Doug Long has already seen it.
“The introduction of HIV drugs, followed by hepatitis C drugs. Now you have GLP-1s,” IQVIA’s vice president of industry relations said in a short interview after having delivered one of its signature presentations on pharmaceutical and healthcare trends, which included rapid delivery of a voluminous slide deck. “I call them tsunamis.”
Yet the increase in sales of GLP-1 drugs is now “the talk of every professional (health care) organization.” This is a real game changer,” Long said during his presentation Thursday at the PBMI’s 2023 Annual National Conference in Orlando.
Long’s in-depth, data-rich review also addressed health care utilization after the COVID-19 pandemic, spending on specialty medications, increased spending on mental health medications, and drug shortages .
The now famous GLP-1s include Ozempic (semaglutide), Wegovy (also semaglutide but at a higher dose), and Mounjaro (tirzepatide).
Long showed sales data collected by IQVIA that identified Ozempic as second to Humira in terms of non-discounted sales – $20.6 billion in rolling annual target (MAT) as of June 2023, up from $32.7 billion in dollars for Humira (adalimumab). Sales of Ozempic, which is a trending topic on TikTok, soared 78.4% in the year to June. “Thanks to social media for that,” Long joked.
Mounjaro, which was approved by the FDA as a diabetes drug in May 2022 but is used off-label for diabetes, ranked 11th on Long’s list of top drugs in terms of undiscounted spending, with a revenue of $8.4 billion, and Long said Mounjaro was second only. to Harvoni (ledipasvir and sofosbuvir), a hepatitis C drug, in sales during the first 10 months of marketing.
According to Long, spending on GLP-1 as a drug class is also rising sharply northward, from $8.9 billion in 2018 to $35.2 billion in 2022. Most prescriptions are written for women (77%) and middle-aged people (59%). for people aged 40 to 59). Trulicity (dulaglutide), Rybelsus (semaglutide tablets), Victoza (liraglutide) and several other drugs belong to the GLP-1 class, but Ozempic and Mounjaro are responsible for most of the sales growth in that class, Long said .
Health plans and PBMs have taken steps to limit the number of GLP-1 prescriptions, such as requiring patients to try other medications (called step therapies) before taking Ozempic or Mounjaro. But Long said in the brief interview that he expected insurers to cover GLP-1 drugs because of the greater proportion of Americans who are overweight.
Here are some of the other topics Long covered during his presentation:
- The use of in-person and telehealth visits in 2023 is running roughly at the rate of 2022. Telehealth visits represent 7-8% of medical visit requests, up from 20% during the pandemic.
- Specialty drugs accounted for 51% of drug spending, using manufacturer net prices, in 2022, a continuation of the trend of shifting spending from so-called traditional drugs to specialty drugs. Definitions of specialty and traditional medications are imprecise and vary by source. IQVIA defines specialty medicines as medicines intended to treat rare, complex or chronic diseases whose cost or distribution characteristics require special management. Long’s slide on the specialty-to-traditional ratio showed it narrowed from 32% to 68% in 2012 to reach an even level in 2019, and then specialty overtook traditional afterward.
- Among specialty drugs, spending on those for immunological diseases, such as rheumatoid arthritis, has increased 451% since 2012, using net manufacturing to make the calculations, and 349% for cancer. Long said biosimilars coming to market are likely to moderate these upward trends.
- FDA manufacturing inspections have not returned to pre-pandemic levels. In 2019, agency officials inspected 1,397 domestic sites and 1,205 foreign sites, compared to 840 domestic inspections in 2022 and 349 foreign sites. However, Long’s slide on inspections noted that the data is incomplete and does not include inspections by state officials, pre-approval inspections, mammography facility inspections, inspections in pending final enforcement action and non-clinical laboratory inspections.
- The number of drugs in shortage has decreased from last year but still remains higher than normal, according to an FDA-provided tally presented by Long. Grouped by the conditions they treat, 60 of the 237 drugs affected by shortages in 2023 were those used to treat cancer.
- About 88.8% of prescriptions this year were for unbranded generics. Citing a 20% drop in prices since 2019, Long said the downward pressure on prices “is getting to the point where it’s unsustainable for these generic companies.
This article was originally published on Managed Healthcare Executive.
