The top-line findings in the IQVIA Institute for Human Data Science’s U.S. Medicine Use Trends 2026 report all point toward robust growth. In 2025, Americans received a record 210 billion days of medicine therapy — a 1.5% increase over the prior year and 13% growth across five years. Spending on medicines also climbed significantly, rising 10.6% to $606 billion at net manufacturer prices. That increase was driven by mid-life protected brands, particularly in oncology and immunology.

By most measures, the U.S. health system is delivering more treatment to more people. Yet closer examination reveals a more nuanced picture. In the same year that use and spending set records, a large share of patients still couldn’t afford and/or couldn’t access the treatments they were prescribed. That reality persisted despite implementation of a new federal policy aimed at improving affordability.

Medicare OOP Limit Proves Beneficial, but Only to Select Patients

For patients, the most important development in 2025 was the new annual cap on out-of-pocket (OOP) costs in Medicare Part D. This new policy had a measurable effect, as evidenced by a 2.2% decline in total Medicare out-of-pocket spending. For beneficiaries, that translates to $638 million in cost savings — the first meaningful drop after years of annual spending increases.

However, the benefit of the OOP cap was uneven. While it protects patients with high prescription costs on covered drugs, it does little for the many Medicare beneficiaries whose annual spending falls below the threshold. What’s more, it doesn’t apply to medicines Medicare doesn’t cover. As a result, some Medicare patients continue to pay cash for drugs outside their plan — including some obesity and erectile dysfunction treatments — and those costs never count toward the cap. For these individuals, total out-of-pocket costs can easily exceed $2,000.

Look beyond Medicare and the outlook is even less positive. Total patient OOP costs went up $6 billion to reach a record $110 billion in 2025. In other words, the Medicare spending decline was more than offset by rising costs everywhere else. Commercial insurance OOP spending, which accounts for 52% of all such outlays, rose 5% in the year and 37% over five years.

With no comparable cap on the horizon for commercially insured or cash-paying patients, affordability remains a system-wide pressure.

Patients Still Struggle to Start Novel Therapies

The other reality beneath the growth headline: continued difficulty in accessing new treatments.

For medicines newly launched in the U.S., nearly two-thirds of the prescriptions written in the first year go unfilled. Across 99 novel medicines that launched between 2020 and 2024, an average of 35% of first-year prescriptions were filled. The remaining 65% didn’t reach patients, with 49% rejected by payers and 17% abandoned after payer approval, often due to high OOP cost.

Although fill rates are expected to improve as a medicine ages, more than half of new prescriptions remain unfilled by the fourth year on the market. That’s notably higher than the 29% of unfilled prescriptions across all brands and branded generics. It suggests that U.S. patients are still unable to access therapies their healthcare providers have already determined were needed.

Among the most relevant examples are GIP/GLP-1 agonists. Despite high demand and a strong clinical case for these medicines, only a fraction of patients who are prescribed these therapies end up getting them. Coverage is frequently denied, and few patients are willing and able to pay hundreds of dollars a month out of pocket. It adds up to a growing class of treatments that show up in national spending totals — yet remain inaccessible to many of the people who stand to benefit most.

Growth in Medicine Use Still Leaves Many Patients Behind

Medicine use and spending are climbing, innovation is reaching the market, and the headline figures look healthy. Even so, the system leaves a substantial number of patients unable to afford or obtain their prescriptions. The new Medicare cap has addressed only part of the problem.

This tension is likely to continue over the next several years. U.S. medicine spending is forecast to rise by roughly $200 billion by 2030, with an average of 50 to 55 new medicines expected to launch each year. Whether more of those medicines reach patients will depend on what happens next on coverage and affordability.

The IQVIA Institute for Human Data Science is hosting a webinar on this report on July 15, 2026. Register now  to join us in exploring more of the key trends and implications for the U.S. market. The webinar may also be viewed on demand after the live session by registering at the same link above.