The COVID-19 pandemic affected nearly all major components of the health system, according to presenter Douglas M. Long, MBA, vice president of industry relations at IQVIA, in his annual update for AMCP 2021.
Mr. Long began by noting that the 2020 flu season was a nonevent in terms of how many people received flu shots and got medication for the seasonal flu. From the standpoint of the pharmaceutical marketplace, the impact was substantial. Prescription medication sales for flu symptoms were down considerably in 2020 due to lockdowns, virtual classrooms, and social distancing. Additionally, he noted that during the pandemic, people were more reluctant to see their care providers, where most prescriptions are generated. During the initial lockdowns in March 2020, many people shifted from monthly to 90-day prescriptions, as part of a “stockpiling period.”
Missed Prescriptions, Visits Due to Pandemic
IQVIA estimated that more than 1 billion U.S. physician office or hospital visits for new diagnoses did not occur in 2020 (a reduction of 21%). In 2021, IQVIA expects a 12% gap in expected diagnosis visits versus what should happen without COVID-19 (or about 288 million fewer office visits). The result is a 3.8% loss of projected prescription utilization through June 2021 (or a total of 111 million fewer prescriptions).
Although telehealth visits were up considerably, he said, they do not result in the number of prescriptions that office visits do since physicians are not able to use the same diagnostic tools or physically examine the patient in the way they would with an in-person office visit. Telehealth accounted for an all-time peak of 18% of total office visit claims in April 2020. Telehealth utilization has decreased over time, but Mr. Long reiterated that telemedicine is here to stay (which means fewer prescriptions written overall).
The number of elective procedures was also down dramatically, although this has rebounded to some extent. Similarly, lab tests and preventive testing (colonoscopy, mammography, routine blood tests, etc.) showed considerable dips in utilization over the past 12 months.
Other Marketplace Developments
On the positive side, the heavy influx of COVID-19 vaccines have had a positive effect on the drug spending side of the market in 2021.
“We are showing 4.6% growth as of February 2021,” said Mr. Long.
Generic drugs accounted for about 90% of drug sales, but for just 18.5% of pharma spending. Oncology, immunology, and diabetes drugs were responsible for 60% of positive absolute growth in the U.S. and for 40% of recent drug launches. Innovative biologics contributed over half of global growth in 2020. Biosimilars also grew 40% during 2019-2020.
“New drug launches in the U.S. in 2020 were about the same number as in previous years,” said Mr. Long, “but had the weakest [sales] trajectory in recent years, again, because of the pandemic.”
Retail patients fell to 93 million during the spring lockdowns, then rebounded in the fall. The use of discount cards has been growing all year, he pointed out, which may be driven by lack of coverage or unemployment.
Mr. Long expressed surprise that the pharmaceutical supply chain held up as well as it did. He noted that there were few drug shortages, and people were in general able to obtain their medications during the pandemic.
Long D. 2020-2021 Pharmaceutical Marketplace Trends. Presentation K6. Presented at AMCP 2021; April 12-16, 2021.