Trends and Drug Launches Impacting the US Health Care Market in 2021-2022

The COVID-19 pandemic has shaped US health care over the last 2 years. It remains to be seen what changes will be permanent, but some affected areas are returning to normal, explained Doug Long, MBA, vice president, Industry Relations, IQVIA, who delivered the Thursday keynote session at the Association of Managed Care Pharmacy annual meeting.

Early in the pandemic, new diagnoses dropped precipitously. While cancer screenings have recovered, they are not back to where they should be, he said. For example, there were 87% fewer mammograms in April 2020, and in the first quarter (Q1) of 2021, there were still 14% fewer. There are similar trends in other cancer screenings:

1. Pap smears were down 83% in April 2020 vs baseline expectations and still down 20% in Q1 2021
2. Colonoscopies were down 90% in April 2020 and still down 25% in Q1 2021
3. CT scans were down 53% in April 2020 and still down 10% in Q1 2021
4. Prostate-specific antigen tests were down 60% in April 2020 and still down 15% in Q1 2021

“So, it's not a surprise that people that have finally gotten to see the doctor, probably are in more advanced [disease stages],” Long said.

Oncology wasn’t the only affected specialty. In 2020, there were nearly 1 billion fewer diagnosis visits compared with the expected number if there had been no pandemic. The specialties with the biggest gap in diagnosis visits were endocrinology, rheumatology, primary care, and oncology, he noted.

Current Drug Market

In the years leading up to the pandemic, the specialty drug spend has outpaced traditional drug spend and there were expectations that specialty spend would grow larger than traditional drug spend by now. However, this hasn’t happened yet, although Long expects it to finally happen in 2022. In 2018, specialty sales were 45.3% of drug spend and now they account for 49.3%.

IQVIA data identified the therapeutic areas with the greatest growth in the short term (1-year growth) and long term (5-year compound annual growth rate). Immunology and anticoagulants showed the greatest 1- and 5-year growth in the United States. While pain had a 1-year growth, its 5-year growth was negative. In comparison, multiple sclerosis has a positive 5-year growth, but a negative 1-year growth.

In 2021, the top therapy class was antidiabetics, with $69.3 billions in sales and a year-over-year growth of 16.4%. However, the top product was apixaban (Eliquis), an anticoagulant, which had $12.0 billion in sales and 23.0% growth year over year. The top 5 products in 2021 by sales were rounded out with dulaglutide (Trulicity) with $10.1 billion, semaglutide (Ozempic) with $7.3 billion, empagliflozin (Jardiance) with $6.6 billion, and bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) with $5.8 billion.

Branded pharmaceutical list prices increased 4.4% in 2020, but net prices decreased 2.9%, which is the fourth year at or below the Consumer Price Index, according to IQVIA data. Long also pointed to the annualized percentage change in prices for national health expenditures as published in an Altarum report in November 2021. This report showed a negative change in prices for prescription drugs as of October 2021 vs the previous year, but hospital and physician prices are up.

“The perception is health care is very expensive here, and it is, but it’s not due to drug costs,” Long said. “What’s driving it is [the costs of] hospital services,” which he showed are up 200% since 2000.

Product Launches

In 2021, there were 74 product launches, up slightly from 71 in 2020. More than a third (35%) of launches in 2021 were in oncology, 15% were in infectious disease, and 12% were in the central nervous system (CNS). In 2020, oncology accounted for 32% of new launches, CNS 25%, and infectious disease 10%.

The biggest launch by sales was semaglutide (Wegovy) for weight loss with $601.8 million in sales in 2021, followed more distantly by sotorasib (Lumakras) for non­–small cell lung cancer (NSCLC) with $63.7 million, and the meningococcal vaccine MenQuadfi with $61.6 million.

Long highlighted some potential launches in 2022 to keep an eye on:

• Donanemab from Eli Lilly and gantenerumab from Genentech, both for Alzheimer disease
• Tirzepatide from Eli Lilly for diabetes
• Deucravacitinib from Bristol Myers Squibb for moderate to severe plaque psoriasis
• Vutrisiran from Alnylam for amyloid transthyretin amyloidosis
• Mavacamten from Bristol Myers Squibb for hypertrophic cardiomyopathy
• Adagrasib from Mirati Therapeutics for NSCLC

He pointed out that there is a mix between small and large pharmaceutical companies developing the anticipated potential launches. Traditionally, drug launches have been from large companies, but smaller companies are also getting into drug launches.

“When you think about launches and development…the innovation is not really in traditional pharmaceutical products anymore,” Long said. “It's in specially, it's in orphan drugs, it's in monoclonal antibodies, it's in cell and gene therapies. And all of these things are expensive products [with a] very small patient population.”