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 Spending on medicines rose 3.2 percent in the United
States last year to $329.2 billion. While that was far less than the
double-digit increases seen in previous decades, it was a rebound
from a 1 percent decline in 2012, the report by IMS Health Holdings
Inc. found.
Among factors driving the increased spending were the cost of new
medicines, price increases on some branded drugs, a $10 billion
reduced impact of patent expirations compared with 2012, and the
first rise in the use of healthcare services in three years, IMS
found.
IMS compiles and provides data on prescription drug use and trends
for the pharmaceutical and healthcare industry.
The relatively small spending increase was helped in part by greater
use of cheap generic drugs, which edged up to 86 percent of all
prescriptions filled in the United States from 84 percent in 2012,
despite fewer major new generic drug introductions compared with the
impact seen in 2012.
Healthcare utilization was up across the board, with rises in doctor
office visits, hospitalizations and volume of prescriptions filled,
IMS said.
The increased use of healthcare services does not reflect those
newly insured under the Affordable Care Act and Medicaid expansion,
which did not fully kick in until this year. But it could be
reflective of declines in unemployment, with more people gaining
employer-based health insurance, and recent gains in consumer
confidence.
"The recession was officially over a long time ago, but what has
taken a much longer time is for the (healthcare services) demand to
recover," Michael Kleinrock, director of research development for
IMS Institute for Healthcare Informatics, said in a telephone
interview.
"In late fall of 2012, we started to see a beginning of the recovery
in terms of new therapy starts," Kleinrock said.
New medicines for cancer, hepatitis C, multiple sclerosis, diabetes
and rare diseases has led to a shift in some patient spending
tendencies, the report found.
Patients gained access to 36 novel new medicines in 2013, including
a record 17 so-called orphan drugs that treat small patient
populations at typically very high cost.
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"We saw patients see more specialists than primary care for the
first time," Kleinrock said. "Incurring a primary care visit co-pay
in order to be referred to see a specialist certainly doesn't feel
like value for money, so many patients may be self referring," he
suggested.
Those trends could well continue over the next two years as
several promising new cancer drugs come to market, as well as new
oral hepatitis C treatments with extremely high cure rates and few
side effects.
The first of those hepatitis drugs, Sovaldi, from Gilead Sciences
Inc, has led to intense criticism for its price tag of about $84,000
for a 12-week course of treatment.
"It's interesting to see the debate about cost when you're curing a
disease which has much more overall cost," said Kleinrock, referring
to the cost of treating liver cancer or transplants if the hepatitis
progresses without treatment.
While the overall number of hospitalizations increased, emergency
room visits that turn into in-patient admissions declined
dramatically, by 14.6 percent, IMS found.
That could point to continued use of high-cost emergency services
for non-emergency primary care for many people.
On that front, Kleinrock said, "We noted, that perhaps there's still
some work to do."
(Reporting by Bill Berkrot; editing by Leslie Adler)
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