US Prescriptions Hit New High in 2018, but Opioid Scripts Dip

Megan Brooks

May 10, 2019

Americans filled a record 5.8 billion prescriptions in 2018 — at a rate of 17.6 prescriptions per person — up 2.7% over 2017, according to a report released Thursday. One notable exception, though: Opioid prescriptions went down sharply.

"The very big picture is that more Americans took more prescription medicines than ever in 2018," IQVIA Executive Director Murray Aitken said on a call with reporters.

However, the volume of prescribed opioids continued to decline steeply in 2018. Changes in regulations and clinical guidelines, coupled with increased public awareness, drove a 17% decline in total morphine milligram equivalents (MMEs) dispensed, representing 29.2 billion fewer MMEs. This marks the largest single-year drop ever recorded, down 43% since the peak in 2011.

The report, Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023, was prepared by the IQVIA Institute for Human Data Science.

Most Meds for Common Chronic Diseases

More than two thirds of prescriptions filled in 2018 were for common chronic conditions, such as diabetes and hypertension. These prescriptions were increasingly filled with a 90-day supply through mail order with automatic refills, a fact that speaks to the growing focus on patient adherence, Aitken said.

Prescriptions for antihypertensive drugs grew by 46 million over 2017, owing to the aging population and the Association/American College of Cardiology 2017 hypertension guidelines, which reduced the diagnostic threshold for the disorder, according to an IQVIA news release.

Prescriptions for antihypertensives, lipid regulators, diabetes drugs, anticoagulants, and drugs for mental health all increased by more than 4% over 2017, according to the report.

Prescriptions for specialty medicines for chronic, complex, or rare diseases grew by more than 5% in 2018, yet accounted for only 2.2% of all prescriptions. In total, 127 million specialty prescriptions were dispensed in 2018, up by 15 million since 2014.

2018 saw a growing number of patients treated with relatively new medicines across a number of disease areas. In immuno-oncology, the number of patients who received checkpoint inhibitors has risen rapidly since their introduction in 2014. In 2018, more than 200,000 patients with a variety of cancer types were treated with a checkpoint inhibitor, more than double the number treated in 2016.

Calcitonin gene–related peptide modulators, launched in 2018 for the treatment of chronic migraine, were used by almost 70,000 patients in the fourth quarter of 2018.

Use of medicines for autoimmune diseases increased 20% in 2018. Newly available treatments for ulcerative colitis, psoriasis, and related conditions each led to growth of about 30% in the number of patients treated. "Over 16 million patients in 2018 received an autoimmune disorder medicine, up from 10 million 5 years ago," Aitken noted.

2018 also saw an increase of 6.5 million vaccinations, due, in part, to the availability of the new shingles vaccine.

The volume of lower-cost prescription medicines in the form of generics and biosimilars grew modestly in 2018. Generics made up 90% of prescriptions dispensed in 2018, up from 75% in 2009. When available, generics are dispensed 97% of the time. "We have a very efficient generics marketplace," said Aitken.

Use of biosimilars continues to evolve, the report notes. "The impact of biosimilars in terms of volume is still modest, but we are seeing, for those molecules with a biosimilar available, a reasonably rapid uptake and the biosimilars taking 30% of the volume for those molecules," said Aitken.

Out-of-Pocket Costs Climb, but Coupons Helping

Total overall out-of-pocket costs reached $61 billion in 2018, up from $56 billion in 2014, although some patients have seen their costs decline as generic prescription costs have declined, the report notes.

As out-of-pocket costs have risen, coupons for commercially insured patients have reached an all-time high of $13 billion in 2018 — more than double the $6 billion coupon offset in 2014 — helping lower commercially insured patients' out-of-pocket costs over the period.

With rebates, discounts, and other price concessions, net spending on all US medicines increased 4.5% to $344 billion (up from $324 billion in 2017). The report projects a modest overall increase of 3% to 6% in net spending on drugs in the next 5 years. Total net spending on medicines is expected to be between $405 and $435 billion in 2023.

The largest driver of this growth will be the launch of new brands, which are forecast to contribute $73 billion in new spending. Clinical development across the pharmaceutical industry will result in new drug approvals and uptake. The report forecasts an average of 54 new medicines launching per year during the next 5 years.

The report was produced independently as a public service, according to the institute, without industry or government funding.

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