The Use of Medicines in the US

Key findings in the report:

必威手机APP卫生服务利用指数在19号期间

• During the first quarter of 2021, the use of key health services – as measured by the IQVIA Health Services Utilization Index - was at 82% of pre-COVID-19 levels, up from a low of 42% at the peak of the first wave of the pandemic in April 2020.
• Elective procedures were only 15% of normal at the peak of the lockdowns in spring 2020 and have returned to 80%, but delayed procedures range from hip and knee replacements to procedures which are scheduled (rather than as emergencies) but are generally not seen as optional.

药物使用

• 在2020年，在调整了增加90天的长期疗法处方处方后，总共分配了63亿个处方，增长速度减慢至1.7％。

Medicine Spending and growth drivers

• U.S. medicine spending increased 0.8% on a net price basis to $359 billion, which reflects an increasing gap between list or invoice prices and manufacturer net revenues.
• Real net per capita spending – adjusting for net prices, population, and economic growth – declined in 2020 to $1,085 and has increased only $56 since 2010. •现在，特种药物占支出的53％，高于2010年的27％，受到自身免疫和肿瘤疗法的增长驱动。

Patient Out-of-Pocket Costs and Affordability

• 所有患者的自付费用（包括零售处方和非零售药物）在2020年增加了10亿美元，达到了创纪录的770亿美元。
• Patients without insurance coverage paid $25 billion for prescriptions, 97% of which were for generic medicines. •在过去的五年中，这些现金付费患者的票房总成本增加了46％；在所有类型的保险中，每零售处方的平均支付金额从2015年的10.33美元下降到2020年的9.81美元，主要反映了较低的通用成本。

前景到2025年

• 医学上的净支出预计将在2025年达到3800亿美元，高于2020年的3590亿美元，反映了复合年增长率为0-3％。
• New brand launches are expected to continue at record levels, and the 50-55 new active substances forecast to be launched per year will contribute about $133 billion in spending growth through 2025, slightly higher than the past five years.
• Net prices for protected brands are expected to decline between 0 and 3% per year through 2025, reflecting more intense competition between manufacturers and aggressive negotiations by payers.

图表2：卫生服务利用率必威手机APP指数和2020年基线的组件度量百分比

• Doctor visits- including office, institutional and telehealth – have rebounded strongly to an index of 91 relative to pre-pandemic baseline, the highest of the overall index components but still below prior levels and not yet making up the backlog in healthcare engagement that was created.
• Diagnostics and screening tests are often a part of a treatment sequence, starting with a visit and ultimately resulting in a procedure or drug therapy for many, and the gap in these tests from pre-pandemic levels allows risks for missing a cancer diagnosis or other such screening result.
• Elective procedures were largely stopped in the peak of the shutdowns from COVID-19, dropping to 15% of normal, but have since recovered to 80% nationally, though some states have begun to have above baseline levels.

图表13：独特的治疗患者，用于选定疾病2020年，数百万

• Millions of Americans have a diagnosis and treatment for disease during the year, led by hypertension, with 76 million patients having filled at least one prescription in 2020, up 1.7% from 2017.
• 流感 - 季节流感 - 有更多的诊断，导致2020年治疗，但这主要是由于疫苗接种率高，因为在2020/2021流感季节中季节性流感较大，比以前几年低。
• 在过去的四年中，失眠症的患者下降了7.7％，从2020年的820万人转移到640万，尽管有报道称许多人在大流行期间遇到难以入睡，但在2020年下降了四分之一。没有大流行，2020年的下降将会更大。
• 在过去的3年中，每年平均每年增加2.6％的肿瘤学患者，但2018年的增长3.6％，2019年为3.5％，在2020年，随着癌症筛查和治疗的延迟延迟诊断或减慢诊断，2020年的增长率为0.8％与较早检测到的癌症相比，有可能使数千种更糟糕的预后风险。

• 自2010年以来，根据人口增长调整的医学支出，对人口增长进行了调整，并以目前的（2020年）的价格显示了56美元。
• Real net per capita spending declined by 2.7% in 2020 as a result of the economic impact of COVID-19, while net growth of 0.8% was only slightly above reported population growth.
• 超过10年，人均净支出平均每年增长0.5％，但截至2019年的趋势为0.9％。
• Specialty share of net spending across institutional and retail settings rose from 27% in 2010 to 53% in 2020, driven by innovation, and the declining share for traditional medicines as growth has slowed due to patent expiries.

Exhibit 29: Wholesaler Acquisition Cost (WAC) Growth and Net Price Growth for Protected Brands

• 受保护品牌产品的列表价格（这些产品在推出尚未失去专利保护后两年多）在2020年上涨了4.4％。
• 净制造商价格 - 所有折扣和折扣后的药品成本 - 在2020年下降了2.9％，在过去五年中持续了下降趋势，在2019年中断。
• 美国卫生系统中不同利益相关者支付的价格在不同程度上取决于他们谈判或接受的折扣和折扣，并且不统一地适用必威手机APP于各方。
• 大多数折扣都提供给批发商和药房，并不一定会导致患者的自付费用较低。

Exhibit 39: Aggregate Patient Out-of-Pocket Cost for Medicines Dispensed in Retail and Non-retail Settings, US$Bn

• 所有患者的自付费用（包括零售处方和非零售药物）在2020年增加了10亿美元，达到了创纪录的770亿美元。
• 没有保险覆盖的患者为处方支付了140亿美元，其中97％用于仿制药。
• Patients with Medicare Part D or high-deductible private health plans have seen individual prescription costs rise in line with the rising list prices of drugs but be offset by the Medicare “donut hole” subsidy program or the use of coupons, respectively.
• 随着自付费用的上涨，商业保险患者的优惠券在2020年达到140亿美元，包括使用制造商向合格患者发行的预付借记卡。

图表49：美国医学支出和增长在发票级别和估计的净收入2011–2025

• 预计2025年的药品净支出预计将达到380-400亿美元，高于2020年的3590亿美元，包括所有渠道和产品类型的支出。
• 在接下来的五年中，医学支出将在发票的基础上增长2-5％，在发票折扣和折扣后的0-3％之间增长了0-3％。
• 通过采用新推出的创新产品，增长将驱动，预计将在过去五年中平均每年推出50-55种新药，包括肿瘤学或专业或专业或专业或孤儿状态。