This Surveillance Snapshot presents trends in pharmacy prescriptions ordered from 2014 to 2023 for active component service members of the U.S. Army, Navy, Air Force, Marine Corps, Coast Guard, and Space Force. Pharmacy prescriptions were queried from the Pharmacy Data Transaction Service, which includes prescription orders originating from military hospitals and clinics, mail order, and retail-dispensed facilities. The American Hospital Formulary System¹ pharmacologic-therapeutic codes were utilized to identify ACSMs with pharmacy orders under a first-tier class (2-digit therapeutic class codes) each year. The annual prevalence of each therapeutic class was calculated per person using mid-year estimates for all ACSMs. The figure depicts AHFS classes representing the 10 highest cumulative period prevalence proportions.

Throughout the 10-year period, central nervous system agents accounted for the highest prescription prevalence. Of the 658,598 ACSMs with prescriptions for a CNS agent in 2023, the leading three prescription orders for ACSMs further classified under a 6-digit AFHS code included other nonsteroidal anti-inflammatory agents (n=424,968; code 280804), analgesics and antipyretics (n=285,082; code 280892), and tricyclics other norepinephrine-reuptake inhibitors (n=172,790; code 281604). Excluding cardiovascular drugs, the prevalence of ACSMs receiving prescription orders decreased in all 9 other therapeutic classes during the SARS-CoV-2 pandemic. From 2019 to 2021, the largest prevalence declines were observed for respiratory tract agents (17.7% to 8.9%), EENT preparations (32.1% to 22.4%), antihistamine drugs (17.6% to 12.3%), autonomic drugs (25.7% to 18.7%), and anti-infective agents (32.6% to 24.8%). Following the pandemic, the prevalence of ACSMs receiving prescription orders during 2023 increased to a highest point observed over the 10-year surveillance period within 2 therapeutic classes, including respiratory tract agents (19.0%) and skin and mucous membrane agents (23.9%).

Two additional therapeutic classes not depicted in the figure demonstrated substantial prevalence increases during the surveillance period. From 2014 to 2023, the prevalence of ACSMs with orders for serum/toxoid/vaccines (class 8000000) increased from 2.4% to 11.6% and miscellaneous therapeutic agents (class 920000) increased from 8.7% to 14.4%. While PDTS includes prescriptions covered under the TRICARE health benefit, intended to provide primary health care coverage for all ACSMs, it does not document over-the-counter medications. Thus, the results presented in this Surveillance Snapshot may underestimate true prevalence for some therapeutic classes.

Author Affiliations

Epidemiology and Analysis Section, Armed Forces Health Surveillance Division, Defense Health Agency

Reference

1. American Society of Health System Pharmacists. AFHS Pharmacologic-Therapeutic Classification. 2023. Accessed Jun. 12, 2023. https://ahfsdruginformation.com/ahfs-classification-drug-assignments