The GLP-1s Are the Latest Drug Sales 'Tsunami,' says Doug Long | 2023 PBMI Annual National Conference

Doug Long has seen it before. “The introduction of the HIV drugs, followed by the hepatitis C drugs. Now you have the GLP-1s,” said the IQVIA vice president of industry relations in a short interview after delivering one of his trademark presentations on pharmaceutical and healthcare trends that feature rapid-fire delivery of voluminous slide decks. “I call them tsunamis.” Still, the surge in the sales of the GLP-1 drugs is the “topic of conversation in every (healthcare) trade organization today. It is really a game changer,” Long said during his presentation Thursday at the 2023 PBMI Annual National Conference in Orlando. Long’s sweeping, data-rich review also touched on healthcare utilization after the COVID-19 pandemic, spending on specialty drugs, increased spending on drugs for mental health and drug shortages. The now-famous GLP-1s include Ozempic (semaglutide), Wegovy (also semaglutide but a higher dose) and Mounjaro (tirzepatide). Long showed sales data collected by IQVIA that identified Ozempic as second only to Humira in nondiscounted sales — $20.6 billion in the moving annual target (MAT) in June 2023 compared with $32.7 billion for Humira (adalimumab). Sales have of Ozempic, which has trended as a topic on TikTok, soared 78.4% in 12 month prior to June. “Thank you social media for that” Long quipped. Mounjaro, which was approved by the FDA as a diabetes drug in May 2022 but is being used off-label for weight loss, ranked number 11 on Long’s list of top drugs by nondiscounted spend at $8.4 billion in sales, and Long said Mounjaro was second only to Harvoni (ledipasvir and sofosbuvir), a hepatitis C drug, in sales during the first 10 months on the market. Spending on the GLP-1s as a class of drugs is also on steep northward pitch in Long’s telling, increasing from $8.9 billion in 2018 to $35.2 billion in 2022.Most of prescriptions are written for women (77%) and middle aged (59% for individuals ages 40-59). Trulicity (dulaglutide), Rybelsus (semaglutide tablets), Victoza (liraglutide) and several other drugs are in the GLP-1 class but Ozempic and Mounjaro are responsible for most of the growth of the sales of the class, Long said. Health plans and PBMs have taken steps to rein in the number of GLP-1 prescriptions by, for example, requiring patients to try other medications (which is called step therapy) before taking Ozempic or Mounjaro. But Long said during the brief interview that he expected to insurers to cover the GLP-1 drugs because of the large proportion of Americas who are overweight. Here are other topics that Long covered during his presentation: The use of in-person and telehealth visits in 2023 is running at about the same rate as in 2022. Telehealth visits account for 7% to 8% of the claims for healthcare visits down from 20% during the pandemic. Specialty drugs accounted for 51% of drug expenditures, using net manufacturer prices, in 2022, a continuation of the trend of spending shifting from so-called traditional drugs to specialty ones. The definitions of specialty and traditional drugs are imprecise and vary with the source. IQVIA defines specialty drugs as drugs for rare, complex or chronic diseases that have cost or distribution characteristics that require special management. Long’s slide on the specialty-traditional ratio showed it narrowing from 32%-68% in 2012 to it being even in 2019 and then specialty exceeding traditional afterwards. Among the specialty drugs, spending on those for immunologic conditions, such as rheumatoid arthritis, has increased 451% since 2012, using net manufacturing to make the calculations, and 349% for cancer. Long said biosimilars coming on the market are likely to moderate those upward trends. FDA inspections of manufacturing have not rebounded to pre-pandemic levels. In 2019, agency officials inspected 1,397 domestic sites and 1,205 foreign ones compared with 840 domestic inspections in 2022 and 349 foreign ones. However, Long’s slide on inspections noted that that the data are incomplete and do not include inspections by state-level officials, preapproval inspections, mammography facility inspections, inspections waiting for a final enforcement action, and inspections of nonclinical labs. The number of drugs in short supply decreased from last year but still remains above normal, according to an FDA-supplied count presented by Long. When grouped by the conditions they treat, 60 of the 237 drugs affected by shortages in 2023 were those used to treat cancer. Approximately 88.8% of prescriptions this year have been for unbranded generics. Citing price decrease of 20% since 2019, Long said the downward pressure on prices is “getting to the point where it is unsustainable for these generic companies.

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