Diagnosis visits in the past six months were down by more than a quarter of a billion trips, according to Doug Long, IQVIA’s vice president of industry relations, who addressed attendees on day 2 of NACDS’ virtual Total Store Expo Tuesday. That 11% downturn in visits has a very real impact on the industry's bottom line.
"Those visits correlate with prescriptions. We’re down in prescriptions the first part of this year, particularly in oncology and pediatrics," he said. “The absence of the cough-cold season led to some prescriptions declines.”
On the subject of market trends utilization, Long spoke about medical claim activity.
Noting that a visit to a doctor is the ability for a prescription to be generated, Long said that office visits have came back stronger than institutional visits. “Institutional visits have regressed, around the time that the Delta variant came up strong in the U.S. It’s difficult to get into institutions now because of lockdowns.”
Despite telehealth visit numbers contracting, and the relatively low number of them that drive prescriptions, Long said that telehealth is not going away. “A visit to a telehealth provider doesn’t generate new prescriptions to retail pharmacy, due to the unwillingness of doctors to generate new therapy without seeing diagnoses and vitals," he said. "Telehealth is finding its proper space and will improve when providers have more access to vitals,” he said.
As far as dollar growth, Long said that dollar growth in retail mail has accelerated. “You see growth was hurt in 2020 in nonretail. It started to rebound, but not the double digits seen in 2017.” Looking at specialty spend vs. traditional, Long said specialty grew by 7% and traditional grew by 6%,
“The brand inflation environment continues to slow between 4% and 5%," he said. "It’s pretty low in a traditional sense. Most people think, that what’s driving healthcare expenditures is brand pricing. What’s driving the pharma industry is new products and volume growth. They represent the two biggest growth rates. Brand list prices increased 4.4%. in 2020, net pharma prices went down 2.9%.“
Long also focused attention on generics and biosimilars, stating that the generics market which has price deflation has the same dollar value over the last four years. "The dollar value of generics is going down. The adjusted numbers are up, unadjusted are down, because there was not much of a cough/ cold flu season,” he said. “The unbranded share of generics is declining a bit, with about 86% of all adjusted prescriptions are generics. Those adjusted prescriptions represented 10% of the dollar.”
Long said several factors contribute to generic deflation, including consolidated buying power in three entities, and generics firms not seeing commercial value in launching small-molecule products. “Look at biologics and see they are growing faster than small molecules. You need to pay attention to anything that happens in diabetes,” he said, noting that the biosimilar market is poised to deliver serious cost savings as that market is set to exceed $100 billion over the next five years.
Scott Biggs, IQVIA director of supplier services, highlighted various group's adherence, noting that in IQVIA’s area of focus, diabetes, adherence is not uniform regionally and varies by different factors, such as method of payment, with those on Medicare D being the most adherent.
"About 4% of patients are on the cusp of being adherent,” Biggs said. “Retailers may be able to convert these patients. Ninety-day prescriptions are an effective way to increase adherence rates.
Biggs also addressed the opioids issue, noting that during COVID there were fewer new patients receiving prescription opioids. "Patients taking benzodiazepines, opioids, or a combination of both have declined,” he said. ”Prescription opioids are being controlled in this industry. I commend pharmaceutical companies for what you are doing."
Finally, as Long surveyed the future he said, "For pharmacies, the number one thing is reimbursement, controlled substances, access to specialty drugs, Amazon and online, and cash discount cards,” he said. "For brand manufacturers, attention is less on brand price increases and more on launch increases. Wholesalers are dealing with controlled substances."
Telehealth and the future of flu vaccines are the big question marks for now, according to Long.
Long went on to credit the pharma industry for how well the supply chain held up despite shutdowns in India and China, and the expense of moving everything by plane.
"We saw self-administered options come to the forefront, health care provider engagement and COVID testing and vaccines,” he said. ”We’re at the point of what will be the new normal. The pharmaceutical industry will continue to grow. Pharmacists stepped up with more things they can do and their role expanded during COVID.”