Trends in Managed Care Pharmacy

San Francisco—Over the past year, there has been a slowing in the rate of growth of expenditures for drugs. At a Contemporary Issues session at the AMCP meeting, Douglas Long, MBA, vice president, industry relations, at IMS Health, Inc., provided an overview of the US pharmaceutical market in a session titled Emerging Issues and Trends in Managed Care Pharmacy.

Mr. Long opened his presentation by listing reasons for the slowdown drug-related expenditures, including increased cost sharing for consumers, the recent recession, a lack of innovation in the industry, concerns about safety for some medications, converting some prescription drugs to over-the-counter availability, and the continuing introduction of first-time generic versions of brand drugs.

He noted that generics and specialty drugs outperformed the pharmaceutical market in 2011; spending on generics increased by 13.8% and 6.0% on biologic molecules. He added that spending was concentrated on small molecule pills in pharmacies.

In 2011, generics accounted for 54% of the growth in drug spending (in US dollars). Generics have reached an all-time high proportion of the drug spending, increasing from 13.6% in 2006 to 18.2% in 2011. As a percentage of the total prescriptions dispensed, generics increased from 59.7% in 2006 to 76.7% in 2011.

Mr. Long continued by noting trends in distribution channels, saying that retail spending grew 3.6% in 2011 while institutional spending increased by 3.7%. Retail spending totaled $227.3 billion in 2011 and institutional spending amounted to $92.5 billion. Retail spending includes pharmacy chains, mail-order services, independent pharmacies, and food stores; institutional outlets include clinics, hospitals, long-term care facilities, home health care, and health maintenance organizations.

Turning to trends in classes of drugs, Mr. Long said that nearly one third of spending was concentrated in 5 therapeutic categories: oncologics, respiratory agents, lipid regulators, antidiabetics, and antipsychotics. He also noted that spending on specialty drugs reached $80 billion across a range of conditions including oncologics, medications to treat autoimmune diseases, HIV antivirals, and multiple sclerosis therapies.

By absolute growth in dollars, the top 3 therapy classes are antipsychotics, lipid regulators, and analogs of human insulin. By absolute growth in total prescriptions dispensed, the top 3 classes are antidepressants, codeine combinations, and synthetic non-narcotic analgesics. On a dollar basis, the top 3 classes in the United States are lipid regulators, antipsychotics, and antidepressants. When calculated by total prescriptions dispensed, the top 3 classes are antidepressants, lipid regulators, and codeine combinations.

In terms of absolute growth in dollars, the top 3 products are Eloxatin^® (oxaliplatin), enoxaparin sodium, and Incivek^® (telaprevir); by total prescriptions dispensed, the top 3 products are simvastin, furosemide, and amoxicillin. When rated by relative growth in dollars, the top 3 products are Incivek^® (telaprevir), methylphenidate extended release, and Pradaxa^® (dabigatran). By total prescriptions dispensed, the top 3 are lisinopril (QLT), metoprolol, and lisinopril (wok). Rated on the basis of dollars spent, the top 3 products are Lipitor^® (atorvastatin calcium), Plavix^® (clopidogrel bisulfate), and Nexium^® (esomeprazole magnesium).

For biologic drugs, the top 3 molecules on the basis of total prescriptions dispensed are acetaminophen/hydrocodone, levothyroxine, and simvastatin. Categorized on the basis of dollars spent, the top 3 are atorvastatin, clopidogrel, and esomeprazole.

Mr. Long concluded the session by naming the top pharmaceutical companies. Based on absolute growth, the top 3 growth companies are Watson Pharmaceuticals, Inc., Novartis (including Sandoz), and Bristol-Myers Squibb. In terms of relative growth, the top 3 are URL Pharma, Inc., Camber Pharmaceuticals, Inc., and Cadista. On a dollar basis, the top 3 companies are Pfizer (including Greenstone), AstraZeneca, and Merck & Co. Based on total prescriptions dispensed, the top 3 are TEVA, Mylan Labs, and Novartis (including Sandoz).