14 May 2019
Spending on all U.S. medicines increased 4.5% to $344 billion on a net price basis, despite lower price growth, due to higher patient use of new and protected brands, according to IQVIA Institute’s “Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023″ report.
Prescription opioid dosage volume — as defined by morphine milligram equivalents, or MMEs — declined 17% in 2018, marking the single-largest annual drop ever recorded within the U.S. market, the report said.
In 2018, 29 billion fewer MMEs were dispensed to patients on a volume basis compared to 2017. The steepest decline occurred in the “high-strength” formulations of 90 or more MMEs per day, which declined by 61% since 2011.
Decline drivers include shifts in clinical usage, new regulatory and reimbursement policies and legislation tightening restrictions on prescription opioid use since 2012. Overall medicine spending is expected to increase 3-6% on net basis to $420 billion by 2023.
The study shows that prescription opioid volume had increased annually since 1992, reaching its highest level in 2011. A series of regulatory and legislative restrictions subsequently occurred. Those combined with tighter clinical prescribing guidelines and greater reimbursement controls resulted in 4%-per-year declines on average from 2012 through 2016, followed by a 12% drop in 2017 and the historic 17% decline last year, according to the report.
Despite those national trends, state-level variability was wide regarding per capita volume of opioid and medication-assisted treatment, or MAT prescriptions. Specifically, Arkansas, Oklahoma and Kansas had the highest number of opioid prescriptions relative to MAT prescriptions, while all New England states showed fewer than average opioid prescriptions and higher MAT use.
Prescription drug monitoring programs now in place in 49 states significantly limit prescribing of high-dose opioids, which are associated with a higher risk of dependency and overdose and saw the steepest decline in 2018.
“As the national discussion regarding the opioid epidemic in this country continues, we hope to inform and advance that dialogue with some of the important findings in this report,”
Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science, said.
“For instance, while prescription opioid usage continues to decline, we saw many more people receiving medication-assisted treatment for opioid addiction. Our research shows new therapy starts for MATs increased to 1.2 million people in 2018, nearly a 300% increase compared with those seeking addiction help in 2014. This is an important indicator of the effects of increased funding and support for treatment programs to address addiction.”
Additional highlights of the 2019 U.S. Medicines Report include:
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