IQVIA's Long sizes up pharmacy trends in DSN webinar

Doug Long discussed where we are with COVID-19, cough, cold and flu, and RSV, medical claims, telehealth, channels of trade, generics, biosimilars and opioids.

Sandra Levy

10/28/2022

In a Drug Store News webinar on Oct. 28, Doug Long, vice president of industry relations for U.S. retail at IQVIA, and Scott Biggs, director of supplier services, shared trends impacting the pharmaceutical marketplace.

The webinar was sponsored by Winthrop Pharmaceuticals.

You can watch the full webinar here.

The areas Long highlighted were COVID-19, cough, cold and flu, and RSV, medical claims, telehealth, channels of trade, generics, biosimilars and opioids.

Pointing out that you can’t look at COVID-19 any longer as far as cases, because everybody self tests, Long said when looking at the global seven day moving average for COVID-19 deaths, we are coming back to almost zero now. "The last time we were finishing up Delta, then Omicron came. There’s nothing at this point that’s brewing. This is good news,” he said.

Although COVID-19 hospitalizations and deaths are both down, Long noted The New York Times reported that hospitalizations are up for respiratory viruses.

Reflecting on how the retail market stepped up with COVID-19 vaccines, Long said that only 50% or 60% of people are planning to get the next booster.

Long said he is concerned about RSV, a respiratory virus that we've been hearing about over the past few weeks. "There’s a spike in RSV, and there’s a lot of those cases in Virginia. It’s something to be concerned about.”

Pointing out that Australia is usually a good indicator of what kind of flu season the United States will experience, Long said they are seeing the biggest spike in five years. “This didn’t exist when people were masked up during COVID,” he said, noting “Cough, cold and flu were low in 2021 and they are starting to come back in 2022. We may see a more severe flu season than in the last 10 years.”

Reflecting on the shutdown in March 2021, when people couldn’t get to a hospital or see a doctor and it was difficult to get a new prescription, Long said refill prescriptions did much better and they held up. “A lot of times it would be 90-day prescriptions,” he noted.

Noting that telemedicine, which during the peak of the pandemic in March/April/May of 2020 was 15% of medical claims, and is now reaching only 8% of all claims, Long said the disadvantage of telehealth is that physicians lack access to vitals and diagnostics, which are important for writing prescriptions. For example, how can you look at melanoma on a telehealth call?” Long said.

“Office visits are up for many different classes and telehealth are generally down, with the exception of asthma and ADHD," Long said. "There’s a big increase in ADHD visits. You see that in telehealth and in the office. One of the concerns CVS and Walmart have, was prescribing for ADHD in telehealth made them uncomfortable so they stopped doing business with some of these telehealth firms."

Long also weighed in on elective procedures, saying there was a comeback at the end of last year and the beginning of this year, but they have been sliding off for the last three months. "Is there a correlation with inflation and economic constraints?" he asked, noting that when you look at elective procedures in the GI, cardiology and orthopedic categories, the biggest increase is in cardiology.

Noting that hospitals and long-term care were affected the most from COVID-19 as home care grew, Long said that long-term care has recovered.

Weighing in on the specialty market, Long said it is now 50% of the total market for the first time. "Specialty is outpacing traditional. Specialty medications are 55% of net spending, up from 28% in 2011, driven by growth in autoimmune and oncology."

The classes in specialty that are growing the most are immunology and diabetes. "The world of immunology is going to change January of next year with Amgen's biosimilar to Humira," Long said.

Noting that Hepatitis C was a tsunami in 2011 and that it’s substantially down, Long noted that migraine is a big category with a lot of new entrants.

"Specialty sales increased in all channels. Retail dominates the traditional marketplace. It’s a substantial amount of share in retail," he said.

Long also touched on opioids, noting that suicides increased during COVID-19 and overdose deaths increased substantially. Long noted that prescribers, particularly dentists, are prescribing less prescriptions for opioids. "The NP and physician assistant numbers are not down as much, because there are more of these professionals in the retail clinics," he said, noting that he is concerned about fentanyl that comes in colored, flavored pills.

On the subject of generics, Long said 88% of all adjusted prescriptions are unbranded generics. "You have pressure on price deflation. It used to be if your product was approved, 66% of those were launched as recently as three years ago. Now that number is 20%. Of $56 billion we see in brand losses over the next five years, $42 billion will be in biologics, and only $14 million of that will be in small molecules. We’re running out of small molecule generic opportunities. We need to embrace biosimilar opportunities if we want to contain costs to pay for some of these new innovative treatments," Long said.

Biggs discussed medication adherence, noting that it declines as SDOH risk factors increase.

Pointing out that over 750 pharmacies have disappeared within the last two years, Biggs said, "We are year one into CVS' announcement late last year that they were closing 900 stores, and Rite Aid and Walgreens announced store closures," he said.

Biggs also noted that food stores are gaining share, while mass is losing share.

"The big challenge the market faced was acute scripts disappeared during the height of the pandemic, while maintenance stayed well. Food did well in 2021 and 2022. Food’s market share gains are being driven by maintenance products," he said.

Biggs also shared that independents are rebounding. "They were impacted by acute products during Covid; they’re seeing those numbers turn around," he said.

Lastly, Biggs said that one of four prescriptions dispensed at retail is now a 90-day prescription, compared to 2019, when they were one of five. "There is a measurable increase in 90-day percentage for those 65 and over. Chain outpaces mass in the 60 and over age group. Chain has the largest percentage of scripts dispensed for those under 60," he noted.

What does the future hold? Long was enthusiastic about a group of emerging biopharma companies that he recently spoke with. "One is working on nonaddictive treatment for neuropathic pain, another is doing interesting things in cardiovascular," he said.

Finally, Long was optimistic about pharmacists' opportunities in the future, noting that patients visit pharmacies 10 times more frequently than they see other healthcare providers. He touched upon their expanding roles, noting that in 50 states they have pharmacy immunization authority and can provide naloxone services in all 50 states, and hormonal contraceptive services in 21 states.

"The challenge has been how do you do new things with the manpower you have to get with the shortage of pharmacists and technicians? You have a trend of trying to get health care closer to home and pharmacy is closer to home than a hospital," Long said.

He also cited a recent J.D. Power report as evidence that the future looks rosy for pharmacists. The report showed that 82% of older Americans support reimbursing pharmacists and that 80% want access at the pharmacy.

In conclusion, Long provided the following summary:

Global COVID-19 deaths are down for the moment;
The Australian flu season was huge and early indications are that ours will be too;
RSV is rampant;
Telehealth has settled at 8% of medical claims;
Elective procedures still haven’t recovered by acute prescriptions;
Food stores gained the most through the pandemic while mass merchandisers lost;
Discount card growth has moderated;
Prescription opioids are about 12% of the overdose deaths;
Generic prescriptions are growing, but dollars aren’t due to price deflation;
The role of the pharmacist has expanded;
Pharmacists see patients 10 times more often than other healthcare providers; and
Retail pharmacy store counts continue to decline due to mergers, acquisitions and closures.

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