Conferences | AMCP Annual The COVID-19 pandemic has had a big impact on the US health care market. Some areas impacted are returning to normal and innovation is continuing, explained Doug Long, MBA, of IQVIA, during the Thursday keynote at the Academy of Managed Care Pharmacy annual meeting, AMCP 2022 The COVID-19 pandemic has scrambled many sectors of the American economy and life the past two years, including delivery of healthcare services and some aspects of the pharmaceutical industry. During today's keynote session today at the Academy of Managed Care Pharmacy annual meeting in Chicago, Doug Long, MBA, vice president, industry Relations, at IQVIA, described some of the disruptions, sketched the trends and made some projections about the near-future of U.S. healthcare. Overall, Long gave the "health ecosystem" an A+ for its response to the pandemic, pointing to the success of bringing three vaccines to market in record time, scaling up vaccine production and adjusting the supply chain processes to handle volume increases and decreases. Long heaped praised on pharmacists and healthcare providers for stepping up and taking on new tasks.
“So, A rating and congratulations," said Long, a seasoned presenter at healhtcare meetings. He compared the healthcare sector to the automobile industry: "Think about how this ecosystem held up better than trying to get a car today,” he said.
One well-documented impact from the pandemic was the drop in new diagnoses, particularly in cancer. Early in the pandemic in April 2020, there were 87% fewer mammograms, 83% fewer Pap smears, and 90% fewer colonoscopies compared with baseline expectations.
“So, it's not a surprise that people that have finally gotten to see the doctor, probably are in more advanced [disease stages],” Long said.
While these screenings have recovered, they are not yet back to where we would expect them to be, he noted. By the end of the first quarter in 2021, mammograms were still down 14%, Pap smears were down 20%, and colonoscopies were down 25%.
In 2020, there were nearly 1 billion fewer diagnosis visits. These are visits that didn’t happen including visits to the physician’s office, telehealth visits, and elective procedures. Oncology, endocrinology, and rheumatology had the biggest gaps, Long noted.
At the end of 2021, the trend of general medical claims did start to increase. Office visits had recovered early in the year and accelerated at the end of the year, but institutional or hospital visits were not as stable. Telehealth visits peaked at 13% of all medical claims.
Drug sales Moving on from the effects of the pandemic, Long turned his attention to the where the drug market currently stands. The growth in the specialty market continues to outpace the growth of traditional drugs; however, conventional wisdom had expected specialty to have been larger than traditional at this point. While that hasn’t happened yet, Long expects it to do so in 2022. Right now, traditional drugs account for 50.3% of the total nondiscounted spend compared with 49.3% for specialty.
While medications for diabetes were the top therapy class in 2021 with $69.3 billions in sales in 2021 and a year-over-year growth of 16.4%, the top product was the anticoagulant Eliquis (apixaban), which had $12.0 billion in sales and 23.0% growth. The diabetes drugs Trulicity (dulaglutide), Ozempic (semaglutide), and Jardiance (empagliflozin) were ranked second, third and fourth.
Branded pharmaceutical list prices increased 4.4% in 2020, but net prices decreased 2.9%, which is the fourth year at or below the Consumer Price Index, according to IQVIA data. Long also pointed to the annualized percent change in prices for national health expenditures as published in an Altarum report in November 2021. This report showed a negative change in prices for prescription drugs as of October 2021 compared with the previous year, but hospital and physician prices are up.
“The perception is health care is very expensive here, and it is, but it’s not due to drug costs,” Long said. “What’s driving it is hospital services,” which he showed are up 200% since 2000.
Data from IQVIA analyzing the total drug spending as a percentage of health care in the United States and 10 other countries found that the United States spends 14% of health care spending on drugs, which is slightly lower than the average of 15% for all 11 countries. Germany, France, Japan, Italy, Spain, and South Korea all spent a larger percent of health care spending on drugs than the United States.
Generic sales continued to decline and were down 5.2% in January 2022 because of price deflation, Long said. As a result, 83.5% of prescriptions were unbranded generics in 2021, but they only accounted for 9.5% of dollars. Overall, unbranded and branded generics accounted for 18.4% of spending in 2021.
In addition, there are more savings coming from biosimilars. “We’re in the sweet spot of biosimilars now,” he said.
Between 2020 and 2024, there is an expected $104 billion of savings as a result of biosimilar use and much of those estimates are due to Humira coming off patent. There are already seven FDA-approved Humira biosimilars with anticipated launch dates between January and November 2023.
Biosimilars account for more than 60% of bevacizumab and trastuzumab market share and biosimilars account for more than 50% of rituximab market share. In addition, sales of filgrastim and pegfilgrastim continue to grow.
Long told the audience to keep an eye on Humira biosimilars next year and after that, biosimilars for Stelara.
Product launches In 2021, there were 74 product launches, of which 35% were in oncology and 15% in infectious disease. The biggest launch by sales was Wegovy (semaglutide) for weight loss with $601.8 million in sales in 2021.
He highlighted some potential launches in 2022 to keep an eye on:
“What's interesting is that it's a mix of big companies and small companies,” Long said. “It used to be that big pharma was the commercial engine of launches. And now some of these launches can be done by smaller companies, because they require fewer people, smaller patient populations, and all of that.”