IQVIA report sizes up medicine use, spending, immunization rates, drug shortages

New prescriptions for chronic and acute conditions were both above pre-pandemic levels in 2023, reflecting continued growth of chronic prescriptions and a resurgence of seasonal respiratory ailments driving higher acute prescriptions. This finding comes from IQVIA Institute for Human Data Science's newly released "Use of Medicines in the U.S. 2024 report."

Among the key findings in the report:

• Flu vaccination rates fell by 17% from the 2022 level and other routine adult and pediatric vaccination rates remain below pre-pandemic levels, although adult vaccination rates have improved since 2021.
• In 2023, total prescription medicine use increased by 3% and reached 210 billion days of therapy. Non- retail medicine use, including a large portion of cancer treatment, was disrupted early in the pandemic but has seen a sharp rise, especially in clinics and doctor’s offices.
• Retail prescriptions reached 6.9 billion, a 2.9% increase from 2022 but slower growth than the prior year. 
• Shifting enrollment patterns for insurance in 2023 resulted in more patients covered by commercial insurance, while Medicaid enrollees and the uninsured declined. Both Medicare and Medicaid saw rising average numbers of prescriptions per enrollee, while the commercially-insured and the uninsured had flat to declining usage per beneficiary.
• Many therapy areas had high growth in days of therapy in 2023, including GLP-1 agonists in obesity and diabetes, immunology treatments, lipid regulators and gastrointestinal medicines, all of which had increased use of more than 9% in 2023. Antibacterial use continued to grow in 2023 to 2.6 billion days of therapy, returning to pre-pandemic levels. Per capita prescription opioid use has declined to levels last seen in 2000. Traditional contraception methods declined in use, while on- demand and permanent surgical options increased.
• Growth in prescription medicine days of therapy was 3% in 2023 compared to 2022, with similar growth in retail and non-retail.

[Read more: IQVIA report sizes up trends in new drug launches, clinical trials, R&D funding]

Additional key findings: 

•  In non-retail drug usage, use of medicines in clinics has grown 13% since 2019, while long-term care and hospitals remain below pre-pandemic levels.
• In retail drug usage, dispensed prescriptions reached 6.9 billion in 2023, with 2.9% growth compared to 2022. 
• Medicaid enrollment dropped 7% in 2023 while prescriptions grew 5% to an average 10 per enrollee during the year.
• Nearly 100 million prescriptions were provided to patients through illegal online pharmacies in 2023. 
• More shortages continue to be reported than resolved, with 58% of the 132 current molecule shortages ongoing for more than two years.
• Many therapy areas had high growth in days of therapy in 2023, with GLP-1 agonists driving growth in both obesity and diabetes. 
• Use of medicines is growing across all autoimmune diseases, with Crohn’s disease and psoriasis contributing most to growth.
• Newer diabetes therapies have seen significant growth over the last five years with GLP-1 agonist use rising in both diabetes and obesity in 2022 and 2023.
• Use of antibacterials grew 4.6% in 2023 to 2.6 billion days of therapy, returning to levels seen before the pandemic as historic levels of seasonal respiratory illnesses return.
•  Per capita prescription opioid use has declined to levels last seen in 2000, while overdose deaths continue to rise and over-the-counter naloxone launched in 2023 providing easier access to this life-saving medicine.
• Use of more traditional forms of contraception have declined while on-demand and permanent surgical options have grown.

Drug shortages:

• Drug shortages are an ongoing issue in the U.S. healthcare system, although the number and severity of shortages have changed over time, with 132 active shortages as of June 2023.

• Over the past five-and-a-half years, 160 new molecule shortages have occurred through June 2023 while only 51 have resolved; 75% of current shortages have been ongoing for more a year and 58% have been ongoing for more than two years.

• Shortages tend to be in generic and injectable drugs, with 84% and 67% of shortages, respectively, and are more common at lower prices, with 56% of molecules in shortage priced less than $1 per extended unit — a measure of volume which varies by the form of a drug (oral, injectable, etc.).

• Drug shortages have occurred across several therapy areas with causes ranging from increased demand to manufacturing disruptions, meaning a single solution may not prevent or resolve future shortages. 

[Read more: IQVIA reports global market for medicines to rise to $1.9 trillion by 2027]

• Notable shortages have occurred in recent years in oncology, antibacterials, ADHD, anesthetics, and GLP-1 agonists,14 limiting or delaying patient treatment which could impact patient outcomes.

Medicine spending:

• Spending on medicines at net manufacturer prices reached $435 billion in 2023, up $10 billion over the prior year.

• The U.S. market at net prices grew by 9.9% in 2023, not including the declining contribution of COVID-19 vaccines and therapeutics, while spending growth including COVID-19 vaccines and therapeutics slowed to 2.5%.

• Spending at list prices grew at 7.6% over the past five years, but payers’ spending grew at 5.2% and patients’ costs grew at 2.1%.

• Spending at list prices has increased faster than all-payer net spending but far slower than 340B institutions.

• Specialty medicines now account for 54% of spending, up from 49% in 2018, driven by growth in immunology and oncology

• Median annual costs of new medicines have been rising particularly those in oncology and rare diseases

• Protected brand list prices increased 4.9% in 2023, while net prices increased by 3.0%

Outlook to 2028:

• The U.S. spending forecast reflects continued growth driven by innovation, offset by notable expiry events and characterized by a continued increasing gap between list price spending which will grow at 6–9% and manufacturer net revenues which will grow at 4–7%.

• New brand spending in the U.S. is projected to total $122Bn in the next five years, down from the $149Bn in the past five years.

• Net prices for protected brands are forecast to decline -1 to -4%, while list prices will grow 1 to 4% including impact of price cuts.

• The impact of exclusivity losses will increase to $93.6Bn over five years, including significant biosimilars.

• Oncology and obesity drive growth through 2028 while diabetes, immunology and COVID-19 contribute to slowing.