2024年美国药品使用情况：使用和支出趋势以及2028年展望报告（英文版）-IQVIA艾昆纬

IQVIA

NSTTUTEFORHUMANDATASCIENCE

TheUseofMedicinesintheU.S.2024

USAGEANDSPENDINGTRENDSANDOUTLOOKTO2028

APRIL

2024

Introduction·

TheU.S.emergedfromtheCOVID-19pandemicin2023andhealthcaresystemsadjustedtothelonger-termconsequencesontheutilizationofhealthservices,

medicineuse,andtotalexpenditureonvaccinesandtherapeutics.Asweexaminethepastyearandlooktothefuture,newareasofinterest—mostnotably

treatmentsforobesityandtheimplementationoftheInflationReductionAct

–havecometotheforeandcommandattention.Atthesametime,spending

trendshavedemonstratedaresiliencetothebroadermacroeconomictrendsandacceleratedtolevelsnotseeninnearlyadecade,maskedbythedecliningvolumeandspendingonCOVID-19vaccinesandtherapeutics.

Thisannualtrendreportispartofacontinuedeffort

toadvanceourcollectiveknowledgebyproviding

evidence-basedresearch,whichcanhelpestablishacommonfoundationfordiscussionandunderstandingbyallstakeholders.Itisintendedtocontributetotheadvancementofhealthinasystemthatremainshighlyfragmentedandopaque.

Areasoffocusinthisyear’sreportrangefromlookingathealthsystemutilizationanditsrecoveryfromthe

pandemic,tohowmedicineusagepatternshaveshifted,tothecomplexnatureofdrugpricing,totheimpactofout-of-pocketcostsonpatients.Dynamicsthathave

becomeapparentduring2023havedrivensignificantrevisionstotheoutlook,andinthisreportthedriversofchangeinmedicinespendingoverthenextfiveyearsaredeconstructedtoenablebetterunderstanding.

Thisexaminationincludestheimpactofbiosimilar

introductionsaffectingthesinglebiggestsellingdrug

intheU.S.,andtheuptakeofothernewmedicinesthataspiretobesuccessorstothattopspot.

Thisstudywasproducedindependentlybythe

IQVIAInstituteforHumanDataScienceasapublic

service,withoutindustryorgovernmentfunding.ThecontributionstothisreportofMohitAgarwal,Allen

Campbell,RuthyGlass,LukeGreenwalt,UrvashiPorwalandmanyothersatIQVIAaregratefullyacknowledged.

FindOutMore

IfyouwishtoreceivefuturereportsfromtheIQVIA

InstituteforHumanDataScienceorjoinourmailinglist,visit.

MURRAYAITKEN

ExecutiveDirector

IQVIAInstituteforHumanDataScience

REFERENCINGTHISREPORT

Pleaseusethisformatwhenreferencingcontentfromthisreport:

Source:IQVIAInstituteforHumanDataScience.TheUseofMedicinesintheU.S.2024:UsageandSpendingTrendsandOutlookto2028.April2024.Availablefrom

©2024IQVIAanditsaffiliates.Allreproductionrights,quotations,broadcasting,publicationsreserved.Nopartofthispublicationmaybereproducedor

transmittedinanyformorbyanymeans,electronicormechanical,includingphotocopy,recording,oranyinformationstorageandretrievalsystem,withoutexpresswrittenconsentofIQVIAandtheIQVIAInstitute.

TheUseofMedicinesintheU.S.2024:UsageandSpendingTrends,andOutlookto2028

TableofContents+—

Overview4

Healthservicesutilization6

Medicineuse12

Patientout-of-pocketcosts26

Medicinespendingandgrowthdrivers42

Outlookto202859

Notesonsources70

Methodologies72

References74

Abouttheauthors76

AbouttheInstitute77

Overview

HEALTHSERVICESUTILIZATION

TheIQVIAHealthServicesUtilizationIndex–anindexdevelopedtoprovideacompositeviewofmultiple

typesofhealthservicesovertime-trackspatientvisits,screeningsanddiagnostictests,electiveprocedures,newprescriptions,andvaccinations.TheIndexfell

to97for2023,adeclineof3%from2022,reflectinga4-6%reductionacrossallindicatorsexceptfornewprescriptions,whichwereup4%.

Newprescriptionsforchronicandacuteconditions

werebothabovepre-pandemiclevelsin2023,reflectingcontinuedgrowthofchronicprescriptionsanda

resurgenceofseasonalrespiratoryailmentsdriving

higheracuteprescriptions.Fluvaccinationratesfellby17%fromthe2022levelandotherroutineadultand

pediatricvaccinationratesremainbelowpre-pandemiclevels,althoughadultvaccinationrateshaveimprovedsince2021.

MEDICINEUSE

In2023,totalprescriptionmedicineuseincreased

by3%andreached210billiondaysoftherapy.Non-

retailmedicineuse,includingalargeportionofcancer

treatment,wasdisruptedearlyinthepandemicbuthasseenasharprise,especiallyinclinicsanddoctor’soffices.Retailprescriptionsreached6.9billion,a2.9%increasefrom2022butslowergrowththantheprioryear.

Shiftingenrollmentpatternsforinsurancein2023

resultedinmorepatientscoveredbycommercial

insurance,whileMedicaidenrolleesandtheuninsured

declined.BothMedicareandMedicaidsawrising

averagenumbersofprescriptionsperenrollee,whilethecommercially-insuredandtheuninsuredhadflattodecliningusageperbeneficiary.

Manytherapyareashadhighgrowthindaysoftherapyin2023,includingGLP-1agonistsinobesityand

diabetes,immunologytreatments,lipidregulators,and

gastrointestinalmedicines,allofwhichhadincreased

useofmorethan9%in2023.Antibacterialusecontinuedtogrowin2023to2.6billiondaysoftherapy,returningtopre-pandemiclevels.Percapitaprescriptionopioid

usehasdeclinedtolevelslastseenin2000.Traditional

contraceptionmethodsdeclinedinuse,whileon-

demandandpermanentsurgicaloptionsincreased.

PATIENTOUT-OF-POCKETCOSTS

Patientout-of-pocketcostsinaggregatereached$91Bnin2023,anincreaseof$5Bnovertheprior.Thisamountisafter$23Bnincopayassistanceprogramsprovidedbymanufacturers,withpatientsusingcopaycardsfornearlyone-thirdofbrandcommercialprescriptions

inthetop10therapyareasand63%ofobesity

prescriptions.BothcommercialandMedicarepatientshaveseendrugout-of-pocketcostsrise,whilethe

amountpaidbyuninsuredpatientshasdeclinedduetoasmalleruninsuredpopulationevenasrisinglistpriceshaveexposedthemtohighercosts.

Morethanr90%ofprescriptionscostpatientslessthan$20,but1%,or71millionprescriptions,exceed$125.

Medicarepatientsweremorelikelytoreachannual

out-of-pocketcostsover$2,000thanotherpatientsin2023.Annualout-of-pocketcapsinMedicarePartDsettogointoeffectin2025couldsave1.2millionpatientsmorethan$1,900onaverageifpatternsofdruguse

aremaintained.Dueinparttohighout-of-pocketcosts,98millionnewtherapyprescriptionswereabandonedin2023,andforrecentlylaunchedmedicines,morethanhalfofnewprescriptionsarenotfilledbecauseofhighcostsandpayercontrol.

Theaverageout-of-pocketcostperretailprescription

increasedin2023,drivenprimarilybyhigherbrand

costsforGLP-1agonistsindiabetesandobesity.Insulincostshavedecreased,yetpaymentsabove$35arestillcommonand$35monthlyout-of-pocketcapswouldsaveanadditional$270millionforpatients.

4|TheUseofMedicinesintheU.S.2024:UsageandSpendingTrends,andOutlookto2028

Spendingincreasedby9.9%in2023withouttheimpactofdeclining

COVID-19vaccinesandtherapeutics.

MEDICINESPENDINGANDGROWTHDRIVERS

TheU.S.marketatnetpricesgrewto$435Bnin2023,

anincreaseof9.9%whenthedeclineinCOVID-19

vaccinesandtherapeuticsisexcluded.Thisrepresentsasignificantaccelerationinspendinggrowthdriven

byinnovationandashiftinthemixofuseofolder

medicinesthatisbringingbettermedicinestomore

patients.SpendinggrowthincludingCOVID-19vaccinesandtherapeuticsslowedto2.5%asthemarketforthesemedicinesfellsharplyin2023.

Spendingatlistpriceshasincreasedfasterthanall-payernetspendingbutfarslowerthanthespendingeligible

for340Bdiscounts,whichincludeschildren’scancer,andsafetynethospitals,andwhichareentitledtopurchaseatthelowestpricesinthemarket.Variationsingrowthatdifferingpricelevelshighlightthecomplexinteractionbetweenlistpricesandthevarieddiscountsapplicabletodifferentstakeholders.

Specialtymedicinesaccountfor54%ofspending,upfrom49%in2018,drivenbygrowthinimmunologyandoncology,whiletraditionaltherapieshavegainedsharerecentlyfromrisingspendindiabetes,obesity,andvaccines.

Themedianannualtreatmentcostofnewmedicines

exceeded$150,000forthecohortof2023launches,withthoseforoncologyandrarediseasesbothapproaching$300,000perpatient,althoughmosthigh-costtherapiestreatsmallpatientpopulations.

Totalspendinggrew$10.4Bnin2023,drivenprimarily

by$19Bninspendingonnewbrands,a$22Bnimpact

onchangesinthemixofmedicinestowardhighervalue

medicines,andoffsetbya$28BndeclineinCOVID-19

spendingand$17Bnimpactofexpiries.Protectedbrandnetpricesincreased3.0%,notincludingthesignificantnetpricereductionsforoff-patentbrandssuchasadalimumab(Humira).Volumeuptakeforbiosimilarshasaveraged

morethan50%ofthetotalmarketwithinthefirstyearbuthasbeenhighlyvariedandmostnotablyonlyreached2%ofvolumeforadalimumabattheendof2023.

OUTLOOKTO2028

TheU.S.spendingforecastreflectscontinuedgrowth

drivenbyinnovation,offsetbynotableexpiryevents.Thenextfiveyearsareexpectedtobringanincreasinggapbetweenlistpricespending,whichwillgrowat6–9%,

andmanufacturernetrevenues,whichwillgrowat4–7%,includingtheexpectedimpactsofpricenegotiationandotheraspectsoftheInflationReductionAct.

NewbrandspendingintheU.S.isprojectedtototal

$122Bnoverthenextfiveyears,downfromthe$149Bn

intheperiod2018–23.Netpricesforprotectedbrands

areforecasttodecline-1to-4%.Theimpactofexclusivitylosseswillincreaseto$93.6Bnoverfiveyears,includingsignificantcontributionsfromnewbiosimilars.

Oncologyandobesitywilldrivegrowththrough2028

whilediabetes,immunologyandCOVID-19contributetoslowing.Obesitydrugspendinghasacceleratedinthepasttwoyearsfromnoveldrugs,withfurtherupside

ifavailablemedicinesaremorewidelyreimbursed.

Netspendingondiabeteswillbeflatto2028aswider

adoptionofnoveltherapiesisoffsetbybothlistandnetpricecuts.Immunologyspendinggrowthisexpected

toslowto2–5%through2028fromtheimpactof

biosimilars,whilevolumeincreases75%overthesameperiod.Next-generationbiotherapeutics—includingcellandgeneandRNAtherapies—areexpectedtoreach

$18Bnby2028,morethan3.5timesthecurrentlevel.

|5

Healthservicesutilization

•TheHealthServicesUtilizationIndexintheU.S.in

2023was97,asutilizationfell3%below2022levelswithfewervisits,screeningsanddiagnostictests,electiveprocedures,andvaccinations,offsettoadegreebymorenewprescriptions.

•Telehealthvisitsaccountedforlessthan1%ofvisits

priortothepandemic,roseto26%inApril2020attheheightofthepandemic,anddeclinedto5%in2023,suggestingalargerroleoftelehealthpost-pandemic.

•Newandcontinuingchronicprescriptionswere3–4%higherin2023thanpre-pandemiclevels,andacuteprescriptionsgrewto4%above2019levels,drivenbythereturnofhistoriclevelsofseasonalrespiratory

illnessesfollowingsignificantdisruptionthroughoutthepandemic.

•Influenzaactivityinthecurrent2023–2024seasonis22%belowlevelsfromlastyearandpeakedinJanuary,morecloselyalignedwithinfluenzaseasonsfroma

decadeago,whilefluvaccinationsdeclined17%.

•Adultvaccinationrateshaveshownimprovementsince

2021whilepediatricrateshaveremainedflat,althoughbothremainbelowpre-pandemiclevels.

Overallhealthcareutilizationin2023was3%below2022levels,asallindicatorsdeclinedexceptnewprescriptions.

6|TheUseofMedicinesintheU.S.2024:UsageandSpendingTrends,andOutlookto2028

HEALTHSERVICESUTILIZATION

HealthservicesutilizationintheU.S.in2023wasbelow2022levelsacrossallmetricsexceptnewprescriptions

Exhibit1:OverviewofHealthServicesUtilizationIndex

95

94

Office,institutionalandtelehealthvisits

Health

Services

Utilization

Index

97

2023

Screeninganddiagnostictests

Electiveprocedures

95

Newprescriptions

104

96

Baseline100=2022value

Adult,pediatric,andfluvaccinations

Source:IQVIAInstitute;IQVIAMedicalClaimsData;LAADPrescriptiondata,weekending12/29/2023.

•ThelevelofutilizationinthehealthsystemiscriticaltoensureallAmericansreceivethepreventiveandtreatmentservicestheyneed.

•AHealthServicesUtilizationIndexhasbeencreated

andincludesfiveessentialcomponentsofahealth

systemandmeasurestheirutilizationagainstthe

prioryeartounderstandchangesinhealthcareandpotentialgapsincare.

•Thefiveindexcomponentsareequallyweighted,andforeachcomponent,ascoreof100orhigherindicatesequivalentorhigherlevelsofutilizationcomparedtotheprioryear,includingelectiveprocedures,doctorvisits(face-to-face—office,hospitalorclinic—orviatelehealth),diagnosticlabtests,newbrandorgenericprescriptionsfilled,androutinevaccinations(adult,

pediatric,andflu).

•In2023,theoverallutilizationindexwas97,indicatingadeclineinaverageutilizationacrosstheindex

componentsof3%comparedto2022despiteU.S.populationgrowthof0.5%.1

•Newprescriptionswere4%abovebaselinein2023,howeverroutinevaccinationsweredown4%,visits

andelectiveproceduresweredown5%,andlabtestsweredown6%.

•Declinesacrossthesemetricscouldreflectdecliningpatientengagementoranoverburdenedhealth

systemleadingtodelaysincare,bothconcerningwhenitcomestotreatingandpreventingillnesses.

Notes:Eachcomponentoftheindexcompares2023levelsto2022levelsandthecomponentindicesareaveragedfortheoverallutilizationindex.Adultandpediatricvaccinesareroutinevaccinesonly(seeExhibit5)anddonotincludetravel,COVID-19,andRSVvaccines.NewprescriptionsexcludeallvaccinesandCOVID-19therapeutics.

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HEALTHSERVICESUTILIZATION

Telehealthvisitsaccountedfor5%ofvisitsin2023,downfrom26%inApril2020butupfrom<1%pre-pandemic

Exhibit2:Shareofvisitsface-to-facevs.telehealth,2020–2023

100%

90%

80%

70%

60%

Face-to-face

Source:IQVIANationalMedicalandTreatmentAudit,Dec2023.

Telehealth

•Thepandemiccausedshiftsinhowpatientsreceivedcare,astelehealthvisitswereusedtocontinueto

providepatientcarewhilelimitingthespreadofCOVID-19.

•Telehealthvisitsaccountedforlessthan1%ofvisits

priortothepandemic,roseto26%inApril2020attheheightofthepandemic,anddeclinedto5%in2023.

•Telehealthhasdifferingutilizationacrosstherapyareasassomeconditionsmaybemorereadily

addressedthroughavirtualinteractionandothers

mayrequireanin-personphysicalexamination.

•TheSouthandMidwesthavelowerutilizationof

telehealthat4%ofvisitscomparedto6%and7%intheNortheastandWest.Thiscouldbeimpactedbyaccesstobroadbandinternet,whichislowerinrural

communitiesandtheSouthhasthelowestrateofruralbroadbandaccess.4

•Subscription-basedtelehealthservices,suchasHims&HersHealth,Ro,andBetterHelp,arepaidforby

patientsout-of-pocketanddonotresultinmedicalclaims,potentiallyleadingtoanunderestimateoftheoverallimpactoftelehealthonthehealthsystem.

•Telehealthvisitsaremoreoftenusedbythosewith

anxietyordepression,2,3asvirtualappointmentscanmakementalhealthcaremoreconvenient

andaccessible.

Notes:Basedonunprojectedpre-adjudicatedmedicalclaims.

8|TheUseofMedicinesintheU.S.2024:UsageandSpendingTrends,andOutlookto2028

HEALTHSERVICESUTILIZATION

Newandcontinuingchronicprescriptionswere3-4%higherin

2023thanpre-pandemiclevels

Exhibit3:Annualdispensednewandcontinuingprescriptionsbytherapytypeindexedto2019levels(2019=100)

110

100

90

80

NBRxchronicNBRxacute

TRxtotal

CBRxchronic

20192020202120222023

Source:IQVIANationalPrescriptionAudit:NewtoBrand,Dec2023.

•Newtobrandprescriptions(NBRx)arethosewhere

thepatientisnewtothemedicineinthepastyear,andthesehavegrownoverthelastfiveyearsfollowing

pandemicdisruptions.

•Patientsstartingchronictherapiesslowedin2020,

falling6%buthavesincerebounded,andnewchronicprescriptionswere4%abovebaselinein2023.

•Acuteprescriptionsweresignificantlydisrupted

throughoutthepandemic,dropping16%in2020asrespiratoryillnessesdeclinedsignificantlydueto

publichealthmeasuresinplacetoreducethespreadofCOVID-19.

•Asignificantrespiratoryillnessseasonlatein2022

andearly2023resultedinanincreaseinacute

prescriptions,andacuteprescriptionswere4%abovebaselinein2023.

•Chroniccontinuingprescriptionshaveremained

relativelystablesince2019andwerelargely

unaffectedbythepandemic,growingto3%abovebaselinein2023.

Notes:Prescriptionsareunadjusted.NewtoBrand(NBRx)prescriptionsarethosewherethepatienthadnoprescriptionofthemedicineintheprioryear

andincludesnaïvepatientsaswellasthosewhoswitchfromanotherdrugoraddanewdrugtotheirexistingregimens.Continuingprescriptions(CBRx)arethosewherethepatienthasfilledaprescriptionofthesamemedicineinthepastyearandcanincludegapsindispensing.Chronicisdeterminedaswhetherthemedicineisgenerallyintendedtobeprescribedformorethan180-days,andacuteareallothermedicines.Chronicandacutearenotspecificpatientorprescriptionattributesanddonotreflectthepotentialforsomemedicinestobeusedonalong-termbasisagainstrecommendations.ExcludesallvaccinesandCOVID-19therapeutics.

|9

HEALTHSERVICESUTILIZATION

ThecurrentfluseasonpeakedinJanuarywithcasesandfluvaccinationsdownfromthepriorseason

Exhibit4:EstimatednumberofU.S.influenzacasesandtotalfluvaccinations

10

Estimatednumberofinfluenzacases(Mn)

8

6

4

2

Aug-12

Aug-26

Sep-9

Sep-23

Oct-7

Oct-21

Nov-4

Nov-18

Dec-2

Dec-16

Dec-3

Jan-13

Jan-27

Feb-10

Feb-24

Mar-9

Mar-23

Apr-6

Apr-20

May-4

May-18

Jun-1

Jun-15

Jul-29

Jul-13

Jul-27

0

2022–20232023–20242012–2022

3Ssnavg(2016/17,2017/18&2018/19)

Fluvaccinationsperseason(Mn)

163

-17%

146

135

140

117

2019–2020

2020–2021

2021–2022

2022–2023

2023–2024

Influenzaseason

Source:IQVIAConsumerHealthFAN,weekending2/17/2024;IQVIANationalSalesPerspective,Jan2024;IQVIAInstitute,Mar2024.

•DuringtheCOVID-19pandemic,publichealth

measuresreducedthelevelsofinfluenzaintheU.S.;

however,influenzaactivityreturnedtohistoriclevelsin

the2022–2023influenzaseason,whichpeakedearlierthanhistoricseasons,butoverallcasesfortheseasonended2%belowthehistoricthree-seasonaverage.

•Influenzaactivityinthecurrent2023–2024seasonis22%belowlevelsfromlastyearandmorecloselymirrorsinfluenzaseasonsfromadecadeago.

•Althoughoverallestimatednumbersofinfluenzacaseshavereturnedtohistoriclevelsinthetwomostrecentseasons,changesinseverity,seasonalpatterns,andconcurrentincreasesinotherrespiratoryillnesses

(e.g.,COVID-19,RSV)canoverwhelmthehealthsystemandshouldbemonitoredcloselywithprecautions

takentolimitthespread.

•Influenzavaccinationsgrewsignificantlyduringthepandemicduetoconcernsofmultiplecirculating

respiratoryviruses,withvaccinationspeakinginthe2020–2021seasonatmorethan160million.

•Vaccinationshavesincecontinuedtodeclineand

dropped17%inthecurrentseasoncomparedtothe

priorseasonandare14%belowpre-pandemic–a

concerningtrendasinfluenzavaccineshaveshown

effectivenessatreducingtheriskofsevereinfluenzaandarethebesttooltopreventinfluenzaandpotentialseverecomplications.5

Notes:IQVIA’sFAN(Flu/Cold/RespiratoryActivityNotificationProgram)modelingdrawsonacombinationofdiagnosticsinformationfromoffice-based

medicalclaims,prescriptionclaimsfromretailpharmacies,anddeliveriesofover-the-countermedicationstoestablishestimatesofdiagnosedandtreatedpopulations.Fluvaccinationsincludethosedistributedthroughbothretailandnon-retailchannelsanddonotreflectreturnsorunusedproduct.

10|TheUseofMedicinesintheU.S.2024:UsageandSpendingTrends,andOutlookto2028

HEALTHSERVICESUTILIZATION

Bothadultandpediatricvaccinationsremainbelowpre-pandemiclevels,despiteimprovementinadultratessince2021

Exhibit5:Numberofvaccinesgivenannuallyforselectedvaccinesbyagegroup(Mn),2019–2023

PediatricAdult

-13%

64

55

56

55

55

-6%

52

49

46

44

39

2019202020212022202320192020202120222023

Source:IQVIANationalSalesPerspective,Dec2023;IQVIAInstitute,Mar2024.

•Routineadultandpediatricvaccinationsshownhereonaveragerepresent99%ofallvaccine

(excludinginfluenza,COVID-19,andRSVvaccines)volumeintheU.S.,withtheother1%ofvolume

composedoftravelvaccines.

•Annualpediatricvaccineshaveremainedflatsince

2020butarebelowpre-pandemiclevels,with202313%below2019levels,whilethepediatricpopulationhasremainedstable.6Coincidingwiththisdropin

vaccinationisa12%increaseintheshareofAmericanswhobelieveparentsshouldbeabletochoosenotto

vaccinatetheirchildren.7

•Adultvaccinationsin2023increased6%fromtheprioryearbutremain6%below2019levels.PneumococcalvaccinescontinuetogrowandTdapvaccineswhich

declinedsignificantlyduringthepandemichavereturnedtohistoriclevels.

•Demographics,reimbursement,andaccessto

providersandpharmacistswhocanadminister

vaccinesareimportantfactorsthatimpactvaccinationratesanddevelopingstrategiesthatincorporate

thesefactorsarecriticalinensuringpublichealthandhealthequity.8,9

•ThelargestdeclinesinpediatricvaccineshavebeeninHepatitisAandBvaccinesandHPVvaccines,whicheachdeclined15–25%from2019.

Notes:Pediatricvaccinesincludevaccinesforhaemophilusinfluenzaetypeb(Hib),hepatitisA,hepatitisB,HPV,poliovirus,pneumococcal,rotavirus,varicellaandthecombovaccinesformeasles-mumps-rubella(M-M-R),DTaP/hepatitisB/polioandDTaP/Poliovirus/Hib/HepatitisBVaccine.Adultvaccinesinclude

vaccinesforshingles,pneumococcal,andTdap.Adultandpediatricvaccinesareretailandnon-retail.ListandagegroupbasedonareviewofCDC’sU.S.Vaccine’swebpage:

/vaccines/terms/usvaccines.html

andtheFDAlabelforvaccinesnotincludedonCDC’slist.Wherevaccinesareapprovedforbothpediatricandadult,packsizeandvolumewereusedtodistinguishbetweenadultandpediatric.

|11

Medicineuse

•Growthinprescriptionmedicinedaysoftherapywas3%in2023comparedto2022,withsimilargrowthinretailandnon-retail.

•Innon-retaildrugusage,useofmedicinesinclinicshasgrown13%since2019,whilelong-termcareandhospitalsremainbelowpre-pandemiclevels.

•Inretaildrugusage,dispensedprescriptionsreached6.9billionin2023,with2.9%growthcomparedto2022.

•Medicaidenrollmentdropped7%in2023while

prescriptionsgrew5%toanaverage10perenrolleeduringtheyear.

•Nearly100millionprescriptionswereprovidedtopatientsthroughillegalonlinepharmaciesin2023.

•Moreshortagescontinuetobereportedthanresolved,with58%ofthe132currentmoleculeshortages

ongoingformorethantwoyears.

•Manytherapyareashadhighgrowthindaysof

therapyin2023,withGLP-1agonistsdrivinggrowthinbothobesityanddiabetes.

•Useofmedicinesisgrowingacrossallautoimmunediseases,withCrohn’sdiseaseandpsoriasis

contributingmosttogrowth.

•NewerdiabetestherapieshaveseensignificantgrowthoverthelastfiveyearswithGLP-1agonistuserisinginbothdiabetesandobesityin2022and2023.

•Useofantibacterialsgrew4.6%in2023to2.6billiondaysoftherapy,returningtolevelsseenbeforethepandemicashistoriclevelsofseasonalrespiratoryillnessesreturn.

•Percapitaprescriptionopioid