Expert weighs in on the growth of specialty drug spending, particularly with drugs in immunology, neurology, and weight loss.
Doug Long, MBA, the vice president of Industry Relations at IQVIA, joins Pharmacy Times at the National Association of Chain Drug Stores (NACDS) Total Store Expo, happening August 12 through 14, 2023, in San Diego, California, to discuss top-of-mind trends in drug spending, potential growth categories, and explains how current drug spending patterns allude to the cultural landscape.
PT Staff: Could you break down the dramatic increase in specialty drug spending?
Doug Long, MBA: Specialty drug spending is about 51% of the total spending. It hit that mark in 2022. It probably would have hit that mark a little earlier except the COVID-19 vaccines, which [are considered] traditional drugs, not specialty drugs. The thing that's driving specialty is immunology, oncology, in neurology. Now, what's interesting about those 3 is, as Scott said, immunology because now we're going to have biosimilars and you have biosimilars on adalimumab (Humira), the number 1 product.
Down the road there'll be biosimilars on ustekinumab (Stelara) the second biggest immunology product. There's biosimilars on oncology, 3 big oncology drugs, and neurology is going to be interesting because you now have new Alzheimer drug (lecanemab-irmb (Leqembi; Eisai R&D Management Co., Ltd.) to hit the marketplace. That'll be more non-retail than it will be in retail. The diabetes category is fast-growing, but it's not a specialty category as such, although a lot of the weight loss and semaglutide injection (Ozempic; Novo Nordisk) could be determined as being specialty. So that's why it's kind of plateaued out if 51%. So I think it's going to stay at that level, maybe reduce a little bit because of the biosimilars on adalimumab.
PT Staff: What drugs (or categories of drugs) could experience high absolute sales growth in 2023/24?
Doug Long, MBA: Thebiggest one is going to be the glucagon-like peptide 1 (GLP-1) diabetes category for weight loss; not only pre-diabetes, weight loss, and 40% of the US population is obese. So there's a big, big market potential market for that. And it's top of mind of all the retailers because they lose money on every GLP-1 prescription that they dispense. So we expect it's going to be very fast growing. And it's going to have long term implications if people are healthier, not obese, maybe they don't need to cholesterol drugs, maybe we need the cardiovascular drugs and things like that.
PT Staff: What do drug spending patterns reflect about the current pharmacy/cultural landscape?
Doug Long, MBA: There's clearly a market for obesity and weight loss because there's a lot of people are overweight. There's clearly a market for Alzheimer and dementia because it's not a well- treated marketplace. And as the population gets older, they're more susceptible to dementia and Alzheimer disease. The other thing to watch is mental health issues. The big increase is in attention-deficit hyperactive disorder (ADHD) drugs. My initial reaction was that it [would be] for kids, but it’s women aged 20 to 40 years [which represents] the biggest increase in ADHD drugs, and ages 40 to 60 years as well. And it might have been that these mothers were at home homeschooling their kids or trying to work and have their kids at home, and maybe they needed ADHD drugs. So that's another one— emphasis on mental health.
PT Staff: What could be an opportunistic (but untapped) marketspace or issue that pharmacists should jump on? (i.e., specialty drugs; value-based care; novel health screenings)
Doug Long, MBA: I think the role of pharmacy is really increased. And they stepped up hugely in big time, during COVID-19. And they were open. And people went to them where other people were closed. They were able to do the first COVID-19 vaccines. They were able to do COVID-19 boosters. They're able to do flu shots and COVID-19 shots at the same time. And so, they've stepped up in terms of their role of practice and are now more centered on wellness than ever before. So, I'm a huge supporter of pharmacy, and pharmacists and they were truly the unsung first line.
PT Staff: What does this wellness-centered approach look like in the retail setting?
Doug Long, MBA: I think it's a combination of a couple of things. CVS is hugely into Minute Clinics and Health Hubs. Walgreens has a big relationship with Village MD for clinics. Walmart's doing kind of doing the same thing. So a one-stop-shop. You can go make an appointment in a Minute Clinic, go see them and then pick up a prescription at the same time. So, I think it really goes to the trend of trying to treat people closer to home.