Douglas Long Highlights Key Trends in Health Care, Pharmaceutical Marketplace

During his AMCP 2023 keynote session, “2022-2023 Health Care and Pharmaceutical Marketplace Trends,” Douglas Long, MBA, vice president of industry relations at IQVIA, highlighted key trends in health care and telemedicine utilization, rates of respiratory infections, drug spending, and more in the United States.

Among his takeaways, Long reported that health care utilization had bounced back, telemedicine is here to stay, and traditional drug spending has decreased. He also noted a rise in attention-deficit/hyperactivity disorder (ADHD) prescriptions and decline of generics from a business perspective. However, he painted a bright picture for biosimilars, citing data that showed an increase in specialty drug spending.

Respiratory Illnesses

He started by showing mapped-out data from IQVIA’s Flu, colds, and respiratory illness Activity Notification (FAN) report, which highlighted trends in respiratory infection rates and alert status between the last season and current season.

These respiratory illnesses were worse in 2023 compared with 2022. In fact, all FAN-recorded symptoms were seen above historical trends in 2022-2023 compared with 2021-2022 and 2020-2021, and year-over year there are highs in late fall to early winter. Projections anticipate declines in these symptoms. These trends were especially notable among children, with greater increases in respiratory infections starting in September, and clear drops over what would be students’ winter break.

“Why it was so bad this year…people lost their natural immunity because they were masked up, weren’t going to work, or weren’t going to school, so it came back with a vengeance,” Long said. “This is where pharmacy in particular really stepped up. Think about all the vaccines that were dispensed or injected at retail pharmacies, because that was the place to go for COVID vaccines, COVID boosters…flu vaccines.”

As of this January, COVID-19 vaccines made up only 0.8% of all retail pharmacy prescriptions. This is down from 2% from last year, and even further down from 5.8% in 2021.

“It looks to me that COVID is kind of in the background at the moment, and who knows what will happen, because nobody really knows,” Long said, also noting the decline in COVID-19 deaths.

Health Care Utilization

While numbers are still being finalized on the end of 2022, an IQVIA health services utilization index report showed that health care in the United States was operating at nearly pre–COVID-19 levels. According to the report, screening and diagnostic tests as well as office, institutional, and telehealth visits were happening at higher rates in the fourth quarter of 2021 than in the first 2 months of 2020, with elective procedures and new prescriptions 95% back to normal rates.

Claims data also showed that utilization of office and institutional services increased by 6.2% and 1.1%, respectively, with telemedicine dropping by 0.5% between the 2 time periods. Retail prescriptions also dropped by 1.3%, which may be due to the decline in COVID-19 vaccination, while mail-order prescriptions increased by 4.3%.

There was a pronounced change in oncology care visits, with a 41% increase in in-person visits in 2022 compared with 2021. However, trends in in-person primary care visits generally did not change. Long was not too surprised by these numbers, as many offices were still shut down for in-person visits at the beginning of 2021. More patients were also becoming comfortable using telehealth over time, which made up 7% to 9% of claims in 2022, suggesting “sustainable long-term trends.”

Trends in Spending

Drug sales in the retail sector have experienced a surge in revenue. According to Long's data, there was a 20.4% year-to-date increase in sales in food stores between January 2022 to January 2023. He said this growth is understandable as individuals began to get in the habit of buying everything they need from one place during the height of the pandemic, and started to pick up their prescriptions from the same store as they did their grocery shopping.

Long presented data from IQVIA sales on specialty and traditional drugs, which showed that specialty drugs in 2022 accounted for 51% of the total drug spend, excluding discounts, while traditional drugs made up less than 50% of spending.

Charted data revealed that traditional drugs made up 72% of net spending in 2011 and specialty drugs constituted only 28%. However, net spending on traditional drugs gradually decreased while net spending on specialty drugs increased. The trend lines intersected in 2018, and by 2021, 55% of net spending was on specialty drugs, while 45% was on traditional drugs.

A breakdown of net specialty drug spending trends for different diseases between 2011 and 2021 showed that spending on autoimmune disease medications increased by a whopping 459% in that decade. Also demonstrating large growth, cancer drug spending increased by 326%, specialty drugs by 305%, HIV drugs by 219%, and multiple sclerosis drugs by 211%

For traditional drug spending, diabetes was the only disease state with growth comparable to those mentioned above, increasing by 217%. Net spending on mental health medication had the smallest growth of the group, with only a 38% increase over the decade. Interestingly, though, dispensing for ADHD drugs increased by 11.1% as of the third quarter in 2022, compared with the beginning of the pandemic.

Additionally, between 2016 and 2021, pharmaceuticals spending grew by $82 billion, largely driven by new products and brand volume, and offset by expiries.

Top Products of 2022

According to IQVIA data, the top 10 products are growing at 26.2% and account for 22.7% of the market share. Zoomed out, the top 20 are growing at 24.6%, accounting for 30.7% market share.

Unsurprisingly, adalimumab (Humira) tops this list by a landslide, with a moving annual total (MAT) of $30.3 billion as of September 2022, with apixaban (Eliquis) in the next spot with an $18.1 billion MAT. As of January 2023, semaglutide (Ozempic) sales increased by $6.7 billion in absolute growth, marking a 74.7% increase. Empaglifozin (Jardiance) sales increased by $3.9 billion with a 46.6% increase.

Generics and Biosimilars

“For a long time, there has been a race to the bottom on generics,” Long said about their prices and sales.

Over the last 8 years, North American generic gross sales have declined by $17 billion. More IQVIA data showed almost 90% of prescriptions are for unbranded generics, even though they account for 8.4% of sales on a dollar basis.

“It’s a slippery slope,” Long said, mentioning Akorn Pharmaceutical’s filing for bankruptcy and going out of business in February. “We are seeing shortages today and we are going to see a lot more shortages in the future unless we give them breathing room because they can’t reinvest in their businesses.”

Biosimilars, on the other hand, appear to have a brighter future in the marketplace. Now comprising 46% of spending, the biologics market continues to grow faster than non-biologics on an invoice basis. Compared with total US medicines having a compound annual growth rate (CAGR) of 5.6%, this number is 12.5% for biologics and 1.3% for small molecules between 2017 and 2021.

Molecules accompanied by biosimilars constitute a total of $38 billion in invoice spending, and the development of biosimilars is aiming for an additional $96 billion. Long also noted that 30 biosimilars have already been introduced in the US market, with another 10 more set to launch by the end of 2023. Sales are expected to reach $11.4 billion this year and then increase rapidly to $38.5 billion by 2027, more than tripling in size.