2013 favored specialists, specialty Rx

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JAMA studies look at FDA rejections and approvals
Per-capita prescription spending rose 1% in 2013

The latest IMS Institute for Healthcare Informatics assessment of 2013's prescription drug use is full of exclamation-point data points, such as 10% of the year's 3.6 billion written prescriptions don't go home with patients, and that coupons can lower branded medication costs from $50 or $75 to $5.

For readers with an interest in specialty medications, 2013 spending grew 11% to $73 billion for conditions that include cancer, hepatitis C and autoimmune diseases.

Yet the overall takeaway from IMS's 2013 retrospective is that the pharmaceutical industry has a way to go if it considers pre-recession sales figures the number to beat. One reason: real, per-capita prescription spending rose 1% in 2013—not nearly enough to compensate for the year before, when real per-capita spending fell 3.5%.

Another data point of note is that the growth was due to a combination of fewer cash-gutting patent expiries, higher drug prices and growth centered on innovations, such as Hepatitis C treatments and oncology.

Further, IMS found that prescription use among patients 65 and older—the largest per-capita users—fell, and that patients 80 years and up used 2% fewer medications last year than they did two years ago, even though they make up the majority of patients will full medicine cabinets.

Moving beyond even the 2007 recession, researchers note “when measured in 2005 dollars and adjusted for population growth, medicine spending has been growing at historically low levels for the last decade.”

In terms of the patient, versus the pharmaceutical experience, IMS notes that patients visited doctors more frequently in 2013 than they did in 2012, but primary care physicians did not see the impact of this first bump in four years. Instead, researchers note that patients gravitated towards specialists, and that adults continued to stay away from PCP offices for the fourth year in a row.

At the same time, researchers found that 20% of insured patients are covered by consumer-directed healthcare plans, which have a high deductible before patients begin to share costs with insurers. IMS also notes that deductibles were 150% higher than they were in 2012.

Further, IMS found that 38% of workers with employee-sponsored coverage—CDHP or otherwise—have deductibles that are higher than $1,000.

In terms of how these patient factors play out within the pharmaceutical industry's experience, IMS found that 2.3% of prescriptions were “often high-cost specialty medicines," or covered by seniors struggling with Medicare Part D's donut hole. Either way, IMS said this medication subset represented 30% of patient medication costs.

For those wondering where generics, the bane of the 2012 patent cliff and brand names fared, the category accounted for 86% of last year's dispensed medications, increasing the US spend by $5.8 billion in 2013.

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