IQVIA is in part the old IMS, which had a lot of data on pharmaceutical use. The firm continues to produce and release a lot of interesting information, including an annual report on Medicine Use and Spending in the US. (IQVIA Report) In 2018 Americans filled a total of 5.8 billion prescriptions (calculated as 30 day supply equivalents), or 17.6 per person, up 2.7% from the prior year. A lot of drugs. And they cost a lot, $344 billion, a rise of 4.5% from the prior year. Spending was $1044 per person. Almost exactly half of this spending now goes to specialty medications. The out-of-pocket share of spending was $61 billion or about 18%. Here are some telling statistics: patients don’t fill 20% of new brand prescriptions when the copay is above $50 and more than 50% when the copay is above $125. Those are drugs the doctor thought the patient needed. About two-thirds of all prescriptions were for chronic conditions. Generics were 90% of all prescriptions and are dispensed 97% of the time they are available. More importantly, we had three biosimilar approvals in 2018. We need a lot more to constrain spending in speciality biologics. And specialty drugs were only 2.2% of all prescriptions, or 127 million, but grew by 5.7% year-over-year.
The top ten therapy areas account for two-thirds of all prescriptions. Blood pressure medications had almost 1.2 billion prescriptions, with 4% annual growth. Mental health drugs had 517 million prescriptions, a rise of 5.2%. High cholesterol drugs had 463 million prescriptions, with 5.7% growth. Pain meds had 447 million prescriptions, but declined 4.5%. Vaccines also have seen rapid growth, primarily due to new shingles and flue vaccines, but also because of use in other therapy areas. IQVIA sees drug spending rising at a compound annual growth rate of 3% to 6% for then next few years, rising to around $420 billion in 2023, a slower increase than the last five years. Most spending growth is expected to be driven by new brand drugs, largely offset by reduced spending on brands than lose patent protection. And in a bit of good news, opioid prescribing continues to decline rapidly, as well as number of doses per prescription, but unfortunately, patients can often obtain these drugs illegally. Finally adherence appears to be improving. 90 day prescriptions and automatic refills may contribute to this improvement. Medicare Part D and commercial patients are the most adherent to prescribed regimens, while Medicaid patients, despite usually having no copays are non-compliant 40% of the time.