It has been estimated that approximately eight million adults in the United States suffer from ADHD, making it the second most common psychological problem in adults after depression. Yet, it is estimated that only 15% are reported to know that they have the condition. In a report issued in September 2005, Medco Health Solutions summarized a survey of 2.4 million individuals across the life span relative to diagnosis and treatment for ADHD. Medco is a Fortune 500 company with reported revenues of 35 billion dollars in 2004. http://www.medco.com Their home page describes them as a "leader in managing prescription drug benefit programs that are designed to drive down the cost of pharmacy health care for private and public employers, health plans, labor unions and government agencies of all sizes." Medco operates the nation's largest specialty pharmacy operation, including mail order and internet pharmacies.

The primary force driving this survey was a treatment cost analysis. Medco reported nearly 78% of all prescriptions in 2004 dispensed for ADHD were brand name medications reflecting a nearly 30% increase in the use of brands versus generics. New preparations (e.g., Strattera) and delivery systems (e.g., Concerta) contributed to this rise. This led to nearly a tripling in the cost of medication treatment for ADHD. The shift away from generic drug use back to brand name drugs costing more money in combination with the equivocal findings comparing one medication treatment to another for ADHD in the Oregon Health and Sciences University report, will likely spur an increased push by health care providers for patients to use generic rather than brand name preparations.

In a nationwide analysis of 2.4 million subscriber prescription data, Medco reported prevalence rates of medication used to treat ADHD in 2004 of 3.41% for boys and 1.23% for girls below nine years of age. Growth among the adult population between 2000 and 2004 significantly outpaced the pediatric group by a margin of nearly 2 to 1. There was a four fold increase in the amount of money spent between 2000 and 2004 on medication to treat adult ADHD. The prevalence of ADHD medication used in 2003 was 1.1% and grew to 1.3% in 2004, a nearly 25% increase. This ranks second among all drug categories with only growth in rheumatologic drug users being greater. The greatest growth, 117% in the number of adult medication users for ADHD under age 65 was seen in a portion of the central region of the United States, including the states of Kentucky, Tennessee, Alabama and Mississippi. In the CDC Report concerning diagnosis and treatment of ADHD, these were among the states with the highest percentages of diagnosis and treatment. This region also had the largest increase in children ages 19 and under taking medication for ADHD, rising 70% from 2000 to 2004. Medco also reported that between 2000 and 2004 the number of children under the age of 9 using medication for ADHD grew almost 75% and spending increased five fold with males three times more likely to be taking medication for ADHD than females in this age group. Between 2000 and 2004 the number of adults between the ages of 20 to 44 taking medication for ADHD increased from 1 out 200 to 1 out of 100. Among females, ages 20 to 44, the use of ADHD medication more than doubled over the four year analysis period, a growth rate 21% greater than males. In 2004, the use of ADHD medications for adult women between the ages of 20 to 64 was equal to that of men.