IQVIA Report Highlights Shifts in Medicine Use, Spending Across Therapy Areas

As health care systems in the US adjust to longer-term consequences of the COVID-19 pandemic on health services utilization, medicine use, and total vaccine and therapeutic expenditure, new areas of interest have emerged and spending trends have accelerated despite broader economic trends, according to IQVIA’s annual report on medicine spending trends in the US.¹

The annual spending trends report highlights substantial growth in the US market when drops in COVID-19–related costs were excluded. | Image credti: utah51 - stock.adobe.com

The annual trend report aligns with persistent efforts to provide evidence-based research for health care stakeholders to discuss and consider when aiming to advance the US health care system.

In this year’s report, usage and spending trends were examined and forecasted through 2028. Areas of focus included health system utilization and recovery from the pandemic, how patterns of medicine use have shifted, drug pricing, and how out-of-pocket (OOP) costs affect patients. The outlook has changed with dynamics that emerged in 2023, the authors noted, and anticipated drivers of change are broken down throughout the report.

Shifts in Medicine Spending and Drivers of Growth

One key finding was that the overall spending growth for medicines in the US market dropped to 2.5% in 2023 when including COVID-19 vaccines and therapeutics. However, when pandemic-related vaccines and therapies were excluded, the US market at net manufacturer prices grew to $435 billion, which was a 9.9% increase. The difference highlights the sharp decline in COVID-19–related spending, which dropped from $32 billion in 2022 to $4 billion in 2023.

“This represents a significant acceleration in spending growth driven by innovation and a shift in the mix of use of older medicines that is bringing better medicines to more patients,” the authors explained. Areas such as oncology, immunology, diabetes, and obesity were largely responsible for the accelerated growth seen when COVID-19–related vaccines and medicines were excluded from the analysis.

“Specialty medicines account for 54% of spending, up from 49% in 2018, driven by growth in immunology and oncology, while traditional therapies have gained share recently from rising spend in diabetes, obesity, and vaccines,” the authors wrote.

Oncology and obesity drugs are projected to continue driving growth through 2028, while the authors anticipate immunology spending to slow down despite a projected 75% increase in volume. This is due to the impact of biosimilars in the immunology space.

“The introduction of biosimilar adalimumab (Humira) in 2023 and ustekinumab (Stelara) in 2025 will contribute significantly to lower net spending for immunology treatments, with the full impact visible in 2024 when spending growth slows to 3%,” the authors wrote.

Health Care Utilization Declined, but Medicine Use Increased

The analysis found that the use of health care services, including visits, diagnostics, elective procedures, and drugs, declined 3% in 2023 vs 2022 based on the IQVIA Health Services Utilization Index, which offers a composite view of health services over time. The index tracks patient visits, screenings and diagnostic tests, elective procedures, new prescriptions, and vaccinations, all of which saw 4% to 6% reductions aside from new prescriptions, which grew 3%.

“New prescriptions for chronic and acute conditions were both above pre-pandemic levels in 2023, reflecting continued growth of chronic prescriptions and a resurgence of seasonal respiratory ailments driving higher acute prescriptions,” the authors wrote.

Unlike the overall Health Services Utilization Index, total prescription medicine use increased by 3% in 2023, reaching 210 billion days of therapy. Early in the pandemic, there was a drop in nonretail medicine use such as cancer treatments, but retail prescriptions saw a steep rise in the time since, reaching 6.9 billion in 2023.

Several therapy areas saw substantial growth in terms of days of therapy in 2023. These included glucagon-like peptide-1 agonists in obesity and diabetes, immunology treatments, lipid regulators, and medicines for gastrointestinal conditions. Each of these areas saw use increase by more than 9% in 2023. Antibacterial use also grew to prepandemic levels, and while traditional contraception methods saw declines in use, on-demand and surgical options both increased.

Per capita use of prescription opioids dropped to numbers last seen in the year 2000, and opioid prescriptions are down 67% from their 2011 peak. “These decreases in volume have been driven by changes in clinical usage, regulatory and reimbursement policies, and progressively more restrictive legislation enacted since 2012, including class-wide guidance from FDA in 2016,” the authors wrote.

Increases in Patient OOP Costs and Looking to the Future

In 2023, aggregate OOP costs to patients grew $5 billion to a total of $91 billion, with this amount factoring in $23 billion in manufacturer co-pay assistance programs. Co-pay cards were used for almost a third of brand commercial prescriptions in the top 10 therapy areas and for almost two-thirds of prescriptions for obesity medications. Over 90% of prescriptions cost less than $20, but prescriptions exceeded $125 in 1% of cases, or 71 million prescriptions.

Patients covered by Medicare were more likely to have annual OOP costs exceeding $2000 compared with other patients, and the annual OOP cost cap in Medicare Part D, which was set by a provision of the Inflation Reduction Act (IRA),² has potential to save 1.2 million patients over $1900 on average if the current patterns of medicine use persist.¹

“Both commercial and Medicare patients have seen drug out-of-pocket costs rise, while the amount paid by uninsured patients has declined due to a smaller uninsured population even as rising list prices have exposed them to higher costs,” the authors wrote.

The report projects continued growth in the US market driven by innovation but also offset by expiry events such as the pandemic. Through 2028, the authors estimated a growing gap between net price spending and manufacturer net revenues, which are expected to grow by 6% to 9% and 4% to 7%, respectively. This includes anticipated IRA impacts, such as drug price negotiation. In the next 5 years, they also anticipate exclusivity losses to have an impact of just over $93 billion, which biosimilars will contribute to substantially.

Reference

1. IQVIA. The use of medicines in the U.S. 2024: usage and spending trends and outlook to 2028. May 7, 2024. Accessed May 17, 2024. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/the-use-of-medicines-in-the-us-2024

2. Mattina C. Part D drug spending cap could save money for 1.5 million Medicare beneficiaries next year. AJMC. February 8, 2024. Accessed May 17, 2024. https://www.ajmc.com/view/part-d-drug-spending-cap-could-save-money-for-1-5-million-medicare-beneficiaries-next-year