The latest report from the IQVIA™ Institute for Human Data Science presents the 2018 Medicines Use and Spending in the U.S. The report provides extensive metrics on drug usage and its cost to the US Healthcare system. We discuss some of the interesting findings of this report.
2018 witnessed a 2.7% growth in the total prescriptions dispensed and an increase of 4.5% in net spending (defined as the amount received by pharmaceutical manufacturers after rebates, off-invoice discounts and other price concessions have been made to distributors, health plans and intermediaries). 5.8 billion prescriptions (adjusted for 30-day equivalent) were dispensed with a total invoiced value of $479 billion and net spending of $344 billion.
Drug prescriptions for anti-cardiovascular-metabolic drugs had the highest growth (>4%) due to increased disease prevalence and improved adherence. Mental health related drug prescriptions increased by 5% driven by increased use. Prescription for pain medications declined by 4.5% due to the decline in opioid use driven by changes in regulations and clinical guidelines.
Specialty pharma accounts for a mere 2.2% of the total prescription volume (127 million) but accounts for nearly 50% ($517 out of the $1,044) total per person medicine costs in 2018. The higher proportion of spends is accounted for, by new brand entries in US (66% of NMEs first launched in 2018 are in specialty segment), compounded by patent expiries in the traditional medicines.
In the specialty pharma segment, checkpoint inhibitors have been prescribed to 200,000 unique patients in 2018. Oncology accounting for 55% of retail prescriptions in 2018 has seen the largest spending increase, driven by recent launches of oral kinase inhibitors.
The prescriptions in autoimmune disorders grew by 20%, alone in 2018 continuing on a general trend since 2013. This growth is largely attributed to new launches in indications of high unmet need such as Crohn’s disease and Ulcerative colitis and volume growth in RA (41% of the total 16.3 million patients were treated for RA in 2018).
The overall market accessible to biosimilars is about $15.7 B in US of which biosimilars account only for 31% of prescriptions in 2018. Generics make up 90% of total prescription dispensed, up from the 75% in 2007. Despite the increase in generics prescription, the net spending per capita, grew by $44 in the same ten years driven by increase in specialty spending ($255 per person) over the same period.
The total net spending CAGR on pharmaceuticals is estimated at 3-6% CAGR resulting in forecasted 2023 net spending of $420 B. This growth is driven by growth in price and volume and biosimilar uptake. 59 New medicines launched in the past two years contributed $11 B to net growth in 2018. Similarly, the volume growth of existing brands contributed to $13.2 B in net spending. While average OOP cost has come down from $10.28 in 2014 to $9.05 in 2018, these average costs reflect only those patients who adhered and not the ones who did not seek healthcare and/or abandoned a prescription.