"The rise in U.S. medicine spending was largely driven by the increased availability of pandemic vaccines, boosters, and treatments. It's a testament to the resiliency of the biopharmaceutical ecosystem to respond successfully to a health care crisis at both the global- and country-level, while continuing to improve outcomes across the broader health care spectrum," said Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science. "However, the $4 billion increase in OOP costs for patients matched the historical high previously seen in 2018, which is a trend we will need to continue to watch."

A return to normal—with some changes

The study found that although utilization of health care services had returned to near pre-pandemic levels, this did not make up for all the missed health care services in 2020, when many in-person services were shut down or sharply reduced for several months.

The study confirmed other reports that telehealth surged during the pandemic, and is still at higher levels than pre-pandemic, especially in mental health areas. For mental health areas, telehealth use was 1% pre-pandemic, surged to 30% after the pandemic began, and was at 20% at the end of 2021.

Overall, telehealth accounted for about 4% of all visits by December 2021. "Telehealth visits accounted for less than 1% of visits prior to the pandemic, rose to 15% in April 2020 at the height of pandemic lockdowns, and declined to 4% over the last half of 2021," the report said. "Even as restrictions have been lifted, patients and providers have continued to use remote options, suggesting that the pandemic has resulted in some fundamental shifts in the ways patients and providers interact."

More than 250 new drugs in the pipeline

The report noted that prescription opioid use fell by 48% in recent years and is now at levels last seen in 2000, as the health care industry responded to widespread opioid abuse. reflecting efforts by many stakeholders to limit and manage appropriate prescription opioid use.

The IQVIA report said more than 250 new drugs are expected to launch within the next five years and contribute over $100 billion in new spending. "Immunology, oncology and neurology will drive the most growth in spending during the forecast period, and next-generation biotherapeutics may reach as much as $20 billion in annual sales by 2026, though significant scientific and commercial uncertainty exists in this fast-evolving area."

Out-of-pocket costs a concern

The report said that in 2021, OOP costs in aggregate rose $4 billion, or 5.3%, to a total of $79 billion. That is similar to the level seen in 2018, the study said. The researchers said that OOP costs remain a significant burden for a relatively small part of the population, even as average costs per prescription were flat or slightly declining.

Also noted were the differences between list prices and actual payer costs, which can be reduced by industry discounts. In 2021, the difference between list price spending on prescription drugs and payer spending exceeded $190 billion, representing a 24% discount.

"Across all patients, 8% reach annual out-of-pocket costs above $500 compared to 16% of those in Medicare programs, largely due to different benefit designs," the report said. "Due in part to high costs, an estimated additional 81 million prescriptions were abandoned at the pharmacy, with the abandonment rate over one in three for prescriptions above $75 in out-of-pocket cost, especially for high-cost specialty medicines that treat cancer and immunology."

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