The novel coronavirus (COVID-19) continues to raise more questions about the future than it does answer. Yes, the overall rate of new cases throughout the country continues to decrease and the number of Americans receiving vaccinations continues to increase, but the rate of vaccinations is not as high as anticipated. Variant strains continue to spread and, as a result, experts remain unsure about the potential for another spike.

What’s less debatable is the reliance that those in healthcare, including the pharmaceutical industry, will have on data collection and analytics when attempting to identify issues in the marketplace and predicting trends. With more successful approaches to data connections, industry professionals will uncover opportunities with greater insights to make more informed and confident decisions. During the recent virtual Fusion 2021 Connected Intelligence Conference, we examined the market’s prominent challenges, trends, and outlooks.

Diagnosis Claims and Prescription Demand: The Significance of Telehealth

• View a short video clip from Doug's presentation.

Demand versus supply begins with diagnosis claims and the prescriptions they produce. Diagnosis claims, of course, begin with office visits. In 2020, there were one billion fewer patient visits than the industry would normally expect, a 21% decline. Big gaps in oncology, gastroenterology, and dermatology were especially notable. Drops in oncology visits are particularly troubling when considering missed diagnoses.

During the pandemic, the use of telehealth for primary care has grown to 35 million visits, peaking in April at 18% of claims and representing 11% of total claims currently. Still, telehealth health does not generate as many prescriptions because:

• There is less time spent face-to-face
• There are no “onsite” labs or recording of vitals to assist diagnoses
• There is reluctance to generate new therapies.

Of those products that launched, aside from COVID-19 drugs, 37% were in oncology, with the next biggest splash being the central nervous system and infectious diseases, both at 10%, and diabetes at 5%.

Looking beyond 2021, there is reason to believe numbers for diagnosis claims will improve, but the expectation is that the numbers will remain approximately 12% less than a “normal” year as telehealth finds its proper place in the alignment of traditional services ongoing.

Flat Line on Cold and Flu Season: Impact on Prescriptions Throughout the Continuum

• View a short video clip from Doug's presentation.

The financial effects of COVID-19 are most evident today. There have been approximately 111 million fewer prescriptions written than is typical, which can be traced to the lack of a cough-and-cold flu season. Pediatricians themselves are down almost 50% of normal prescription expectations. Children simply haven't been sick because fewer are attending schools or other care settings, and those who are in attendance are wearing masks and probably washing hands more frequently.

From the retail “patient” perspective, there were 106 million “seen” in January 2020 before that number dropped to about 92 million in April and May. A bounce-back occurred in the fall thanks to flu vaccinations while recently, the COVID-19 vaccines have increased traffic in retail pharmacies. Overall, acute prescriptions have seen significant declines because of the lack of physician visits during lockdowns and the absences of the flu season. However, most “maintenance prescriptions” and refill prescriptions have trended above 2020 and 2019 throughout 2021.

Retail acute prescription volume is now above where it had been in the previous two years because of the vaccines, but it is traditionally cough, cold, and flu that should contribute to most acute prescriptions. Acute prescriptions are also less likely to be delivered via mail ordering, and the retail mail category is now stronger than non-retail. Expanding on channels of distribution, the most favorable trend on the retail side has been food markets, where one-stop shopping is now the norm, while mass merchandisers have trended down the most.

Prescription categories that are down include pain, as more focus is placed on controlled substances, and antibacterial in absence of flu. Growth has been seen in drugs for hypertension, mental health, lipid regulation, diabetes, respiratory, and anticoagulants — in many cases due to the “other” health complications brought on by the pandemic.

When considering market branded versus unbranded generic, the brand is growing at 7.2% while unbranded is down 7.1%. There has been some price deflation going back into the unbranded generic category in 2021, but with the issues being faced in India, more inflation could be headed into the marketplace on unbranded generic.

A secondary impact affecting pharmacies today is the increase of 90-day prescriptions versus 30 days due to stockpiling. With an adjusted view of prescriptions, we can take a 90-day script and equate it to three 30-day prescriptions. The data on the adjusted numbers hold up better than the unadjusted numbers, when viewing outside the lens of dollar signs, which is good news for the marketplace.

The Truth About Drug Adherence and Vaccinations

• View a short video clip from Doug's presentation.

Adherence is measured by how much medicine a patient possesses. As such, the shift to 90-day prescribing creates better adherence rates. Using diabetes as an example, adherence is now 72.3% better than the previous year. Adherence for 90-day scripts overall is 80% compared to 50%for non-90 scripts.

Historically speaking, retail has distributed record numbers of vaccines, but with the shutdown of businesses and places of employment, vaccine traffic has come in at unsustainable levels despite potential customers choosing not to be vaccinated.

As of June 2021, the U.S. has still not reached 50% inoculation, and it can be assumed that those ages 65 and older who have not been vaccinated are by and large choosing not to. The temporary pause of the single-dose Johnson & Johnson vaccine has certainly played a role here, but it could realistically be argued that the rate of side effects was small enough that there should have been no pause.

The past year has certainly presented its challenges, especially to those in the healthcare ecosystem. If you missed the 2021 U.S. Pharmaceutical Market: Trends, Issues, and Outlook session from Fusion 2021 Connected Intelligence, click here to watch on demand as well as catch up on our other great sessions!