The COVID-19 pandemic has shaped health care in the United States over the past 2 years. It remains to be seen what changes will be permanent, but some affected areas are returning to normal, explained Doug Long, MBA, Vice President, Industry Relations, IQVIA, who delivered Thursday’s keynote at the annual meeting of the Association of Managed Care Pharmacy.
At the start of the pandemic, new diagnoses dropped precipitously. Although cancer screenings have recovered, they have not returned to where they should be, he said. For example, there were 87% fewer mammograms in April 2020, and in the first quarter (Q1) of 2021 there were still 14% fewer. Similar trends are seen in other cancer screenings:
- Pap smears are down 83% in April 2020 from baseline expectations and still down 20% in Q1 2021
- Colonoscopies were down 90% in April 2020 and still down 25% in Q1 2021
- CT scans down 53% in April 2020 and still down 10% in Q1 2021
- Prostate-specific antigen testing down 60% in April 2020 and still down 15% in Q1 2021
“So it’s no surprise that the people who finally got to see the doctor are probably more advanced [disease stages]”Long said.
Oncology was not the only specialty affected. In 2020, there were nearly a billion fewer diagnostic visits than the number expected if there had been no pandemic. The specialties with the largest gap in diagnostic visits were endocrinology, rheumatology, primary care and oncology, he noted.
Current drug market
In the years leading up to the pandemic, spending on specialty drugs exceeded spending on traditional drugs and it was expected that spending on specialty drugs would now increase more than spending on traditional drugs. However, this has yet to happen, although Long expects it to finally happen in 2022. In 2018, specialty sales accounted for 45.3% of drug spending and now represent 49.3% .
IQVIA data identified the therapeutic areas with the strongest growth in the short term (1 year growth) and long term (5 year compound annual growth rate). Immunology and Anticoagulants posted the strongest growth over 1 and 5 years in the United States. While pain had growth over 1 year, its growth over 5 years was negative. In comparison, multiple sclerosis has positive growth over 5 years, but negative growth over 1 year.
In 2021, the top therapeutic class was antidiabetics, with $69.3 billion in sales and 16.4% year-over-year growth. However, the lead product was apixaban (Eliquis), a blood thinner, which recorded sales of $12.0 billion and growth of 23.0% year-over-year. Top 5 products in 2021 by sales were completed by dulaglutide (Trulicity) with $10.1 million, semaglutide (Ozempic) with $7.3 million, empagliflozin (Jardiance) with $6.6 million and bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) with $5.8 million.
List prices for branded pharmaceuticals rose 4.4% in 2020, but net prices fell 2.9%, the fourth year at or below the consumer price index, the data shows. from IQVIA. Long also highlighted the annualized percentage change in national health expenditure prices as published in an Altarum report in November 2021. This report showed a negative change in prescription drug prices in October 2021 compared to the previous year. , but the prices of hospitals and doctors are on the high.
“The perception is that health care is very expensive here, and it is, but it’s not because of drug costs,” Long said. “What motivates him is [the costs of] hospital services,” which he says have increased by 200% since 2000.
In 2021, there were 74 product launches, up slightly from 71 in 2020. More than a third (35%) of launches in 2021 were for oncology, 15% were for infectious diseases and 12% were for the central nervous system (CNS). In 2020, oncology represented 32% of new launches, CNS 25% and infectious diseases 10%.
The biggest sales launch was semaglutide (Wegovy) for weight loss with $601.8 million in sales in 2021, followed furthest behind by sotorasib (Lumakras) for non-small cell lung cancer (NSCLC) with $63.7 million and MenQuadfi meningococcal vaccine with $61.6. million.
Long highlighted some potential launches in 2022 to watch:
- Donanemab from Eli Lilly and gantenerumab from Genentech, both for Alzheimer’s disease
- Eli Lilly’s Tirzepatide for Diabetes
- Deucravacitinib from Bristol Myers Squibb for moderate to severe plaque psoriasis
- Alnylam vutrisiran for transthyretin amyloidosis
- Mavacamten from Bristol Myers Squibb for hypertrophic cardiomyopathy
- Adagrasib from Mirati Therapeutics for NSCLC
He pointed out that there is a mix between small and large pharmaceutical companies developing the potential launches anticipated. Traditionally, drug launches have come from large companies, but smaller companies are getting into drug launches as well.
“When you think about launches and development…the innovation isn’t really in traditional pharmaceuticals anymore,” Long said. “It’s in especially, it’s in orphan drugs, it’s in monoclonal antibodies, it’s in cell and gene therapies. And all these things are expensive commodities [with a] very small patient population.