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Institute Report
The Use of Medicines in the U.S. 2023
Usage and Spending Trends and Outlook to 2027
May 02, 2023
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Report Summary

As we look back on 2022, the third year of the COVID-19 pandemic, we see areas of greater clarity around the utilization of health services, medicine use, and spending trends, while in other areas — including the impact of the most consequential healthcare reform in more than a decade — greater uncertainty appears to be on the horizon. The U.S. healthcare system remains fragmented, opaque and often dysfunctional, despite the rallying efforts of the pandemic years.

Evidence-based research and dissemination of findings remain a key foundation to advance our collective understanding and interpretation of events, and to take actions that will shape the future for all stakeholders. This annual trend report is intended to contribute to that understanding.

Areas of focus in this year’s report range from looking at health system utilization and its recovery from the pandemic, to how medicine usage patterns have shifted, the complex nature of drug pricing, and the impact of out-of-pocket costs on patients.

While forecasting in this environment is not for the faint of heart, we have laid out our view of the drivers of change in medicine spending over the next five years. This includes the impact of biosimilar introductions affecting the single biggest selling drug in the U.S., and our assessment of the consequences of policy changes already legislated but still unclear and which will take effect in the coming years

Key findings:

  • The U.S. market for medicines grew by 5% in 2022, reaching a total value of $429Bn.
  • Health services utilization reached 100% of pre-pandemic levels for the first time at the end of 2022, up from a low of 66% in Q2 of 2020.
  • Telehealth visits fell to 5% of total vists in 2022, down from peak of 25% early in the pandemic.
  • Biosimilars now account for 25% of total volume of reference molecules prescribed in the U.S.
  • The average patient out-of-pocket cost per retail prescription dropped to $9.38 in 2022, down from $10.15 in 2017.
  • Significant spending growth areas expected over the next five years in oncology, obesity and neuroscience, while total net medicine spending is projected to remain unchanged.

Other findings:

  • The cumulative Health Services Utilization Index across the pandemic (Q2 2020-Q4 2022) remains at 92 despite a recovery in recent quarters to pre-pandemic levels, indicating both concerning gaps in preventive and treatment services that have yet to be addressed and avoided interactions with the healthcare system due to declines in routine illnesses (e.g., flu).
  • Doctor visits — including face-to-face and telehealth — were the least impacted during the pandemic and have remained above pre-pandemic levels since early 2021, however the cumulative index remains 2% below baseline. • Screening and diagnostic tests have remained below baseline throughout the pandemic and declined throughout 2022, likely driven by the declining use of COVID-19 testing in medical settings as testing decreased and at-home testing became more accessible.
  • Screening and diagnostic tests have remained below baseline throughout the pandemic and declined throughout 2022, likely driven by the declining use of COVID-19 testing in medical settings as testing decreased and at-home testing became more accessible.
  • Total prescriptions — adjusted for prescription length — reached 6.7 billion in 2022, up from 6.1 billion in 2018.
  • In total, dispensed prescriptions increased 3.6% in 2022 and had minimal impacts on growth throughout the pandemic.
  • The increasing importance of 90-day prescriptions is evident as the rate of growth without adjustment for prescription length was -0.1% on average over the last five years, but 2.5% after adjustment with 1.1 billion 90-day prescriptions in 2022.
  • Over the past five years, spending at list prices [Wholesaler Acquisition Cost (WAC)] has increased from $600Bn to $858Bn — an average of 7.4% per year.
  • Payer net spending has increased from $461Bn to $603Bn over five years at a compound annual growth rate of 4.5%.
  • Spending at manufacturer net prices, including all products, are estimated to have grown an average of 5.6% over five years.
  • Patient out-of-pocket costs increased $2.1Bn in 2022, exceeding peak levels last seen in 2018.
  • This growth was driven by non-retail out-of-pocket costs, which grew $1.2Bn, or 7.5%, in 2022, returning to pre-pandemic growth rates following a significant decline in 2020.
  • Retail out-of-pocket costs grew $949Mn, or 1.5%, in 2022 and have remained relatively stable over the last five years, growing an average 0.7% annually.
  • Total net spending on medicines in 2027 is expected to be unchanged compared to 2022 as volume growth drivers will be fully offset by drivers of lower prices, including patent expiries and the effects of legislation.
  • Over the next five years, medicine spending will grow between 1–4% on a list price basis and -2 to 1% after discounts and rebates.
  • Growth will be driven by adoption of newly launched innovative products, with an average of 50–55 new medicines launching per year over the next five years, including those in oncology or with specialty or orphan status.

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