Staying up to date on industry trends and forecasts is vital to remaining competitive in the evolving managed care arena—especially because market predictions can shape the approach to managing the pharmacy benefit. During a presentation at AMCP eLearning Days, Douglas M. Long, BS, MBA, vice president of Industry Relations at IQVIA, discussed the current impact of the COVID-19 pandemic on the health care marketplace, plus other industry trends.
Total U.S. market dollar sales are growing at a faster rate than retail and mail combined, indicating that non-retail is growing at a slighter faster pace than retail and mail, said Mr. Long. For the total market, specialty growth is outpacing traditional product growth and now has approximately 48% share of total non-discounted spend.
A record number of innovative medicines were launched in 2018, bringing 59 new treatment options to patients, with the top therapeutic areas being oncology (27%), infectious diseases (20%), neurology (12%), and endocrinology (12%). Late-stage pipeline growth is mostly driven by specialty and niche therapies across a range of diseases.
From 2013 to 2017, the proportion of patient costs paid through deductibles (21% vs. 26%) and coinsurance (24% vs. 29%) increased, and the rate of prescription abandonment has also risen as cost exposure rises.
Next, Mr. Long discussed how COVID-19 has consequences beyond infected patients, leading to potential changes in health care dynamics and outcomes. There has been a sharp decline in office visits and laboratory diagnostics being performed. New diagnoses are down, as are new therapy starts for nearly every therapeutic area. Telehealth volume has surged but falls short of the total lost volume of patient visits. As unemployment is increasing, more patients are being pushed onto Medicaid for health coverage, which puts a strain on the system.
Providers are also financially strained due to decreased patient visits, reduced number of elective surgeries performed, and lower reimbursement rates, and some practices have even temporarily closed. Patients are lacking access to health care, creating a backlog for patients and providers once COVID-19-related implications ease up. Ultimately, patient outcomes may be compromised while the health care system returns to normal.
Prior to COVID-19, telehealth was mostly used for mental health purposes, but now its top uses are for hypertension, diabetes, and cholesterol diagnoses. In the past two weeks, overall telehealth claims have increased by approximately 1,000%, mainly driven by prescribers who are new to telehealth. This could signify a long-term shift in health care delivery in the future.
Retail pharmacies have seen prescriptions drop below benchmark as of the week of March 27, and 90-day dispensing is up dramatically compared with a year-over-year basis. Refill rejections are increasing, as patients are showing greater sensitivity to higher out-of-pocket costs during this time, according to Mr. Long.
Treatment adherence is the biggest source of inefficiency and opportunity, remaining the largest avoidable cost for health care systems, and 90-day prescriptions are an effective way to increase adherence, he said.
Mr. Long then noted the strong forces currently driving health care change: an aging population, increasing prevalence of chronic diseases, unprecedented levels of medical innovation, explosion of data/advances in analytics, and increasing connectivity. In addition, patients are more involved in health care decision-making and becoming more vocal about innovation requirements.
Presentation: 2019-2020 Pharmaceutical Marketplace Trends. AMCP eLearning Days, April 20-24.