Assessing Trends in Patient Out-of-Pocket Costs in 2021, Implications for 2022

Pharmacy Times interviewed Murray Aitken, executive director of IQVIA Institute for Human Data Science, on the increase in spending on medicines in 2021 in the United States and implications for the US health care system.

Alana Hippensteele: Hi, I’m Alana Hippensteele with Pharmacy Times. Joining me is Murray Aitken, executive director of IQVIA Institute for Human Data Science, who is here to discuss the increase in spending on medicines in 2021 in the United States.

So how about patient out of pocket costs? Have these costs risen as well, and if so, what are the implications of the rise for both the health care system and for patients?

Murray Aitken: So patient out of pocket costs, this continues to be an area of great focus and great interest to all stakeholders in the US. We measured the total amount paid out of pocket by all patients, and that is for both retail prescriptions when they're filled, as well as the patient responsibility associated with medicines when they are in in hospitals.

In total, that amount reached $79 billion in 2021. That's up from $75 billion in 2020. But it's about the level it's been actually for several years, it's been in this sort of $74-$79 billion range. Most of the increase is due to an increased number of prescriptions being filled, and a shift in the mix of prescriptions towards those that carry higher out of pocket costs.

When we look at the average out of pocket costs for all retail prescriptions, we have been tracking a slow decline, actually, in the average cost. It was about $10.14 back in 2016, and it was $9.41 in 2021—that's across all payers and all products. Now, of course, that's an average. So when you dig down, and you look at the prescriptions that are being filled at more than $250 or $500 out of pocket, it's a very small percentage. But we do see growth in that part of the out-of-pocket market.

We also, by the way, see growing concern about abandonment rates. So this is where a prescription has been called into a pharmacy, it's been there on the shelf. But for whatever reason, the patient doesn't actually take the prescription and pay the out-of-pocket cost. The rates of abandonment can be quite high, particularly again for the higher priced out of pocket levels, and that of course is of great concern as well.

Alana Hippensteele: Absolutely. IQVIA data showed that health services utilization returned to pre pandemic levels by the end of 2021 but has yet to make up for the pandemic induced backlog of missed patient visits, screenings and diagnostics, elective procedures, and new prescription starts. What do you think may be the cause of this according to the data, and do you think 2022 might be the year when health services utilization returns to pre-pandemic levels?

Murray Aitken: Yes, so we have created what we call the health services utilization index that incorporates a number of factors. But it's a way to really look at the total amount of activity that's happening in the health system involving patients. When we look at that index, cumulatively, since the beginning of the pandemic, we're at about 10% below where the index was prior to the pandemic, and that's the backlog that we talked about.

Part of it was a consequence, clearly, of the initial lockdown, the social distancing, and hospitals and clinics and doctors’ offices that also placed restrictions on visits. That's all changed over time. But I think we do have a significant number of patients who have become disengaged from the health system, if you like. People who have missed their regular checkups. They've missed their regular screenings and diagnostic tests. This is definitely something of concern because we know that underlying health conditions can continue to evolve, and disease can continue to develop whether or not you're going for your regular wellness check or not.

Whether this year we'll see the turnaround—we’re not sure. Again, we're tracking that utilization index, which needs to be above 100%, or above the baseline, for quite some time to reflect the clearing of the backlog. It's not there yet in most areas, or it's only slightly above. Of course, we have other issues now coming into play, including inflation and the prospect of a recession in the next year or 2 that might also have some impact on this reengagement with the health system. But this is definitely an area of concern. We need people to be engaged with their own health, we need people to be going for their wellness checks, their checkups, and really going back to the way things were in terms of that level of engagement with the health system.