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Annual study sees the end of the 'generics bubble' and worrisome trends in consumer utilization of healthcare
The annual analysis from the IMS Health Informatics Institute (Parsippany, NJ) calculates overall US spending on pharmaceutical products at $325.8 billion in 2012—the first annual decline IMS has reported since beginning the study in 1957. In other contexts, a reversal like that would be a startling development, but in this case, most forecasters could see that with the rise of patent expiries (the so-called “patent cliff,” which, from the other side of the ledger, IMS is calling the “generics bubble”), the thin pipeline of new products (already reversing itself) and the overall pressure on both healthcare costs and demonstrable health outcomes, a slowdown in pharma sales has long been expected.
And this decline is already reversing itself: FDA approved 39 new molecular entities in 2012 (28 of which were introduced into the market); the cost of loss of exclusivity on patented drugs has peaked at 2012’s $28.9 billion, and will decline in the next few years. IMS Institute projects that pharma sales will be flat in 2013 (0-1% growth), but then begin climbing again in 2014 (4-5% growth). “Lots of analysts are focused on the impact of Obamacare, which kicks in in 2014,” notes Michael Kleinrock, director at the Institute, “but we see it as a combination of the new patients that Obamacare will bring in as well as fewer patent expirations.” Patent expirations over the past five years have removed $75 billion in pharma sales; over the next few years, the growth of specialty pharmaceutical spending (calculated at $87 billion in 2012 by IMS) will become “the focus of discussion,” says Kleinrock.
Pharmaceuticals are a declining part of overall healthcare spending—but there are some worrisome trends hidden within that. The number of office visits by patients declined in 2012, continuing a trend of several years. At the same time, the out-of-pocket expenses by patients is rising—for commercially insured under age 65, they reached $1,146 in 2012, a 30% jump in one year. Per capita usage of pharmaceuticals declined by 0.1% (although overall prescription growth was 1.2%). “One can assume that managed care is removing unnecessary costs from healthcare, but the higher out-of-pocket costs might also be removing patients with chronic conditions from getting necessary healthcare—and that could result in higher healthcare costs down the road,” says Kleinrock.
The IMS report also provides data on pharmaceutical distribution by channel. In 2012, a decline in chain-pharmacy sales (-3.1%) was almost matched by an increase in mail order (+3.0%). Independents saw a decline in sales (-1.0%), reversing a near-term growth trend of the past two years—and the number of prescriptions filled at independents also declined by the same percentage. Food store pharmacies remained absolutely flat. Among institutional channels, clinics showed a 1.8% increase, while most others were flat or declining. There is an influence of the drug mix to be seen here: “Long term care is heavily dependent on cardiovascular and mental-health drugs, and both of those experienced significant patent expiries,” notes Kleinrock.
The full report, “Declining Medicine Use and Costs: For Better or Worse,” is available at the IMS Institute website. Data are derived from IMS’ National Sales Perspectives, National Prescription Audit and other reports; pharma pricing is reported ex-manufacturer and does not include off-invoice rebates and discounting. The report is published with no industry or institutional support.