pump inhibitor, at $1.46 billion. The 

combined expenditures for the top five drugs totaled $11.4 billion and represented 17.5 percent of the 

$65.2 billion of total drug expenditures for the elderly age 65 and older. 

The average total payment per purchase for Nexium ($159.59) was higher than the average total 

payment for any other drug in the top five for the elderly in 2004. The lowest total average payment was 

for Norvasc at $69.52. Plavix had a higher total average payment ($123.44) than Lipitor ($107.57). 

During 2004, the average out-of-pocket payment per purchase was highest for Nexium ($109.12), and the 

lowest average out-of-pocket payment per purchase was for Norvasc ($37.12). There was no significant 

difference in the average out-of-pocket payment per purchase for Lipitor ($61.29), Zocor ($61.40), or 

Plavix ($60.68). 

Definitions/Methodology 

Age is the last available age for the sampled person. For most persons, this was their age at the end of 

the year. 

 

The out-of-pocket category includes payments by user or family. 

Expenditure rankings are based on drug name. Generic and brand name drugs with the same active 

ingredient are not combined into one category. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 
Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care,

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Stagnitti, M. N. The Top Five Outpatient Prescription Drugs Ranked by Total Expense for Children, 

Adults, and the Elderly, 2004. Statistical Brief #180. July 2007. Agency for Healthcare Research and 

Quality, Rockville, Md. http://www.meps.ahrq.gov/mepsweb/data_files/ publications/st180/stat180.pdf 

∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850