US prescription sales were up 3.2% in 2013, totaling $329.2 billion

In 2012, for the first time in decades, spending on pharmaceuticals declined in real terms. That wasn’t expected to continue, and it indeed has not, based on the annual compilation by the IMS Institute for Healthcare Informatics (Parsippany, NJ). The 2013 figure is $329.2 billion and represents a 1.0% increase in sales in real, per capita terms over 2012. Even with this slight increase, Murray Aitken, research director, says that pharmaceuticals are continuing to contribute to the “bending of the cost curve” of healthcare generally, through the combination of providing lower healthcare costs compared to hospitalization, and the effects of generic substitution. In the latter instance, loss of exclusivity removed $29.3 billion from pharmaceutical costs overall during 2013 (the continuation, at a lesser level, of the “patent cliff” that the industry has been going through for the past three years).

IMS counts 36 new molecular entity launches in 2013 (as distinct from FDA approvals; some drugs are launched well after approval), including 10 new cancer treatments and 17 orphan drugs. Both of these are recent highs; the orphan drug number represents the most new drugs in that category since the Orphan Drug Act was passed in 1983.

Healthcare utilization trends of note:

• Patient office visits grew by 2.7%, reversing four years of declines
• Scheduled inpatient admissions at hospitals grew by 10.5%, but only account for 2.4% of hospitalizations
• 1.6% more prescriptions were filled in 2013, an increase of 0.4% over the year before, but representing per capita growth of only 0.9%

Distribution channels

Continuing a years-long trend, chain drugstores outpaced independents, with the former growing by 4.0% in sales volume, and the latter by 0.3%. Mail service rebounded from 2012’s significant decline, rising by 3.1% in 2013. In terms of prescriptions filled, chains grew by 1.4%, while independents continued a four-year slide, dropping 0.3%.

Given the attention being paid to specialty pharmaceuticals, one would expect that clinics (for things like infusions) would be jumping in parallel with the growth in specialty sales. That has occurred—clinic sales increased by 5.3%--but that’s less than the 9% growth in specialty sales that IMS counted in 2013. Aitken notes that specialty sales in retail and mail has been growing faster than the overall growth (it was up 12.6% in 2013). It would seem from this statistic that chain drugstores and mail are keeping up with the shift in pharma products to specialties. One factor helping retail and mail keep pace with clinics is the shift to oral drugs, especially oncolytics, that don't require a clinical setting for administration. Another element in this transition—not dealt with in this report—is the movement of specialty drugs from being reimbursed as a medical benefit to one being reimbursed as a pharmacy benefit.