Six things you need to know about prescription drug use and spending

Dispensing statistics in 2018

• 5.8 billion prescriptions were dispensed in 2018, a 2.7 percent increase over 2017.

• 7.5 million patients began new medication therapies in 2018, a 40 percent increase over 2017.

• Total patient out-of-pocket costs for medications (excluding coupons) were about $61 billion in 2018.

• The volume of opioids prescribed in 2018, measured in morphine milligram equivalents (MMEs), dropped by 17%, due largely to changes in regulations and clinical guidelines and increased public awareness of opioid addiction.

Trends in prescription medication usage

• The top 10 traditional therapy areas (e.g., antihypertensives, mental health, pain) made up 97.8 percent of prescriptions in 2018.

• Prescription adherence rates rose across all geographic regions and types of payers (Medicare, Medicaid, commercial) between 2016 and 2018.

• Prescriptions for specialty medications-used to treat chronic, complex or rare diseases-increased by 5 percent to 127 million between 2017 and 2018.

• The overall rate of generic dispensing, where it’s possible to do so, has been at 97 percent since 2013.

Medicine spending and growth dynamics

• In 2018, spending on medicine grew by 4.5 percent after accounting for off-invoice discounts and rebates, while spending at the invoice level increased by 5.7 percent.

• Per-capita spending on medicine has grown by $44 since 2009, after adjusting for population growth and inflation.

• Spending on new drug brands was $11 billion in 2018, compared with $12 billion in 2017. Spending in 2018 reflected the launch and uptake of about 60 new active substances.

• Net spending on biologics was $125.5 billion in 2018, a 9.5% increase over 2017.

Opioid prescribing and use

• The volume of opioids prescribed dropped by 29.2 billion MMEs in 2018, or 17.1 percent, the largest single-year decline ever.

• The number of annual opioid prescriptions declined from 244.5 million to 169 million between 2014 and 2018, while medication-assisted treatments increased from 11 million to 16.2 million.

• Adult per-capita MME use peaked at 768 in 2011, and has since declined to 432 MMEs.

• Prescription drug monitoring programs are now in place in 49 states, which has significantly limited prescribing of high doses of opioids.

Patient out-of-pocket costs

• Overall out-of-pocket costs rose by 3.3 percent in 2018, from $59 billion to $61 billion.

• 8.8 percent of all insured patients pay more than $500 in out-of-pocket costs for prescription medications annually, but among those covered by Medicare 19.8 percent pay that amount.

• Coupon spending among patients with commercial insurance was $13 billion in 2018, an all-time high and an 18 percent increase over the previous year.

•  The final average out-of-pocket costs, including brand-name drugs and generics, was $9.05 in 2018, compared with $9.28 in 2017.

Outlook to 2023

• Net total spending on medicines is expected to be in the range of $405 billion-$435 billion.

• Net total spending growth will average between 3% and 6%.

• The number of expiring patents on medications will steadily increase, peaking in 2023 when protected brands will lose $33 billion due to patent expirations and associated competition.