The Pandemic Shook Up American Healthcare. Now the Rebound and the Aftershocks.

The COVID-19 pandemic left no part of the American healthcare system untouched in 2020 and even as the country and healthcare system rebounds, the pandemic influence is apparent and likely to be lasting, according to a stream of facts and figures presented today by Doug Long, MBA, vice president of industry relations at IQVIA at the 2021 Annual National Conference of the Pharmacy Benefit Management Institute® in Orlando, Florida.

Doug Long

Using sales and other sorts of data assembled by IQVIA, Long showed that a billion fewer visits that resulted in a diagnosis occurred in 2020 than in the past, which works out to a 20% decrease. This year, people are starting to come back for visits, but Long shared data showing that diagnostic visits are still substantially down. Fewer diagnostic visits result in fewer prescriptions, and Long showed a wide assortment of data documenting various aspects of the effect on drug prescriptions and sales.

Lockdowns and people’s hesitancy to seek in-person healthcare are part of the reason for fewer visits, Long explained. But the dramatic decline in flu cases last year and first part of this year was another significant factor, and Long said one of the major questions in the months ahead is whether flu will resume to normal levels. He showed data from Australia, which has a southern hemisphere flu season ahead of countries in the northern hemisphere, that suggests that there will still be far fewer cases of flu and therefore fewer diagnostic visits, especially for pediatricians.

Long’s data also showed the much-discussed increase use of telehealth. In the past, telehealth visits have tended to generate fewer prescriptions than in-person visits because the lab and other tests that result in prescriptions are not done as often if a patient is seen digitally. As telehealth becomes a more fixed part of healthcare delivery, that separation from testing and prescriptions may change.

“What is going to be interesting to watch is how digital plays into the marketplace,” Long said in a brief interview Managed Healthcare Executive® after his talk.

Here are some other data that Long discussed during this PBMI presentation

• Specialists with greater gaps in claims in 2020 are working through the patient backlog, particularly ophthalmologists and dermatologists. Long showed data for new-to-brand prescriptions (NBRx) — a metric that the pharma industry tracks to gauge drug sales — and claims comparing the first half of 2020 to the first half of 2021. Both claims and NBRx increased for ophthalmology, dermatology and obstetrics and gynecology.
• The nonretail channel is recovering the effects of COVID-19. Nonretail growth in sales dipped t 1.8% in 2020, but Long showed a chart based in IQVIA data that show a rebound to 6.1% during the first half of 2021.
• Specialty drug growth is outpacing traditional growth and now accounts for just under half of the nondiscounted spend. Almost every speaker at the meeting referenced the growth in spending on specialty drugs. In 2017, the specialty-traditional share of sales spit was 43.1% specialty and 56.9%, according to the IQVIA sales data that Long showed. In the 12 months prior to June of this year (MAT June), it was 48.9% specialty and 51.1% traditional.
• Manufacturer new revenues increased by $48 billion over the past five years, driven by new products and protected brand volume.
• Growing payer control continues to challenge patient access. Specialty patients are 20% more likely to not fill a prescription today as they were in 2013, according to IQVIA data shared by Long, and 60% of specialty patients with a step edit (coverage of a less expensive medication before a more expensive one will be covered) are not able to overcome the restriction within 30 days.