State of the market: Are generic drugs approaching their peak?

Generic drugs have been on a roll with their share of total prescriptions dispensed in the country seeming to increase on a nearly constant basis. But it appears the peak is coming soon.

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According to IMS VP industry relations Doug Long, in the next few years, generics will likely peak at about 86% to 87% of the total prescriptions dispensed due to fewer high-profile drugs coming off patent. More liberal estimates predict a somewhat higher market share, around 90%. The current share is 83%.

In recent years, much of the rapid growth has been due to several blockbuster drugs losing patent protection, creating windfalls for generic drug companies and pharmacy retailers alike. The most high profile of these was Pfizer's statin Lipitor (atorvastatin calcium), whose patent expired in November 2011. In 2016, AstraZeneca's cholesterol drug Crestor (rosuvastatin calcium), which belongs to the same class of drugs as Lipitor, will lose its patent. According to IMS, it is currently the No. 3 drug in the United States, with 2012 sales of $5.1 billion.

The shift to generics for a large percentage of primary-care disease states — particularly cardiovascular disease and gastroesophageal reflux disease — comes at a time when generic drugs are growing in sales and prescriptions, but branded drugs are not. According to EMS, generic sales grew by 5% during the 12-month period that ended in March, while dispensed prescriptions grew by 7.8%.  At the same time, branded drug sales fell by 6.2% and dispensed prescriptions fell by 16%. Of the top 10 companies in sales growth as of June 2013, four were generic companies. Johnson & Johnson took the top spot with 1.6% sales growth, and generic drug maker Mylan was not far behind with 1.5%. Meanwhile, among the nine companies with the highest growth in prescriptions, all but Endo were generics-focused, with Apotex ranking at the top with 43% growth.

An even greater contrast was seen among the top 10 drugs, ranked by sales and prescription growth. For sales, all 10 drugs were branded, with AbbVie's autoimmune disorder treatment Humira (adalimumab) at the top, having grown by $977 million year-over-year as of June 2013. But among the drugs that grew the fastest in terms of prescriptions dispensed, Johnson & Johnson's Xarelto anti-clotting (rivaroxaban) was the only branded drug on the list, dead last with prescription growth of 5 million. Generic versions of Lipitor made by Apotex and Mylan showed the strongest growth, at 15.2 million and 12 million prescriptions, respectively.

There's even more evidence of how far generic drugs have come when one looks at the overall growth of spending on medicines in the United States — or rather, the lack thereof. According to a report released by IMS in May, "Declining Medicine Use and Costs: For Better or Worse," spending on medicines fell 3.5% on a per capita basis in 2012 as use of healthcare services overall declined. According to the report, patent expiries that year contributed $28.9 billion to the reduction in medicine spending. Total spending on medications was $325.8 billion.

"The cost curve for medicines was clearly bent in 2012, for better or for worse," IMS Institute for Healthcare Informatics executive director Murray Aitken said. "To some extent, this is a harbinger of more efficient use of our healthcare resources, but it also reflects a decline in utilization that may be the result of under treatment and an imbalance between prevention and care."

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