An Overview of Health Care and Pharmaceutical Trends, 2023-2024

The closing day of The Academy of Managed Pharmacy (AMPC) 2024 annual meeting featured a keynote session led by Douglas M. Long, BA, MBA, vice president of industry relations, IQVIA. His talk centered on health care and pharmaceutical marketplace trends over the last year, as well as explored the pressing challenges facing the industry today.

Health Care Trends 2023 Concept | image credit: Parradee - stock.adobe.com

The modern challenges confronted by the health industry are numerous; however, considerable growth has also taken place across the pharmaceutical market. Long’s agenda addressed a plethora of these obstacles and trends, including the rise of GLP-1s and biosimilars, patterns in specialty and traditional medicine, the obesity epidemic, the flu season, and more.

Flu Season

Long began by citing data from IQVIA’s Fan Alert Network that indicated flu symptoms and the number of infections have returned to more average, expected rates since the COVID-19 pandemic. In 2017-2018, 38 million people were affected by the flu, and this dropped to below 18 million in the pandemic (which he attributed to isolation measures). However, in the last year, the numbers have jumped back up to 31 million.

Other figures from IQVIA indicate that the rates of COVID-19 and flu vaccination trended downward in the last year (decreases of 28% and 10.7%, respectively); however, respiratory syncytial virusvaccines have been on the rise after being recently introduced to the market.

“One of the movements we've seen because of COVID is a lot of these vaccinations now take place in retail pharmacy,” Long commented, pointing to data revealing that over 60% of flu vaccines took place at pharmacy settings in 2023-2024.¹ These vaccinations have often been administered at people’s place of employment, he added, suggesting that the transitions to remote work have influenced this uptick in the retail marketplace.

Market Trends: Utilization

As of December 2022, IQVIA’s Health Services Utilization Index revealed shifts in the US utilization landscape and indicated that operations had returned to pre–COVID-19 levels. With a baseline score of 100, their data scores revealed that office, institution, and telehealth visits (108), as well as new prescriptions (104) had increased, while elective procedures (98) and screening and diagnostic tests (89) declined.

Interpreting this data, Long speculated that the drop in elective procedures could have been a consequence of the COVID-19 pandemic, as prime candidates for these procedures had passed away. The rise of telehealth was also logically associated with COVID-19.

“So the screening numbers are abysmal,” Long added, “And that's going to lead—at least in cancer—to more extensive cancer care for some people because they were diagnosed late, not early.”

Other features from the report indicate that the use of antibiotics was up 8%, the use of ADHD medications had grown 11% in 5 years, and mental health prescriptions have increased by 9% since 2019. Additionally, new prescriptions for GLP-1 agonists grew 152% vs the prior year, prescription opioid use had dropped 64% since its 2011 peak—yet overdose deaths were up 253% in the same time frame due to fentanyl and methamphetamine—and the use of contraception by women had declined by 6% since 2022.

Notably, in 2022, spending on specialty medicines accounted for over half of market spending, and, since 2012, considerable growth increases were seen across immunology (451%), oncology (349%), and HIV (206%). Traditional medicines also underwent significant growth, especially in diabetes (223%) and respiratory (140%).

Where Are We Now?

The IQVIA National Sales Perspectives report showed that the market experienced double-digit growth in 2023. Sales have increased across the board by 13.2% ($647.6 billion to $$733.3 billion), with almost 15% growth seen in retail and mail markets, and nearly 11% in nonretail. The biggest contributor to this outcome was a volume increase, which accounted for over 6% of the growth.

The top 10 therapy areas, according to this report, were led by antidiabetes medications ($130.1 billion), immunology ($129.1 billion), and oncology ($101.6 billion), which experienced growth of 15.7% and made up over 72% of the market share. Furthermore, the top 10 products on the market, spearheaded by Humira ($34.2 billion) and Ozempic ($26.8 billion), demonstrated growth rates of just over 30%, which accounted for 25.4% of the market share.

The market for antidiabetes medications has constituted a major trend in the last year. Ozempic (semaglutide) and Mounjaro (tirzepatidcde) demonstrated the highest sales gains among all products over the last 12 months in IQVIA’s assessment, with GLP-1s as a whole experiencing an estimated growth of 58% ($23.1 billion). Approximately 84% of these sales took place in the retail space, which was indicative of the marketplace shift Long referenced in vaccination rates.

Long speculates that GLP-1 us is only going to continue to grow due to their indication for obesity, as the US remains the country with the most prevalent obesity rates.² In light of these data, he also suggested the widespread impact of GLP-1s beyond obesity, stating, “the concept is that if people lose the weight and become less obese, they will not require some of the cardiovascular drugs and other drugs that they require today.” At present, he adds, over 120 products for weight loss are being developed by more than 60 companies.

Generics and Biosimilars

Data gathered from IQVIA indicate that nearly 88% of prescriptions in the US in 2023 were dispensed as generics. Generic pricing has been continually dropping, falling 20% since 2019, in large part due to generic price deflation. This trend constitutes a serious problem for the market.

“There are 3 buyers who control 91% of the generic purchasing,” Long mentioned. “You have a prolific FDA that approves all these active, abbreviated new drug applications for generics. Hundreds of them—90% of what they approved—they've already approved something in that molecule. So, it's easier to do the second, third, fourth, and fifth [drug application] than to do the first one.”

He went on to say how pricing is not necessarily an important factor in generics because their data show that generics are growing due to the sheer volume of them; however, the market is more fractionated than it ever has been due to the increased numbers of companies in this field, and generics companies are left unsure of whether they will get approved.

“So it used to be back in the day 66% of those actually got launched. Today . . . 20%. So think about all the effort it took, and all the money it took to get a product through the FDA abbreviated new drug application. And you can't watch it because there's no possibility of the commercial return.”

The big takeaway from their analysis on biosimilars is that the market is demonstrating great sustainability. Currently, there are 46 biosimilars that have been approved since 2015, according to the FDA, and IVQIA indicated that nearly 41% of the total market sales in 2023 were driven by biosimilars and biologics. Additionally, the biosimilars that have been launched thus far have accounted for 24% of the competitive molecule volume. And yet, 28% of biosimilars do not have a pipeline right now.

“The reason this is important is that the generics create a financial habit to pay for innovation. And we expect the same thing to happen on biosimilars. But what happened on the medical benefits side has not happened enough on the pharmaceutical benefit side, and we have a lot more of these products that are going to go biosimilar.”

Drug Shortages and Pharmacy Closings

The demand for various drugs across the board—for example, in Ozempic, Adderall (amphetamine/dextroamphetamine), and more—has contributed to the increasing issue of drug shortages, with very few being resolved. Additionally, as Long notes, there are some purchasers who anticipated drug disruptions and, in response, increased their orders.³

Retail pharmacies were a large topic for this part of Long’s talk. After assessing the stores available in the IQVIA Rx Universe, these data revealed there are 2202 less retail pharmacies open today compared with January of 2020. Among the burdens pharmacies took on that influenced their ability operate, Long listed margin pressures related to GLP-1 dispensing, insufficient reimbursement rates from branded drugs, and the prevalence of discount cards.

“[Retail pharmacies] are doing more work for less money than they ever have . . . They make money on dispensing generics, they lose money or break even on brands.” He then mentioned time pressures brought on by staffing shortages, increased volumes of prescriptions and demand for immunizations, attention-deficit/hyperactivity disorder drug shortages, less pharmacist enrollment, and stricter regulatory environments (influenced by legislation such as the Drug Supply Chain Security Act). These pressures create a need for automation to perform these extra services without requiring extra staff.

“So stores closed, but the volume per store is up so that means there's more prescription buying going to each store. And so the averages of prescriptions are up 2%, or 1.1%, from last year, and up 50% from where they were in 2020.”

References

1. Influenza vaccinations administered in pharmacies and physician medical offices, adults, United States CDC. Updated April 19, 2024. Accessed April 19, 2024. https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-administered.html

2. Overweight & obesity. CDC. Updated September 21, 2023. Accessed April 19, 2024. https://www.cdc.gov/obesity/index.html

3. Drug shortages in the U.S. 2023: a closer look at volume and price dynamics. IQVIA. November 15, 2023. Accessed April 19, 2024. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/drug-shortages-in-the-us-2023