The latest report from the IQVIA™ Institute for Human Data Science found prescription opioid dosage volume — as defined by Morphine Milligram Equivalents (MME) — declined 12 percent in 2017, marking the largest annual drop in more than 25 years of measurement.

The study, Medicine Use and Spending in the U.S.: A Review of 2017 and Outlook to 2022, shows that prescription opioid volume had increased annually since 1992, peaking in 2011. Then a series of regulatory and legislative restrictions combined with tighter clinical prescribing guidelines and greater reimbursement controls resulted in average 4 percent per year declines from 2012 through 2016.

Overall, prescription opioid volume decreased annually during the past five years across all 50 states. In addition to MME declines, actual dispensed opioid prescriptions decreased 10.2 percent in 2017, while high-doses, those where the patient was prescribed more than 90 MMEs per day and which correlate with higher risk of dependency and overdoses, declined by 16.1 percent for the same year.

"The U.S. opioid epidemic is one of the most challenging public health crises we face as a nation, and our latest report provides novel insights and evidence as part of that ongoing societal discussion," said Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science. "Our research and analytics revealed that 2017 saw new therapy starts for prescription opioids in pain management decline nearly 8 percent, with a near doubling of medication-assisted therapies (MATs) for opioid use dependence to 82,000 prescriptions per month. This suggests that healthcare professionals are prescribing opioids less often for pain treatment, but they are actively prescribing MATs to address opioid addiction. These opioid details, as well as more general evidence-based findings, are explained in this study."

Additional highlights of the 2018 U.S. Medicines Report include:

Medicine Spending and Growth Dynamics: In 2017, spending grew 0.6 percent net of off-invoice discounts and rebates as invoice-level growth slowed to 1.4 percent. Overall, spending reached a total of $453 billion on a gross invoice basis but $324 billion on a net basis. Discounts, rebates and other price concessions on branded medicines reduced absolute invoice spending by an estimated 28 percent to $324.4 billion. When adjusted for off-invoice discounts and rebates, population and economic growth, real net-per-capita drug spend declined by 2.2 percent in 2017 and had a compound annual growth rate of only 1.0 percent during the past decade. Retail prescription drugs accounted for $212 billion in net spending for the year, reflecting a 2.1 percent decline from 2016.

Medicine Usage Trends: Patient use of medicines continued to rise in 2017 with the significant increase of 90-day prescriptions for the treatment of chronic conditions. This trend toward 90-day dosing cycles is intended to improve patient adherence. Every year, there are hundreds of billions of dollars in avoidable healthcare costs, with the largest portion of these relating to non-adherence to drug therapies and the associated complications. Hypertension is the largest therapy area by drug volume, and it affects nearly one-third of Americans. New guidelines recommend treating nearly half of the population, which could further increase the prescription volume within that growing category.

Patient Out-of-Pocket Costs: List prices at pharmacies rose by 58 percent during the past five years, while final out-of-pocket costs declined 17 percent as increasing adoption of generic medicine and greater use of coupons lowered patient costs. These divergent trends reflect the complex dynamics determining how much patients pay for their medicines and the influence those costs have on whether patients fill their prescriptions. Almost 31 percent of prescriptions were dispensed at zero patient out-of-pocket cost, while patients paid $500 or more out-of-pocket when filling 3.4 million prescriptions in 2017.

Profile of New Medicines and Pipeline: New drug launches rebounded in 2017, with 42 new active substances introduced, more than double the number launched the prior year, with 21 for rare diseases and 14 for cancer. Significant shifts in the regulatory process are becoming apparent, with 19 drugs receiving breakthrough designation and 18 including patient-reported outcomes as part of their FDA-approved label in 2017.

Outlook to 2022: A modest overall increase of 2-5 percent net spending is projected during the next five years, with 1-4 percent growth in retail and mail-order prescription drugs. That is expected to drive overall medicine spending in the U.S. to an estimated range of $550-600 billion by 2022, or $380-410 billion on a net basis. This growth, driven primarily by the large number of new medicines, many of which will be specialty and orphan drugs, will be offset by the impact of losses of brand exclusivity.

The full version of the report, including a detailed description of the methodology, is available at www.IQVIAInstitute.org. The study was produced independently as a public service, without industry or government funding.

About the IQVIA Institute for Human Data Science

The IQVIA Institute for Human Data Science contributes to the advancement of human health globally through timely research, insightful analysis and scientific expertise applied to granular non-identified patient-level data.

Fulfilling an essential need within healthcare, the Institute delivers objective, relevant insights and research that accelerate understanding and innovation critical to sound decision-making and improved human outcomes. With access to IQVIA’s institutional knowledge, advanced analytics, technology and unparalleled data, the Institute works in tandem with a broad set of healthcare stakeholders to drive a research agenda focused on Human Data Science, including government agencies, academic institutions, the life sciences industry and payers

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