Keynoter Doug Long Sees Fragility, ‘Pretty Anemic’ Launches As He Looks Ahead to Retirement | PBMI 2024

Doug Long, MBA, vice president of industry relations at IQVIA, delivers one of his last presentations before retirement.

In what is likely to be one of his final presentations, Doug Long, MBA, painted a fairly bleak picture of U.S. healthcare system and the prospects for the pharmaceutical industry in this keynote address this morning at the Pharmacy Benefit Management Institute (PBMI) Annual National Conference in Orlando, Florida.

Surveying issues ranging from cancer screening rates that haven’t recovered from the decline during COVID-19 pandemic to low returns on investments for generic and biosimilar manufacturers to the declining number of retail pharmacies and “pharmacy deserts,” Long said he had never seen the industry in a “more fragile state.”

He also took a swipe at the Inflation Act Reduction — “some people in pharmaceutical land call it the innovation Reduction Act instead of the inflation Reduction Act — and noted that through June, only 26 new drugs have been launched this year and that that the FDA has approved only 22 new molecular entities. “The launch landscape in 2024 has been pretty anemic,” Long said.

Long, a vice president of industry relations at IQVIA, has been a frequent speaker at the pharmacy and managed care meetings for decades, announced after he was finished with his presentation that he would retire next May when he turns 74. Long’s rapid-fire delivery and voluminous slide decks — today’s deck had 83 slides delivered over 45 minutes — have become set pieces at meetings such as PBMI’s annual meeting.Long oted that Zantac (ranitidine) was the top selling drug (in terms of sales) when he got started, followed by Lipitor (atorvastatin), then Humira (adalimumab) and Ozempic (semaglutide).He mentioned Scott Biggs, a longtime IQVIA executive, as a successor. “It has been a good run,” Long said.

Here are a few highlights from Long’s talk:

Tough times for retail pharmacy. Long described the beginning of the year as “perfect storm” for retail pharmacies as direct and indirect remuneration (DIR) fees changed from being retrospective to prospective; the unfavorable economics of the glucagon-like peptide 1(GLP1) inhibitors that means some pharmacies lose money on every prescription the Change Healthcare cyberattack. Long also spoke the CVS and Walgreens closing stores and Rite-Aid’s bankruptcy creating “pharmacy deserts” in rural and urban areas.

The prescription opioid epidemic has ebbed but not the overdoses. The opioid epidemic as far as prescription narcotics “is in the rearview mirror,” Long said, and has been since 2011 and continues to subsid. Yet more people in the U.S. overdosing today than ever before because of illegal fentanyl and methamphetamine.

Prescriptions rejected,drugs not taken. Long shared data that out of every 100 prescriptions written for 51 are rejected by the original payer but 17 are then subsequently approved by a new payer. After that, though, 18 prescriptions are “abandoned” — not picked up by patients. ”There’s a big challenge, a, in getting somebody on a prescription and, b, to get them to continue to on that prescription. Long said. Long also shared IQVIA data showing that of the 100 prescriptions filled for chronic disease, after a year, only 31% patients were “persistent” continuing with prescriptions for the medication. “This is pretty lousy when you think about it,” Long said,

Oncology launches down. Long said one of the most trends in new drug launches, in addition to the numbers overall falling off, is the relative lack of new oncology drugs. In 2022 and 2023, oncology drugs accounted for the largest proportion of new drug launches when drugs are grouped by the diseases that treat. So far, in 2024, they are not among the top three categories. “I don't know whether that's because oncology has got more saturated than ever before. There's multiple options … there's eight PD-1s [programmed cell death 1] and there's not as much room for innovation. We'll have to see. But that's a big that's a big difference.”