Specialty Medications Are Now More Than Half of Drug Spend, Says Doug Long 2022 | PBMI Annual National Conference

Specialty medicines now account for 55% of medication spending in the United States, up from 28% in 2011, said Doug Long, vice president, industry relations IQVIA, at the Pharmacy Benefit Management Institute (PBMI) annual meeting in Orlando, Florida. This is being driven by prescriptions growth in the HIV, auto-immune, and oncology drug classes.

“Diabetes is growing at a rate of 217%, whereas the rate of spending growth in the rest of the classes — respiratory, CNS, cardiovascular, and mental health —have actually dropped from where they were in 2011 because they are mainly generics now,” Long said.

Within the retail pharmacy segment, HIV antivirals is the largest specialty drug class. Based on sales dollars, specialty drug spending is increasing with all channels that IQVIA tracks, including retail, mail order pharmacy and non-retail segments.

On a non-discounted spend basis, the top 10 products are growing at 25.2% and account for 21.8% market share. One of those top products is Humira (adalimumab), an immunosuppressive drug to treat patients with arthritis, plaque psoriasis, Crohn’s disease, and ulcerative colitis. But beginning in January 2023, seven Humira biosimilars are expected to hit the market next year.

“This will be the first biosimilar on the pharmacy benefits side instead of the medical side,” Long said. “That's going to be very interesting to watch.”

Looking ahead to 2026, IQVIA predicts that the introduction of biosimilars in the next few years will have a significant impact with about $40 billion of brand losses. In addition to Humira, Lucentis (ranibizumab), which treats wet age-related macular degeneration, and Stelara (ustekinumab), an immunosuppressive drug to treat plaque psoriasis and psoriatic arthritis, also could face competition from biosimilars in the next few years, Long said.

Spending on treatments for autoimmune disorders is expected to exceed $70 billion at net prices by 2026, slowing after 2022 because of biosimilars. IQVIA’s recent Use of Medicines Report suggests negotiations for these biosimilars may even spill over into other brands still protected by patents in the same therapy areas. This, the report suggests, could result in higher discounts, rebates, and use of coupons.

New medicines introduced in the next few years in oncology, immunology and neurology will help contribute to drug spending growth through 2026. For oncology, spending expected to reach $113 billion by 2026, with growth slowing to 9% from biosimilar savings. Spending on next-generation biotherapeutics is expected to reach $11 billion in 2026, up from $3 billion in 2021. Diabetes spending is expected to decline 12% through 2026 although list prices are expected to 10% to 13% annually.

U.S. market growth overall will return to pre-pandemic projection by 2023 despite year-to -year fluctuations and incremental vaccine and incremental therapeutic spending. Diabetes spending at estimated net manufacturer prices to decline 12% through 2026 and list prices will continue to grow at 10% to 13% annually.