Imagine opening your eyes on a spring morning in 2022. As you pick up your smartphone or click on the TV, what will headlines proclaim? Will they affirm that the world bears some semblance to pre-COVID-19 “normal”? Will they suggest some pockets of ongoing uncertainty?

No one at IQVIA has a crystal ball. What we do have is a comprehensive approach to scenario planning. In fact, earlier this year a multifunctional team of IQVIA senior leaders collaborated to develop four scenarios for how the U.S. could look in over the next 12-18 months – and how pharmaceutical and healthcare organizations can plan for each.

This post is the first in a two-part series. It explores the first two scenarios, “The Long Night” and “Too Many Moving Parts,” along with their implications for the U.S. healthcare landscape. The second blog in this two-part series will explore the remaining scenarios, “Journey Disrupted” and “Reputation Reborn.” 

Scenario Development – Plausible, Distinct, and Disruptive

Over a series of workshops, the multifunctional scenario planning team identified the key driving forces that could determine post-COVID-19 scenarios in the U.S. Those drivers include virus and therapy evolution, economic impact and recovery, patient-provider interaction, and evolution of payers and insurers.

The team assessed the interrelationships between the driving forces, developed potential scenarios, and identified four which are most plausible, distinct, and disruptive in the U.S. After that, they outlined additional detail for each scenario for a variety of major market components - such as U.S. insurance evolution, payer power and strategy, and new patient acquisition - along with recommendations for where and how to compete for individual and multiple scenarios. 

It’s important to note that these scenarios have not been quantitatively modeled. They are not forecasts, nor are they predictions. They are meant to help pharmaceutical companies determine what could happen over the next 12-18 months in order to remain resilient and navigate this new post-pandemic environment as successfully and effectively as possible.

Scenario #1: The Long Night

As the name implies, this scenario plans for a high impact from COVID-19 over a lengthy time horizon. In “The Long Night”, the COVID-19 impact in the U.S. continues beyond the next 18 months with no effective disease management before 2022. The economic downturn persists, potentially leading to the deepest recession in 100 years. There is likely no coordinated national healthcare policy, with decision making occurring at the state level and significant inconsistency in terms of policy and restrictions. Surges in infections are common but highly variable in terms of timing and level.

Healthcare provider visits would be significantly depressed over this time period, most noticeably in urban areas, given concern over COVID-19 infection and other diseases, particularly chronic conditions, being de-prioritized. Significant gaps in the patient journey could lead to lower treatment adoption rates, and certain diseases that have been historically hospital-based, like cancer and orthopedic surgery, could shift out of the hospital setting.

There could also be significant consolidation among providers as well as  payers, and an increase in formulary control within the commercial market. Additionally, Medicare would likely need to expand to fill the growing gap in coverage.

Scenario #2: Too Many Moving Parts

The second scenario, “Too Many Moving Parts,” is based on the idea that some COVID-19 impact continues for 18 months or more, but that an effective vaccine is introduced by mid-2021 for high-priority populations. While this helps curb some impact of COVID-19, other effects of the pandemic would likely continue to be felt over the next few years.

There would likely be fragmented response and varying policies at the state level, and a lack of a coordinated national healthcare policy, resulting in high variability in recovery across the U.S. Lack of effective outbreak control could result in a surge of infections in late 2020 or early 2021, bringing renewed restrictions in some states and particularly in urban areas.

Unemployment would be projected to shrink but remain significantly higher than pre-COVID levels. Consumer spending in 2021 would be on the rise but likely depressed compared to 2019 levels.

Variability in policies and societal impact at the state level could result in uneven distribution of care and care quality. Limited numbers of patients would be projected to return to HCP offices in high COVID-19 impacted states, increasing the reliance on telehealth in certain areas. Chronic illnesses would likely continue to be undertreated, with certain states and regions with lower levels of care experiencing higher non-COVID-19 mortality.

In this scenario, the insurance landscape would increasingly vary by state, with some patients incentivized to move based on coverage considerations. Medicaid enrollment would surge in states with high impact, but Medicare will not be expected to expand coverage despite widespread public demand.

Scenarios Implications and Next Steps

Most U.S. pharma companies are already considering the changes they need to make in order to succeed in the new business environment. It’s important to reassess mission and strategy, and to reevaluate portfolio priorities based upon the potential COVID-19 scenarios.

To learn more about the implications of each scenario, and strategies to prioritize going forward, listen to our new podcast series, U.S. Post COVID-19 Scenario Planning & Commercial Implications, or contact us directly to discuss these scenarios and their implications for your business.