Declining use overall of healthcare services drove down spending on medicines in the United States by 3.5% per capita last year, according to a new study.

One of the difficulties that federal regulators ran into during the nationwide scandal surrounding the New England Compounding Center — the Massachusetts-based pharmacy blamed for a nationwide fungal meningitis epidemic that has sickened hundreds and killed dozens — was the issue of when such pharmacies cross the line from compounding to manufacturing.

Drug maker Bristol-Myers Squibb foresees significant effects on its business from the Patient Protection and Affordable Care Act, company executives told attendees of its recent shareholder meeting.

There is as much as $10 billion in branded pharmaceutical sales that could make the switch from prescription-only to over-the counter in the next five years, suggested Joseph Papa, Perrigo chairman, CEO and president, to analysts on Tuesday.