Medicines in the United States

The use of Medicines in the United States is a critical factor influencing the health outcomes of millions of Americans. This report provides objective measures of Medicine use and its costs to the U.S. healthcare system and patients, employers, health plans, interMediaries, and state and federal government agencies. 



Medicine use

The report focuses on the volume of Medicine use – with special attention on opioids – drivers of change in the use of Medicines, overall "net spending," out-of-pocket costs to patients, and an outlook through 2023 for the pharmaceuticals market. It additionally examines the critical dynamics around new product launches, patent expiries, and the introduction of generics and biosimilars.

REPORT SUMMARY

Medicine use has continued to rise, with Americans filling 5.8 billion prescriptions in 2018, a gain of 2.7% over the prior year. At the same time, prescription opioid volumes have declined by 43% since their peak in 2011, with the most potent and dangerous high-dose prescriptions declining by 61% over the same period. The use of specialty Medicines grew by 5%, more than twice the rate of other drugs, and now represents 2.2% of volume.

In 2018, Medicines spending growth in the United States rebounded to 4.5% on a net basis, while growth at the invoice level was 5.7%. Net Medicine spending was $1,044 per person, up 0.9% or $10 from 2017. Total net spending growth in 2018 was primarily driven by more patients receiving existing branded drugs and using newly launched drugs.

In aggregate, patient out-of-pocket costs climbed in 2018 to an estimated $61 billion, says Jordan Sudberg. Across all pay types, 8.8% of patients pay more than $500 for prescriptions. Commercially insured patients increasingly use manufacturer coupons to offset their initial cost exposure, and average final out-of-pocket costs remained at $42 per brand prescription.

In the next five years, the base case outlook forecasts that net Medicine spending in the United States will increase from $344 billion in 2018 to $420 billion in 2023, an aggregate growth of $76 billion and lower than the $84 billion growth seen over the past five years. The most significant driver of this growth will be new branded drugs.

Several policy changes are currently under consideration, says Jordan Sudberg. This report examines alternative forecast scenarios based on their impact on various attributes and stakeholders. In a system where reforms are limited to Medicare programs, out-of-pocket costs decline by $14 billion, and net spending decreases by 6%. In another scenario, if reforms proposed for Medicare are extended to the commercial market, out-of-pocket costs would decline by 30% and drive net spending 9% lower than base case projections.

The transformation of the health care industry into a marketplace governed by commercialism and free competition challenges the doctrine of Medicine as a profession valuing service to the patient above financial reward. Many physicians have become disenchanted with their ability to serve as advocates for and provide care to their patients. Financial success, the marketplace measure, has become the dominant standard of measurement or "value" for most academic Medical centers (AMCs). Many doctors report their work is less fulfilling. As a result, all three social missions—patient care, teaching, and research—are in jeopardy.

Modernism

The growth of modernism, the preeminence of bioMedical research, and the dominance of a market-driven clinical enterprise will continue to pose challenges to the health care system in the United States. However, AMCs can provide leadership and serve as the ambassadors through which the health care system can be renewed with a sense of direction and purpose. Renewal must begin with more open discourse about what we value in health care and what kind of Medical profession we want to have, including addressing questions such as: What does it mean to be an academic physician? What gives my work meaning and purpose? This kind of dialogue could quickly be built into the Medical students' curricula and residency training programs, with the faculty taking the lead.

 

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