US Biosimilar Spending Doubled Last Year, Still Represents Less Than 2% of the Market

A recent report from IQVIA looking ahead to 2023 forecasts that US net medicine spending will increase from $344 billion in 2018 to $420 billion, an aggregate growth of $76 billion, driven by new brands, which are expected to add $73 billion of new spending.

However, that will be offset by brands losing exclusivity, forecast to total $78 billion in savings over the next 5 years, the report said.

The report, titled “Medicine Use and Spending in the US,” said average brand net price changes for protected branded drugs are predicted to fall between 1% and increase to 2% per year through 2023, resulting in about $12 billion in incremental spending.

Over the next 5 years, the $105 billion impact of losses of exclusivity are expected to be 46% greater, including biosimilars, at the invoice price level (invoice-based pricing is derived from IQVIA proprietary information gathered from wholesalers and company direct sales. It includes some price concessions, but not all of them). The report said growth won’t be greater than the combined growth from new brands and volume growth for existing brands.

Patent expirations will increase over the next 5 years, peaking in 2023. Protected brands, including AbbVie’s Humira, will lose $33 billion.

2018 Spending on Biosimilars

Net spending on biologics totaled $125.5 billion in last year, up 9.5% since 2017. Biosimilar spending has doubled since 2017 but still represents under 2% of the total US biologics market. Biosimilars are used less than one-third of the time, the report said.

Looking back to 2018, the report said biosimilars as well as generics had modest growth in volume. The biosimilar share of volume exceeded 30% for those medicines, but in total these medicines represent less than 1% of biologic volume.

Total biologics spending grew by 9.5% last year; 13% of the spending in the market is now subject to biosimilar competition, where biosimilars have captured about 12% of total available spend.

Autoimmune Trends by Treatment Area

Last year, autoimmune prescriptions increased at a 5-year compound annual growth rate (CAGR) of 9%, while patient volume had a 10.2% CAGR; the report said that indicates new patients are being treated, but overall rates of adherence are relatively unchanged.

The number of autoimmune patients being treated is up 63% since 2013, with 6 million more patients per year receiving therapy, largely driven by new treatments for psoriasis and related conditions. In 2018 alone, the number of autoimmune patients being treated grew by 20%.

Rheumatoid arthritis (RA) continues to be the most common autoimmune disease treated, with 41% of all autoimmune patients treated for the condition in 2018. However, this is a decrease from 48% in 2013; IQCVIA said this indicates the emergence of effective therapies for other autoimmune conditions.

Ulcerative colitis (UC) and psoriasis grew the most last year (29% and 30%, respectively), while Crohn disease (CD), psoriatic arthritis, and ankylosing spondylitis increased by 27%, 23%, and 21%, respectively.

Areas of high unmet need, such as CD and UC, both areas of high unmet need, saw a doubling (195%) and tripling (292%) of patients treated since 2013, respectively.

Psoriasis and psoriatic arthritis-treated patient populations both more than doubled, increasing by 120% since 2013. Psoriasis and psoriatic arthritis now comprise 18% and 11% of treated patients, respectively.

Specialty Medicines

Overall, 127 million specialty prescriptions were dispensed in retail and mail pharmacies in 2018, up by 15 million since 2014.

Specialty medicine prescriptions grew by over 5%, even as those medicines account for only 2.2% of prescriptions and have little impact on the overall growth of dispensed prescriptions. Net spending on specialty medicines increased 5.8% on a per capita basis, while traditional medicine costs fell 3.4%.

Prescriptions for chronic diseases account for more than two-thirds of prescriptions, and the increasing use of 90-day prescriptions means patients have significantly more medicine on hand.