Growth in utilization rather than price, particularly since 1994, has been
the primary driver of increased pharmaceutical spending. In this paper I fo
cus on four factors that have increased utilization, even as cost containme
nt efforts have flourished: (1) "the importance of being unimportant"; (2)
increased third-party prescription drug coverage; (3) the introduction of s
uccessful new products; and (4) aggressive technology transfer and marketin
g efforts by pharmaceutical firms. I also consider the roles that these fou
r factors are likely to play in the future.