By Karen Blum and David Bronstein
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Doug Long

The pharmaceutical marketplace may be a hard thing to predict, but there is at least one event that attendees at the major specialty pharmacy conferences can bank on each year: Doug Long’s piercing analysis of industry trends that stakeholders should heed when crafting their competitive strategies.

Mr. Long, the vice president of industry relations for IQVIA, rolls out his presentation at several conferences annually. During Asembia’s AXS24 Summit, in Las Vegas, he focused on key drug utilization data points from the previous year. He first highlighted immunology, novel obesity and antibiotic drugs as particularly hot therapeutic topics.

Immunology drug use reached 1.2 billion days of therapy in 2023, up 60% from 2019, Mr. Long said. Treatment of Crohn’s disease and psoriasis accounted for 26% and 15% of growth, respectively, he added, citing IQVIA in-house data. There were 2.6 billion antibiotic days of therapy last year, returning to prepandemic levels.

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There also were nearly 700,000 new prescriptions for glucagon-like peptide-1 (GLP-1) receptor agonists for diabetes and obesity in February 2024, up 181% compared with two years prior, Mr. Long said, adding that 34% of growth in the total market came from GLP-1s. “That’s from volume and line extensions, not really price, even though they’re expensive.”

It’s a trend likely to continue, he said, as the pipeline can be considered an “obesity gold rush,” with 120-plus weight-loss agents being developed by more than 60 companies. “There’s a whole bunch of them on the horizon—so this is not going to go away.”

Drug Shortages Hit Record High

Mr. Long also cited the perennial issue of drug shortages, which are more numerous than ever before. During the first three months of 2024, there were 323 active medication shortages, according to ASHP and the University of Utah Drug Information Service (bit.ly/3w8ckYi-SPC). Previously, the record high was 320 shortages in 2014.

Looking back on 2023, 58% of drug shortages were in short supply for more than two years, he said. Key drugs on shortage include GLP-1s, cisplatin and carboplatin, dextroamphetamine-amphetamine, albuterol, and amoxicillin. Reasons are multifold and include product disruptions resulting from adverse weather hitting production facilities to a gap in FDA inspections of manufacturing facilities dating back to the COVID–19 pandemic.

Mr. Long shared these other notable marketplace trends:

  • As of February 2024, specialty spending for the previous year grew by 13% while traditional growth grew by 14%. That’s partly because GLP-1s are traditional, not specialty, drugs, he said.
  • The top therapy classes by sales were immunology, antidiabetics and antithrombotics, and oncologics, followed by HIV antiretrovirals, medications for attention-deficit/hyperactivity disorder, respiratory agents and drugs for mental health.
  • Oncology will remain the largest therapeutic area by 2028, although the marketplace is getting crowded, with 10 PD-1 (programmed death-1) immune checkpoint inhibitors and multiple entrants that could slow down growth.
  • In immunology, there are more indications than ever before, with drugs specific to Crohn’s disease, psoriasis, etc.
  • There were 80 drug launches in 2023, compared with 58 in 2022 and 76 in 2021. The top launches by sales were the respiratory syncytial virus vaccines Abrysvo (Pfizer) and Arexvy (GSK) and long-acting monoclonal antibody nirsevimab-alip (Beyfortus, Sanofi).
  • The top eight specialty products exhibited vigorous growth from 2022 to 2023, including a 258% increase in sales for semaglutide (Wegovy, Novo Nordisk), a 248% increase in sales for upadacitinib (Rinvoq, AbbVie), and a 115% increase in sales for daratumumab and hyaluronidase-fihj (Darzalex Faspro, Janssen).

Mr. Long reported no relevant financial disclosures beyond his stated employment.

CMS Incentivizes Payor Health Disparity Performance

By Karen Blum

Medicare Advantage and other health plans are starting to pay more attention to medication adherence, social determinants or drivers of health (SDOH), and where they can intervene in health disparities—not only because it’s the right thing to do but because it will soon affect their bottom line, speakers said at Asembia’s AXS24 Summit, in Las Vegas.

“There is now evidence that if you don’t address social drivers of health, you are not going to achieve good outcomes for a big percentage of the population,” said Christie Teigland, PhD, the vice president of research science and advanced analytics at Inovalon, a software and data solutions company.

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SDOHs drive about 80% of health outcomes, Dr. Teigland added (bit.ly/3QtCwU8). “Only about 20% of our health outcomes is due to the actual clinical care we get. The rest is related to things like income, education, the environment in which we live and our health behaviors. We need to understand them and how they might drive access to care and medication adherence.”

Medication adherence measures that are part of value-based payment systems are now being incorporated in the Centers for Medicare & Medicaid Services’ new Health Equity Index (HEI). The HEI was developed as an enhancement to Medicare Advantage plans, with a goal to incentivize contracts to perform well for beneficiaries with social risk factors, she said. For now, the population being studied includes members who are dually eligible for Medicare and Medicaid, those who receive a low-income subsidy, and those with disabilities, “not because those will be the only SDOHs that are important, but because that’s what they have good access to data on,” Dr. Teigland said.

The HEI will consider Star Ratings of performance for 2024 and 2025 on 12 quality measures such as:

  • adherence for cholesterol, hypertension and diabetes medications;
  • statin use in people with diabetes; and
  • rheumatoid arthritis management.

The goal of the HEI initiative is to look for disparities in outcomes among people with SDOHs and where health plans can intervene, Dr. Teigland noted.

“Those big disparity gaps are really where plans are going to have to focus their efforts to do well on this Health Equity Index, because they’re going to get ranked against everyone else and get scored,” she said.

Performance on these measures will factor into a financial reward or bonus payment for plans starting in 2027. “The trick about these medication adherence measures [for diabetes, cholesterol and hypertension medications] is that they are triple-weighted in this index,” she explained. Plans that rank in the top will get 3 points, those that rank in the middle will receive no points and those in the bottom will get 3 points taken away from their score, “so these are going to be really impactful to plans.”

Although the HEI is initially starting with only a couple of social drivers, it behooves health plans to start tracking the effect of additional SDOHs such as race/ethnicity, education level, household income, social isolation/living alone and English language proficiency, Dr. Teigland said. These entities also should be looking at their performance on medication adherence and other measures among members who are dually eligible, disabled or receive the low-income subsidy versus those who do not, using analytics and medical and pharmacy claims.

“It’s important that they do that exercise to understand where their biggest disparity gaps are,” she said. By doing so, “they can focus their limited resources to improve where it’s going to make the biggest difference in their HEI score.”

For more information about the HEI program, check the CMS website at bit.ly/4bjvEAU.


Dr. Teigland reported no relevant financial disclosures beyond her stated employment.

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