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An estimated additional 81 million prescriptions were abandoned at the pharmacy because of high out-of-pocket costs for patients.
Prescription drug use reached a record level of 194 billion daily doses in 2021 as new prescriptions starts for both chronic and acute care recovered from the slowdown recorded in 2020, according to IQVIA Institute for Human Data Sciences’ most recent Use of Medicines report.
Healthcare use had returned to pre-pandemic levels by the end of 2021 but has yet to make up for the backlog in missed patient visits, screenings and diagnostics, elective procedures, and new prescription starts, IQVIA researchers said.
Patient out-of-pocket costs rose $4 billion in 2021 to a total of $79 billion and remain a significant burden for a small part of the population. Medicare beneficiaries in aggregate have seen a sharp 26% increase in their out-of-pocket costs since 2016.
“An overview of patient out-of-pocket costs shows that while most patients’ costs are falling, a small proportion have high costs which impact their use of medicines with implications for their health outcomes,” Murray Aitken, executive director of IQVIA Institute for Human Data Sciences wrote in the introduction.
About 64 million prescriptions – 1% of the total - were filled in 2021 with a final out-of-pocket cost of about $125. This growth was driven by retail out-of-pocket costs, which grew 4.8% in 2021 following two years of declines.
Overall, 8% of patients reach annual out-of-pocket costs above $500 compared with 17% in Medicare, which IQVIA said is in part due to benefit design. In commercial coverage, 7.3% of patients pay more than $500 and 1.6% pay more than $1,500. While insulin costs have declined, patient payments above $35 are more common for these drugs than in the overall market.
IQVIA analysts estimate that an additional 81 million prescriptions were abandoned at the pharmacy because of high costs. Patients taking therapies for chronic disease who abandoned their prescriptions resulted in 5.3 billion lost patient days of therapy. Of prescriptions with a final cost above $250, 61% are not picked up by patients. Oncology and immunology products have abandonment rates of more than 30%.
IQVIA researchers also found that spending on U.S. medicines rose 12% in 2021 to $407 billion due primarily to COVID-19 vaccines and therapies. Differences between list price (WAC) spending and payer net spending reached $190 billion in 2021, up from $118 billion in 2016 as negotiated discounts and rebates to payers and providers increase in competitive markets.
Specialty medicines now account for 55% of total spending, up from 28% a decade ago and largely driven by growth in autoimmune and oncology treatments, which have tripled in spending.
IQVIA’s report is based on prescription data from pharmacies, payers, software providers and transactional clearinghouses, as well as medical claims and prescription audits the company performs.