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While spending on oncology drugs in the U.S. is anticipated to reach $125 billion by 2027, overall drug savings of $181 billion are expected during that same time frame as newly approved biosimilars launch and existing biosimilars see continued uptake and price reductions.

Those are two conclusions reached in the latest IQVIA report – The Use of Medicines in the U.S. in 2023.

Oncology Spending

According to the report, U.S. oncology spending is expected to increase in 2027 to $125 billion, which would be a 54% increase compared to the estimated amount spent in 2022 of $81 billion. The rate of increase is also expected to slow as patent expirations and biosimilars offset the cost of established treatments.

As noted in the report, new oncology drugs had a median annual cost of $260,000 in 2022, up from $223,000 in 2021.

More than 100 new oncology drugs are anticipated based on the current pipeline, although they are expected to be narrowly focused on precision medicine as biomarker-driven therapies become more common. In addition to the flow of more biomarker-driven therapeutic choices, next-generation sequencing technologies (NGS), which can test for multiple potential mutations at once and guide therapy selection more precisely, are expected to expand as well. According to the report, the continued wider use of novel immunotherapies will also grow in the next five years, providing additional benefits and options for patients.

Additional Highlights of the Report

Below are other highlights of the report:

  • Spending on all medicines — at net manufacturer prices — reached $429 billion in 2022, growing 5.3%.
  • Total overall drug spending at estimated net manufacturer prices increased by $103 billion over the past five years, primarily driven by new products and brand volume.
  • Medicine usage in 2022 reached 242.6 billion days of therapy, growing 2.6% compared to 2021. Retail drug use increased by 3.6%, exceeding pre-pandemic levels.
  • The notable areas of drug usage in 2022 that fostered this growth included ADHD medicines, mental health prescriptions for girls under 19, antibacterials, and newer diabetes therapies also used to treat obesity. Lower levels of utilization were recorded in 2022 for prescription opioids.
  • Specialty medicines — treating chronic, complex, or rare diseases – now represent 51% of net manufacturer revenue.
  • Over 250 new drugs are expected to launch within the next five years and contribute over $100 billion in new spending.

Notable Shifts in Medicine Usage in 2022

There were several notable shifts in medicine in 2022.

For example, the use of antibiotics in children and adults was up 8% in Q4 2022 compared to 2021. In addition, the use of ADHD medicine has grown 11% over the past five years, and women aged 20-64 now comprise 33% of those prescriptions, compared to 27% in 2018. According to the report, these shifts in usage likely reflect the impacts of remote work on adults and increasing awareness of diagnosis criteria among clinicians.

Another notable change has been the use of medicines associated with the mental health of young people.

Mental health prescriptions reached 567 million in 2022, up 9% since 2019. Mental health prescriptions in girls under 19 are up 33% since pre-pandemic levels to 17 million in 2022. This coincides with a concerning trend noted by the CDC among high school students where female students are more likely to experience poor mental health and suicidal thoughts and behaviors, and the percentage has increased more rapidly through 2021 than in male students, according to the report.

Perhaps the two most significant changes (and gaining the most attention in the news) have been the change in obesity medicine.

GLP-1 agonists (drugs used for diabetes and obesity) saw rapid increases in new prescriptions at the end of 2022 and early 2023, with diabetes new prescriptions up 128% in February 2023 compared to the prior year and obesity up 352%. The increasing popularity of GLP-1 agonists led to shortages in 2022 for semaglutide, which is approved for use as Ozempic and Wegovy in diabetes and obesity, respectively, potentially leaving existing patients to find alternative options.

Prescription opioid volume declined for the 11th consecutive year after peaking in 2011. However, overdose deaths have risen, primarily due to illicit synthetic opioids.

Loss of Exclusivity

According to the report, the impact of losses of exclusivity (LOE) of biologics has increased dramatically in the past three years. Most of the impact from LOE in 2020 through 2022 was from biosimilars introduced in the prior three years, including three molecules in the oncology market — bevacizumab, rituximab, and trastuzumab — which have contributed to a significant increase in brand losses due to LOE.

Dr. Minh Huynh, Oncologist and Medical Director at NantHealth, Video Series

Dr. Minh Huynh, Oncologist and Medical Director at NantHealth

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