10 Takeaways from Douglas Long, MBA | AMCP 2023

Douglas Long’s whirlwind tours of conditions in the U.S. healthcare and pharmaceutical marketplace have been set pieces at meetings of the Academy of Managed Care Pharmacy (AMCP) and this year’s meeting in San Antonio is no exception.

After “Stairway to Heaven” played as his walk up song, Long, MBA, vice president, industry relations for IQVIA, launched into a 55-minute talk this morning, accompanied by a rapid-fire showing of a slide deck, that covered everything from the dip in the use of telehealth to the rise in ADHD prescriptions medications to a positive outlook for biosimilars.

Here are 10 takeaways from his talk:

• According to an IQVIA flu, cold and respiratory illness tracker, dubbed FAN, those illness peaked in early January and then faded. Long showed data showing that the flu, cold and respiratory illnesses were worse this year than in prior year, especially among children. Why? “People lost their natural immunity because they were masked up, weren’t going to school and weren’t going to work, so it came back with a vengeance.”
• In 2021, 6% of all retail pharmacy prescriptions were COVID-19 vaccines. In 2022, that proportion decreased to 2% and in January of this year, it was 0.8%. “It looks to me like COVID-19 vaccines and boosters are going to be fading into the background,” Long said, who also pointed to the declining the number of COVID-19 deaths. He complimented pharmacists for their role in administering vaccines and boosters during the height of the pandemic. “This is where pharmacy, in particular, really stepped up. Think about all the vaccines that were injected at retail pharmacies, because that was the place to go for COVID vaccines, COVID boosters.”
• Healthcare utilization had bounced back by the fourth quarter of 2021, according to an IQVIA health services utilization index that Long showed. The bounce back continued last year, according to figures shared by Long. Based on claims data, utilization of institutional (hospitals) services increased by 1% and office visits, by 6.2%. Retail prescriptions fell by 1.3%, which Long said reflected the decline in COVID vaccination, while mail-order prescriptions increased by 4.3%.
• Long invoked the “the telehealth is not going away” mantra as he showed data that telehealth visits made up 7% to 9% of claims in 2022. He also showed data that telemedicine visits dipped by 5% from 2021 to 2022, which Long chalked up to “telemedicine finding its own level.”
• In the retail sector, drug sales on a dollar basis have taken off. Long shared data showing a 20.4% year-to-date increase in January 2023 in food stores. He said the growth makes sense because people got into one-stop-shopping habits during the height of the pandemic, so they pickied up their prescriptions at the same store where they were grocery shopping.
• All manner of drug spending reports over the past few year have shown the growth in spending on specialty drugs — drugs for less common conditions that often have a high price) relative to so-called traditional drugs for more common conditions. According to IQVIA sales data shown by Long, specialty drugs now make up 51% of the total, nondiscounted drug spend. He also showed a chart of net spending that showed that traditional drugs made up 72% of net spending in 2011 and specialty, just 28%. Gradually, net spending on traditional drugs decreased and net spending on specialty drugs increased so the lines crossed in 2018 and in 2021, 55% of net spending was on specialty drugs and 45% on traditional one. Long also showed 2011-2021 net drug spending trends broken down by diseases. Net spending on autoimmune disease medications increased by 459% during that period. For cancer drugs, it increased by 326% and for HIV drugs, by 211%.
• Coincidental with the COVID-19 pandemic has been major upswing the dispensing of drugs for attention-deficit/hyperactivity. Data from IQVIA and its affiliates show a 11.1% increase in the unis of ADHD drugs dispensed from fourth quarter of 2019 through the third quarter of 2011. Long said he was surprised that it was an 11.9% increase in prescriptions for people, ages 20 to 39, that were driving the upward trend. The data shown by Long also should an upswing of 10.1% in people ages 40 to 59.
• Ozempic (semaglutide) and Jardiance (empaglifozin) are diabetes drugs that have become somewhat famous as off-label treatments for weight loss. Both made Long’s list of the top 10 drugs by absolute sales growth in 2022. Ozempic’s sales increased by $6.7 billion, a 74.7% increase, according to IQVIA’s sales figure, and Jardiance’s sales increased by $3.9 billion, a 46.6% increase.
• “For a long time, there has been a race to the bottom,” Long said of the generics and their prices and sales. He painted a bleak picture of generics from a business perspective. Over the last eight years, North American (United States, Canada , and Mexico) gross sales of generics have declined by $17 billion, Long said. He presented IQVIA data that showed almost 90% of prescriptions are for unbranded generics but they account for 8.4% of sales on a dollar basis. And he mentioned that Akorn Pharmaceuticals, a generics manufacturer, had gone out of business. “This is a slippery slope,” Long said. “We are seeing shortages today and we are going to see a lot more shortage in the future unless we give them breathing room because they can’t reinvest in their businesses.
• Long’s take on the future of biosimilars was decidedly sunnier than his take on generics. First, he noted that the spending on biologics has been growing (there is considerable overlap between biologics and specialty drug spending) and now accounts for 46% of drug expenditures. Molecules with biosimilars account for a total $38 billion of invoice spending, and biosimilar development is targeting a further $96 billion, he said. Third biosimilars have been launched in the U.S. market, Long said, and he predicted another 10 would be launched before the end of this year. He showed figures from a recent IQVIA report on biosimilars which show sales reaching $11.4 billion this year and then more than tripling to $38.5 billion in 20 rapidly increasing $38.5 billion by 2027.