National trends in prescription drug expenditures and projections for 2020

Abstract

Purpose To report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2020 in the United States, with a focus on the nonfederal hospital and clinic sectors. Methods Historical patterns were assessed by examining data on drug purchases from manufacturers using the IQVIA National Sales Perspectives database. Factors that may influence drug spending in hospitals and clinics in 2020 were reviewed, including new drug approvals, patent expirations, and potential new policies or legislation. Focused analyses were conducted for specialty drugs, biosimilars, and diabetes medications. For nonfederal hospitals, clinics, and overall (all sectors), estimates of growth of pharmaceutical expenditures in 2020 were based on a combination of quantitative analyses and expert opinion. Results In 2019, overall US pharmaceutical expenditures grew 5.4% compared to 2018, for a total of $507.9 billion. This increase was driven to similar degrees by prices, utilization, and new drugs. Adalimumab was the top drug in US expenditures in 2019, followed by apixaban and insulin glargine. Drug expenditures were $36.9 billion (a 1.5% increase from 2018) and $90.3 billion (an 11.8% increase from 2018) in nonfederal hospitals and clinics, respectively. In clinics, growth was driven by new products and increased utilization, whereas in hospitals growth was driven by new products and price increases. Several new drugs that will likely influence spending are expected to be approved in 2020. Specialty and cancer drugs will continue to drive expenditures. Conclusion For 2020 we expect overall prescription drug spending to rise by 4.0% to 6.0%, whereas in clinics and hospitals we anticipate increases of 9.0% to 11.0% and 2.0% to 4.0%, respectively, compared to 2019. These national estimates of future pharmaceutical expenditure growth may not be representative of any particular health system because of the myriad of local factors that influence actual spending.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…Although current quality standards and market incentives better align with shared goals by patients, providers, and institutions, the cost of nonopioid medications can pose a barrier for institutions to implement multimodal analgesia throughout perioperative care. Intravenous acetaminophen (pending the widespread availability of this formulation from generic manufacturers in early 2021), intravenous NSAID formulations, and liposomal bupivacaine represent newer nonopioid interventions that drive analgesics to rank among the most expensive therapeutic drug categories [ 524 ]. The substantial cost of these agents relative to conventional generic medications may contribute to overreliance on cheap, widely available opioid medications in the perioperative setting [ 391 ].…”

National trends in prescription drug expenditures and projections for 2021

“…This increase was similar to that in 2019 (5.5%), consistent with projections, and occurred despite the COVID-19 pandemic and ensuing economic decline. 2 As usual, the sectors with the highest spending on prescription drugs in 2020 were retail pharmacies (42.6% of the total, or $228.1 billion), the mail-order sector (27.1% of the total, or $145.3 billion), and clinics (18.4%, or $98.4 billion), followed by nonfederal hospitals (6.6%), long-term care (2.7%), and home health care (1.4%). The remaining sectors together accounted for just over 10% of total expenditures, as shown in Table 1 .…”

“…Total drug expenditures and clinic drug expenditure growth in 2020 were within or near the ranges anticipated, whereas nonfederal hospital drug expenditures were much lower. 2 While not precisely meeting the definition of a “black swan event,” since thought leaders from multiple sectors have been warning for decades about the probability of a global pandemic, the COVID-19 pandemic certainly qualifies as a profound disruption, especially as it relates to hospitals. 8 , 9 …”

“…Drug purchases in the nonfederal hospital, clinic, and other sectors of healthcare contribute an additional $156 billion, making sector-wide drug spending 13.3% of overall healthcare expenditures. 2 …”

Budgeting in the time of COVID-19

“…P rojecting future drug expenses is never an easy task. This year, Tichy et al 1 provide key projections that will be needed now more than ever. This year health systems will not only face unprecedented financial challenges due to the coronavirus disease 2019 (COVID-19) pandemic; they may also be facing operational challenges.…”