COVID-19’s Impact on Marketplace Trends Will Continue, but Lessen

The pandemic reduced visits to specialists last year, which in turn reduced the volume of prescriptions, according to a presentation at the Academy of Managed Care Pharmacy 2021 meeting.

In 2020, COVID-19 had an impact on diagnostic visits to specialists that in turn affected the volume of pharmaceutical prescriptions, as well as the use of acute medications due to the lack of a cold and flu season.

And while Douglas M. Long, BS, MBA, vice president, Industry Relations, IQVIA, said COVID-19 will continue to have an impact on the marketplace going forward, he told the virtual audience at the Academy of Managed Care Pharmacy 2021 meeting that the effect of the pandemic will lessen, although there are a number of what he called “wildcards.”

During his annual talk on pharmaceutical marketplace trends, he said there were a billion fewer diagnosis visits that took place in 2020, and a 21% reduction in expected diagnosis visits, he said. The top 5 specialties affected were oncology, gastroenterology, dermatology, ophthalmology, and anesthesiology, as people skipped screening tests like mammograms or getting eye care.

Some specialties had what he called “moments of growth,” such as dermatology seeing a spike in visits in June and July and psychiatry jumping in August and September.

That diagnosis gap is expected to continue in 2021, although it will be a lot less—about a 12% drop in expected visits, and 288 million fewer visits than expected. Whether that creates a new baseline will depend on the continued deployment of COVID-19 vaccines as well as the country reaching herd immunity. IQVIA's chief medical officer is optimistic and thinks it is possible for that to happen by the end of the third quarter, Long said.

But those fewer visits translate into fewer prescriptions, he said—about a 3.8% drop from January 2020 to June 2021, or about 111 million, based on an average 30 days’ supply. Oncology saw 30% fewer prescriptions and drugs for pediatric indications, 45%.

The IQVIA data also looked at telehealth, which does not generate as many prescriptions, Long said. Dermatology did not compensate for the decline in in-person visits with telehealth, but other specialties, notably rheumatology and gastroenterology, did.

Pharmaceutical trends

A few of the pharmaceutical trends Long highlighted include:

  • Growth of specialty drugs continues to outpace traditional therapies, with about 49% of the share of nondiscounted drug spending. In 2017, that percentage was 43.1%.
  • Branded dollar growth was 5.8% in 2020, compared with 7.7% in 2019; it has rebounded 9.2% year to date in 2021.
  • Oncology, immunology, and HIV therapies are responsible for 60% of positive absolute growth and 40% of recent launches. But oncology growth has slowed by 8% since 2019; Long noted that that slowdown was happening before the pandemic.
  • Globally, biologics contributed 55% to growth and innovative small molecules, 25%.

Outlook for rest of 2021

Looking ahead, cost and price will be an issue for just about all stakeholders, Long said. Payers are coping with rising oncology drug costs and managing the costs of other specialty drugs. Consumers continue to face rising out-of-pocket costs and coinsurance amounts.

There's growing net price pressure in immunology and other specialty markets, he said.

Branded drug makers are looking to become more specialized and focus more on orphan drugs while also facing a backlash against price increases.

And generic price deflation will affect both wholesalers as well as generic manufacturers, both of whom are turning to purchasing alliances.