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"The Hard Slog Will Continue:" Trends in Use and Spending on Medicines in the U.S.
Highlights from a webinar about the use and spending on medicines in 2022
Murray Aitken, Executive Director, IQVIA Institute for Human Data Science
Jun 20, 2022

The IQVIA Institute for Human Data Science hosted a webinar on May 10, 2022, which followed the publication of the Institute report, The Use of Medicines in the U.S. 2022. Usage and spending trends and outlook to 2026.

The webinar included participation from an esteemed group of panelists representing academic research, health economics, pharmaceuticals benefits managers, and the life sciences industry.

In the course of the webinar, panelists discussed a number of key topics:
  • The utilization of medicines and health system resilience: There was agreement among the panelists that the entire U.S. health system has demonstrated remarkable resilience during the pandemic. Unlike other business sectors – for example, semi-conductors – the entire pharmaceutical supply chain has held up well and avoided shortages that would have deprived patients of life-saving drugs. This is in large part due to the extraordinary collaboration among all players in the entire supply chain – manufacturers, pharmacy benefits managers, payers, providers, and others working well together. In general, the health system is almost back to pre-pandemic conditions while some disruptions are still lingering, with a cumulative backlog in parts of the care delivery chain. On the flipside, the pandemic has revealed serious challenges with the level of access to care for underserved populations, health disparities, and unresolved challenges such as antimicrobial resistance.
  • Heterogeneity in costs of drugs: The panelists concurred with the findings in the report that spending growth on medicines generally is slowing and that patient out-of-pocket costs on average are trending lower. However, the averages are obscuring the fact that categories of patients, in particular patients with chronic conditions such as cancer, immune disorders and HIV, can have significantly higher costs for their medicines. In certain therapeutic categories, especially those where specialty drugs have limited brand competition, costs can also be higher. In addition, uninsured patients face particular challenges. Overall, the level of heterogeneity across different patient populations, different therapeutic categories, and types of medicine is a big challenge both to understand and to address.
  • The rising role of the 340B Drug Pricing Program: The growth in 340B – the federal drug program that allows qualifying providers, hospitals and specialty clinics serving uninsured and low-income patients to purchase outpatient drugs from manufacturers at discounted prices – was described as resulting in it now being a larger program than Medicare Part D. The 340B program is controversial as studies have shown there is limited evidence that the resulting discounts are being used to reduce the costs of medicines to patients, and that instead cross-subsidization is leading to the savings being used to cover other expenses for hospitals and providers. This leads to distortions in the marketplace and consequences that are far from the original intent of the program.
  • Competition and specialty drugs: There were divergent opinions among the panelists whether there is sufficient competition, especially in the category of specialty medicines which now represent 56% of total drug spending. Some panelists found that competition still puts pressure on the costs of medicines, while others expressed concerns that competition is eroding. Even though there is general agreement in the health system that patients should have access to oncology drugs despite their high cost, patients don’t always get access to the medicines they need because payers demand pre-authorizations and stepped therapy, and price concessions by manufacturers in the form of rebates do not always flow to savings for the patient.
  • Cost-sharing and patient costs: Cost-sharing is an intentional part of insurance design overseen by formulary committees. Coupons are means to circumvent those approaches. However, the point was made that cost-sharing and the use of manufacturer coupons are band-aids on a larger affordability problem. While coupons may be the last resort for patients to get access to a drug, most patients would prefer to get proper access to a medication rather than use coupons.
  • Outlook for drug spending: There were general expectations among the panelists that net prices on medicines in general will continue to stay flat over the next year or so, even though prices on medicines for rare diseases, cancer, and immune disorders will continue to be at high levels. There was a call for smarter spending on medicines, not just more spending. It is also expected that there will be continued pressures to control costs of drugs, push the development of biosimilars, and reduce barriers for entry of generics. In the words of one of the panelists, “It will be a hard slog.”

The panelists represented different sectors of the U.S. pharmaceutical eco-system and research:

  • Kristin Bass, Chief Policy Officer, Pharmaceutical Care Management Association
  • Stacie Dusetzina, Ph.D., Associate Professor, Vanderbilt University
  • Richard G. Frank, Ph.D., Professor of Health Economics, Director – USC-Brookings  Schaeffer Initiative for Health Policy, Brookings Institution
  • Lori M. Reilly, JD, Chief Operating Officer, PhRMA

Join the conversation and hear how panelists responded to the topics above and more by viewing the webinar on-demand.

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