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1、Understanding the Use of Medicines in the U.S.2025Evolving Standards of Care,Patient Access,and SpendingAPRIL202 5The use of medicines in the U.S.has grown significantly as more patients receive treatment for chronic diseases and new novel treatments become available.However,patients still face sign

2、ificant barriers to accessing medicines,including through limitations of their insurance coverage and the high costs of newer therapies.Early impacts of the Inflation Reduction Act have provided some cost savings to patients and will likely continue to drive increased savings as other aspects are ph

3、ased in.Aggregate growth in spending on medicines has accelerated as more patients are prescribed novel medicines and standards of care begin to shift.This annual trend report is part of a continued effort to advance our collective knowledge by providing evidence-based research,which can help establ

4、ish a common foundation for discussion and understanding by all stakeholders.It is intended to contribute to the advancement of health in a system that remains highly fragmented and opaque.Areas of focus in this years report range from looking at how medicine usage patterns have shifted,to the impac

5、t of out-of-pocket costs and benefit designs on patients,to the complex nature of drug pricing.Dynamics that have become apparent during 2024 have driven significant revisions to the outlook,and in this report the drivers of change in medicine spending over the next five years are deconstructed to e

6、nable better understanding.This examination includes the impact of novel obesity and diabetes medicines which have been significant drivers of growth,and the uptake of other novel medicines expanding into new patient populations and becoming established as backbone therapies.This study was produced

7、independently by the IQVIA Institute for Human Data Science as a public service,without industry or government funding.The contributions to this report of Srinidhi BC,Conrad Bhamani,Saksham Bhardwaj,Tanya Bhardwaj,Allen Campbell,Bhagyashree Sitaram Nawar,and many others at IQVIA are gratefully ackno

8、wledged.Find Out MoreIf you wish to receive future reports from the IQVIA Institute for Human Data Science or join our mailing list,visit iqviainstitute.org.MURRAY AITKENExecutive Director IQVIA Institute for Human Data ScienceIntroductionUnderstanding the Use of Medicines in the U.S.2025:Evolving S

9、tandards of Care,Patient Access,and Spending2025 IQVIA and its affiliates.All reproduction rights,quotations,broadcasting,publications reserved.No part of this publication may be reproduced or transmitted in any form or by any means,electronic or mechanical,including photocopy,recording,or any infor

10、mation storage and retrieval system,without express written consent of IQVIA and the IQVIA Institute.REFERENCING THIS REPORTPlease use this format when referencing content from this report:Source:IQVIA Institute for Human Data Science.Understanding the Use of Medicines in the U.S.2025:Evolving Stand

11、ards of Care,Patient Access,and Spending.April 2025.Available from www.iqviainstitute.orgTable of ContentsOverview 2Medicine use 5Patient out-of-pocket costs 28Benefit design impacts on patient access 41Medicine spending and growth drivers 51Outlook to 2029 66Notes on sources 77Methodologies 78Refer

12、ences 80About the authors 82About the Institute 83OverviewMEDICINE USEIn 2024,total prescription medicine use increased 1.7%,reaching 215 billion days of therapy.Growth in retail medicines slowed in 2024,while growth in non-retail medicines continued to accelerate,especially in clinics and doctors o

13、ffices.Retail,mail,and long-term care prescriptions totaled more than 7 billion in 2024,an increase of 2.5%over 2023 though the growth rate continued to slow.New prescriptions for chronic and acute conditions were both above 2019 levels in 2024,though most growth was limited to acute prescriptions w

14、here seasonal respiratory ailments continue to drive increases.Continued shifts in insurance coverage in 2024 resulted in more patients being covered by commercial insurance,while Medicaid enrollees declined.Prescriptions for Medicare enrollees have had the most growth over the last five years,up 25

15、%,and nearly three times the growth in the number of enrollees,as more seniors utilize more medications,resulting in an average of 36 prescriptions per Medicare enrollee in 2024.Most therapy areas had limited growth in days of therapy in 2024 with a few exceptions,including obesity at more than 50%g

16、rowth and 11%growth in immunology,as uptake of novel therapies in these therapy areas,including GLP-1 agonists in both diabetes and obesity,continues to increase.Use of antibacterials overall has declined since 2019,although use of those in the WHOs Reserve group,intended as last-choice options,has

17、grown 42%,highlighting a need for continued antibacterial stewardship.Per capita prescription opioid use has declined to levels last seen in 1999 and overdose deaths declined a remarkable 29%in 2024.Use of targeted cancer treatments has grown 14%since 2019,and oral medicines account for nearly half

18、of targeted medicine use.Flu cases have reached historic levels in the current flu season while flu vaccinations are the lowest since 20162017,and vaccinations for other respiratory viruses as well as other routine adult and pediatric vaccinations declined in 2024.PATIENT OUT-OF-POCKET COSTSPatient

19、out-of-pocket costs in aggregate reached$98Bn in 2024,an increase of$6Bn,with much of this increase in non-retail drugs.Medicare out-of-pocket costs were flat in 2024 compared to 2023,as Medicare Part D redesign began to go into effect,while patients with other pay types experienced increases.The av

20、erage out-of-pocket cost per retail prescription was flat in 2024,though average costs for branded drugs continued to grow driven primarily by increased use of GLP-1 agonists in both diabetes and obesity.More than 90%of prescriptions cost patients less than$20,and a growing share are free,reaching 4

21、6%in 2024 up from 32%in 2019.However,79 million prescriptions cost patients more than$125 in 2024,increasing on average 10%annually over the last five years and 40%of these are for Medicare patients.Retail,mail,and long-term care prescriptions totaled more than 7 billion in 2024,an increase of 2.5%o

22、ver 2023.2|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and SpendingMedicare patients in 2024 were more likely to reach annual out-of-pocket costs for medicines over$2,000 than other patients.In 2024,implementation of Medicare Part D redesign from the

23、Inflation Reduction Act(IRA)began to phase in,with the elimination of patient cost-sharing in the catastrophic phase,and as a result fewer Medicare patients paid more than$3,500 in annual out-of-pocket costs.The annual out-of-pocket cap of$2,000 in Medicare Part D that went into effect in January 20

24、25 could have saved 1.4 million patients on average$2,092 in 2024.GLP-1 agonists have been driving increases in diabetes average prescription out-of-pocket costs over the last two years,even while average insulin out-of-pocket costs have declined significantly due to$35 caps.Insulin out-of-pocket ca

25、ps from both manufacturers and federal law,saved patients nearly$681Mn on insulins in 2024 compared to peak prices paid in 2020.Similar out-of-pocket caps in respiratory inhalers could save patients$672Mn.BENEFIT DESIGN IMPACTS ON PATIENT ACCESSAcross all payment types 27%of new prescriptions go unf

26、illed primarily due to medicines not being covered by payers,but over one-third go unfilled in Medicaid due to a larger contribution from rejections of prior authorizations.Patients starting a new therapy abandoned 96 million prescriptions at pharmacies in 2024 with increasing frequency as costs ris

27、e due to a lack of,or limited,insurance coverage.Over half of new prescriptions for novel medicines go unfilled,and only 29%of patients remained on therapy for a year.Average fill rates for new medicines vary across the country,likely due to differences in insurance coverage.While generics are gener

28、ally preferred by payers,over 25%of new generic claims are rejected by payers two years after generic entry,which can limit generic uptake and savings to patients and the health system.The historic pattern of rapid and deep generic erosion and price reduction may not be continuing as seen by the low

29、er uptake of generics entering in the last five years compared to those entering 10-20 years ago.Biosimilars have also seen varying degrees of uptake across molecules,and overall biosimilars launched to date account for only 24%of competitive molecule volume.MEDICINE SPENDING AND GROWTH DRIVERSThe U

30、.S.market at net prices grew to$487Bn in 2024,an increase of 11.4%.A small subset of products drove much of this growth,though the largest amount of spending was on products with moderate to low growth that declined in aggregate by 0.7%.Thirty-one products had greater than$500Mn in net sales growth

31、in 2024 and contributed in aggregate$50Bn in growth.These products include GIP/GLP-1 agonists,medicines with label expansions,and more mature products becoming established in clinical guidelines.New brand spending reached$24Bn in 2024,largely driven by diabetes and obesity,and was largely offset by

32、the impact of exclusivity losses of$19Bn,mostly from biologics facing biosimilar competition.The U.S.market at net prices grew to$487Bn in 2024,an increase of 11.4%.Thirty-one products had greater than$500Mn in net sales growth in 2024 and contributed in aggregate$50Bn in growth.iqviainstitute.org|3

33、Specialty medicines account for 54%of spending,up from 47%in 2019,driven by growth in immunology and oncology,while traditional therapies have seen significant growth in obesity and diabetes driven by GLP-1 agonists.Net spending for biologic medicines has nearly doubled since 2019 with slower growth

34、 in small molecules.Protected brand net prices were flat in 2024,growing just 0.1%,while list price growth also slowed to 2.3%,including the impacts of list price reductions for insulins and respiratory products.However,the median annual treatment cost of new medicines exceeded$350,000 for the cohor

35、t of 2024 launches,with those for oncology and rare diseases both over$400,000 per patient.Most high-cost therapies treat small patient populations and contribute relatively little to overall medicine spending.OUTLOOK TO 2029The U.S.spending forecast reflects continued growth driven by innovation,of

36、fset by notable expiry events.The next five years are expected to bring an increasing gap between list price spending,which will grow at 58%,and manufacturer net revenues,which will grow at 36%,including the expected impacts of price negotiation and other aspects of the Inflation Reduction Act.Total

37、 estimated net spending on medicines in 2029 will reach more than$600Bn.New brand spending in the U.S.is projected to total$125Bn over the next five years,down from the$141Bn in the period 202024.Net prices for protected brands are forecast to decline by-1 to-4%.The impact of exclusivity losses will

38、 increase to$90.9Bn over five years,including more than two-thirds from small molecules facing generic competition.Oncology and obesity will drive growth through 2029 while diabetes,immunology,and COVID-19 contribute to slowing.Obesity drug spending has accelerated in the past two years from novel d

39、rugs,with further upside if available medicines are more widely reimbursed.Net spending on diabetes will be flat to 2029 as wider adoption of novel therapies is offset by both list and net price cuts.Immunology spending growth is expected to slow to 58%through 2029 from the impact of biosimilars,whi

40、le volume increases 43%over the same period.Next-generation biotherapeutics including cell,gene,and RNA therapies are expected to reach$13 billion by 2029,more than double the current level.The next five years are expected to bring an increasing gap between list price spending,which will grow at 58%

41、,and manufacturer net revenues,which will grow at 36%,including the expected impacts of price negotiation and other aspects of the Inflation Reduction Act.Total estimated net spending on medicines in 2029 will reach more than$600Bn.4|Understanding the Use of Medicines in the U.S.2025:Evolving Standa

42、rds of Care,Patient Access,and Spendingiqviainstitute.org|5 Prescription medicine days of therapy increased 1.7%reaching 215 billion in 2024,as growth has slowed in retail medicines.Use of medicines in clinics has grown 16%since 2019,and long-term care and hospitals recovered to pre-pandemic levels

43、in 2024.Dispensed retail,mail,and long-term care prescriptions reached over 7 billion in 2024,an increase of 2.5%over 2023 though growth continued to slow.New prescriptions and continuing chronic prescriptions were 36%higher in 2024 compared to 2019 levels,with seasonal respiratory illnesses continu

44、ing to drive increases in acute prescriptions.Across all therapy areas,90%of prescriptions are generics while immunology,obesity,and diabetes have more brand prescriptions.Medicaid enrollment dropped 7%in 2024,and prescriptions declined 5%resulting in an average 10 per enrollee in the year.Most ther

45、apy areas had limited growth in days of therapy in 2024,with a few exceptions including obesity at more than 50%growth.Use of medicines is growing across immunology,with Crohns disease and ulcerative colitis contributing most to growth and shifts to newer treatment options.Newer diabetes therapies h

46、ave seen significant growth since 2019,with GLP-1 use in 2024 up four-fold since 2019.Most obesity GLP-1 prescriptions are for patients continuing therapy and use by age and gender is not aligned with prevalence,additionally GLP-1 per capita use across counties in the U.S.is not correlated with obes

47、ity prevalence.Use of antibacterials overall has declined since 2019,although those in the WHOs Reserve group,intended as last choice options,have grown 42%.Per capita prescription opioid use has declined to levels last seen in 1999 and overdose deaths declined a remarkable 29%in 2024.Novel treatmen

48、t options in both HIV and oncology are providing significant benefits to patients,including lower treatment burdens and improved outcomes.Flu cases have reached historic levels in the current flu season while flu vaccinations are the lowest since 20162017 and vaccinations for other respiratory virus

49、es also declined significantly in the 20242025 respiratory season.Both adult and pediatric vaccinations declined in 2024,with pediatric vaccinations at levels last seen during the pandemic.Medicine use The use of prescription medicines in the U.S.based on defined daily doses has grown 14%in the last

50、 five years to more than 215 billion days of therapy in both retail and non-retail settings,though growth slowed to 1.7%in 2024.Retail drugs currently represent 83%of medicine use in the U.S.,with only 17%of use in non-retail settings,and non-retail growth surpassed retail growth in 2024.The use of

51、prescription drugs dispensed from retail pharmacies has continued to grow at a rate of 3.0%annually,on average,over the last five years but growth slowed to 1.3%in 2024 bringing total market growth down.Drugs in non-retail settings,such as clinics,hospitals and long-term care were significantly impa

52、cted by the pandemic,with days of therapy contracting 6.8%in 2020,rebounding significantly in 2021,and growth of 3.3%surpassing that of retail drugs in 2024.As a result,average annual growth over the last five years has been 0.9%.The number of days of therapy per capita has grown significantly to 63

53、3 days of therapy per U.S.resident,up 11%over the last five years as growth in the total days of therapy has outpaced population growth,which has been on average 0.6%annually.Exhibit 1:U.S.defined daily doses(DDD)trend and growth by channel,20192024Notes:Defined daily doses(DDDs)are based on WHO def

54、initions where each medicine is assigned a volume of medicine per day(see methodology).Prescription medicines only.Excludes COVID-19 vaccines and therapeutics and OTC medicines.MEDICINE USEPrescription medicine days of therapy reached 215 billion in 2024,as growth has slowed in retail medicinesSourc

55、e:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Mar 2025.6|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending189190199205212215572574598613628633DDD per capitaDDD by channel(Bn)Non-retailRetail202420232019202020212022Defined daily do

56、ses(DDD)(Bn)by channeland DDD per capita-8%-6%-4%-2%0%2%4%6%250200150100500700650600550500201920202021202220242023Defined Daily Doses(DDD)growth by channel%growth retail%growth non-retail%growth totalDDD per capita Non-retail medicine use has fluctuated significantly over the last five years,up 5%in

57、 2024 from the 2019 baseline following a 7%decline in the first year of the pandemic and a prolonged recovery.Despite a return to baseline,non-retail medicine use has shifted as usage in clinics,which was least impacted by the pandemic,is now 16%above baseline levels.Usage in hospitals declined in 2

58、020 as many facilities implemented restrictions to reduce the spread of COVID-19 and initially recovered to baseline in 2021 but fell again in 2022,recovering to 1%below baseline in 2024.Significant differences exist between federal and non-federal facilities,with federal facilities down 18%over the

59、 period but non-federal facilities up 5%.Long-term care medicine use grew 3%in 2024 recovering to 1%above baseline 2019 levels,following significant disruptions during the pandemic due to concerns about high levels of COVID-19 cases and deaths in these settings.Clinics represent 48%of non-retail med

60、icine use and the significant growth in this channel has brought overall non-retail usage above baseline despite the dynamics in other non-retail settings.Other non-retail settings such as prisons,universities,and home health account for just 6%of non-retail medicine use,and these settings have had

61、varying impacts on medicine use.Exhibit 2:U.S.non-retail defined daily doses(DDDs)indexed to 2019 values and share by channelNotes:Defined daily doses(DDDs)are based on WHO definitions where each medicine is assigned a volume of medicine per day(see methodology).Hospitals includes non-federal hospit

62、als and federal facilities.All other/miscellaneous includes home health,HMO,prisons,universities and all other non-retail not separately defined.Excludes COVID-19 vaccines and therapeutics and OTC medicines.MEDICINE USEUse of medicines in clinics has grown 16%since 2019,and long-term care and hospit

63、als recovered to pre-pandemic levels in 2024Source:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|7ClinicsLong-term careAll non-retailAll other/miscellaneousHospitalsIndex of DDDs by channel,2019=100Share of DDDs by channel,2024Non-retail=36.5BnDDDs909510010511

64、51201102019202020212024202320221161019910548%25%21%6%Total retail and long-term care prescriptions adjusted for prescription length reached 7.1 billion in 2024,up from 6.2 billion in 2019.In total,dispensed prescriptions increased 2.5%in 2024,slower than growth in 2022 and 2023 but similar to the av

65、erage growth over the last five years.The increasing importance of 90-day prescriptions is evident as the rate of growth without adjustment for prescription length was 0.8%on average over the last five years,but 2.6%after adjustment with 1.2 billion 90-day prescriptions filled in 2024.Mail prescript

66、ions peaked in 2022 at 590 million,were flat in 2023,but declined 2.2%in 2024 to 576 million signifying a potential shift away from this channel.Among retail pharmacies,food stores have seen the highest growth in prescriptions over the last five years,up 27.1%in 2024 followed by mass stores at 14.0%

67、,which had the highest growth in 2024 compared to the prior year at 4.7%.Chain stores,which account for 42%of prescriptions,had slowing growth in 2024 at 1.9%compared to 2.6%in 2023 and reflecting slower overall prescription growth.In 2024,52%of all prescriptions were dispensed in 90-day amounts,up

68、from 43%in 2019.This increasing utilization of 90-day prescriptions could lead to higher adherence to chronic medications as patients have been shown to be more adherent with 90-day prescriptions compared to 30-day.The share of prescriptions dispensed as 90-day varies across channel,with 88%of mail

69、prescriptions dispensed in 90-day amounts compared to 53%of retail pharmacy prescriptions.Exhibit 3:Unadjusted and adjusted dispensed retail and long-term care prescriptions(Mn)and growth,20192024Notes:Adjusted prescription counts are adjusted for length of prescription and re-aggregated(see methodo

70、logy).Includes prescriptions dispensed in retail,mail,and long-term care settings.Excludes COVID-19 vaccines and therapeutics.MEDICINE USEDispensed prescriptions reached over 7 billion in 2024,although growth has slowed in the last 2 yearsSource:IQVIA National Prescription Audit,Dec 2024;IQVIA Insti

71、tute,Mar 2025.4,4374,3244,3384,4544,5404,6106,2186,3246,4746,7056,8987,069Unadjusted TRxAdjusted TRxUnadjusted TRx growthAdjusted TRx growthUnadjusted and adjusted prescription growth202420232019202020212022202420232019202020212022Unadjusted and adjusted prescriptions(Mn)-0.4%-2.5%0.3%2.7%1.5%2.3%1.

72、7%2.4%3.6%2.5%1.9%2.9%8|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending New to brand prescriptions(NBRx)are those where the patient has not been prescribed the medicine in the prior 12 months,and these have grown over the last five years foll

73、owing pandemic disruptions.Patients starting chronic therapies initially declined 6%in 2020 but rebounded and were 5%above baseline in 2024,similar to 2023.Acute prescriptions experienced significant disruptions over the last five years from the pandemic,dropping 16%in 2020 as respiratory illnesses

74、declined significantly due to public health measures in place to reduce the spread of COVID-19 and remaining below baseline through 2022.A significant respiratory illness season late in 2022 and early 2023 and a severe season in 2024 resulted in an increase in acute prescriptions,which grew to 6%abo

75、ve baseline in 2024.Chronic continuing prescriptions have remained relatively stable since 2019,growing on average less than 1%annually and reaching 3%above baseline in 2024.Exhibit 4:Annual dispensed new and continuing prescriptions by therapy type indexed to 2019 levels(2019=100)Notes:Prescription

76、s are unadjusted.New to Brand(NBRx)prescriptions are those where the patient had no prescription of the medicine in the prior 12 months and includes nave patients as well as those who switch from another drug or add a new drug to their existing regimens.Continuing prescriptions(CBRx)are those where

77、the patient has filled a prescription of the same medicine in the past year and can include gaps in dispensing.Chronic is determined as whether the medicine is generally intended to be prescribed for more than 180-days,and acute are all other medicines.Chronic and acute are not specific patient or p

78、rescription attributes and do not reflect the potential for some medicines to be used on a long-term basis against recommendations.Excludes all vaccines and COVID-19 therapeutics.MEDICINE USENew prescriptions and continuing chronic prescriptions were 36%higher in 2024 compared to 2019 levelsSource:I

79、QVIA National Prescription Audit:New to Brand,Dec 2024.iqviainstitute.org|980908510095110105201920202021202220232024CBRx chronicNBRx chronicTRx totalNBRx acute Patent expiries that occurred over past decades for products used by millions of patients have contributed to the overall generic share of a

80、djusted prescriptions reaching 90%in 2024 including branded generics.The share of prescriptions dispensed as generics varies significantly across therapy areas,with some therapy areas almost entirely generic.This includes some of the largest by number of prescriptions,such as hypertension,mental hea

81、lth,lipid regulators,and anti-ulcerants,where generics account for 98%or more of prescriptions.Nearly half of all diabetes prescriptions in 2024 were dispensed as branded drugs,a significant increase from 2019 when 39%of prescriptions were brands as novel therapies,particularly GLP-1 agonists and SG

82、LT2 inhibitors,have seen increasing use(Exhibit 11).Similarly,obesity treatments have seen a significant shift to branded drugs,which now account for 61%of prescriptions,with the introduction of GLP-1 agonists.Asthma and COPD have seen an increasing generic share over the last five years,growing fro

83、m 64%in 2019 to 77%in 2024,though 23%are still dispensed as brands often due to the complex devices that accompany these medications.Immunology has the lowest generic share at 10%as many of these medicines have been on the market less than 10 years and are still patent protected.Exhibit 5:Share of a

84、djusted prescriptions for top 30 therapy areas by product type,2024Notes:Adjusted prescription counts are adjusted for length of prescription and re-aggregated(see methodology).Includes prescriptions dispensed in retail,mail,and long-term care settings.MEDICINE USEAcross all therapy areas,90%of pres

85、criptions are generics while immunology,obesity,and diabetes have more brand prescriptionsSource:IQVIA National Prescription Audit,Dec 2024.90%99%98%99%52%96%100%100%100%100%100%100%100%99%88%97%77%54%97%89%93%93%91%90%93%96%84%93%94%39%10%BrandGeneric188.3100%90%80%70%60%50%40%30%20%10%0%TotalHyper

86、tensionMental healthLipid regulatorsDiabetesPainAnti-ulcerantsEpilepsy/ParkinsonsAntibacterialsThyroidOther CNSAsthma&COPDHematologicsDermatologicsInfectious diseaseADHDVitamins&MineralsContraceptionOphthalmologyBPHGenitourinaryAllergyCorticosteroidsSex hormonesOncologyGastrointestinalOther cardiova

87、scularAntigoutOsteoporosisObesityImmunology10|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending Prescriptions have increased across all pay types,except for those paid for without insurance,with the highest growth occurring in Medicare prescrip

88、tions which are up 25%over the last five years,followed by Medicaid at 16%and commercial at 10%.The pandemic caused significant shifts in insurance coverage.Medicaid continuous enrollment implemented as part of the COVID-19 response resulted in a 30%increase in enrollment from 2019 to 2022 however s

89、tates could resume disenrollment beginning in April 2023 and many completed this by August 2024.1 A net 13 million individuals disenrolled from Medicaid through 2024,but disenrollments were partially offset by Medicaid expansion in some states and total enrollment is still up 11%from the 2019 level.

90、The rise in the commercially-insured population coincides with a low unemployment rate of 4.1%in December 2024 and increasing enrollments in Health Insurance Marketplace plans which reached over 21 million in 2024,up 31%from 2023,and growth slowed to 13%for 2025 plans.2,3 Along with enrollment,the p

91、rescriptions per enrollee have changed significantly.Medicare prescriptions have grown nearly three times faster than enrollment as enrollees are using more prescriptions nearly 36 per enrollee in 2024,compared to 32 in 2019.Medicaid enrollment and prescription volume declined 7%and 5%,respectively,

92、in 2024 keeping the prescriptions per enrollee at 10 similar to 2023,and commercial also remained flat at 22 as prescriptions and enrollment grew similarly.Exhibit 6:Adjusted dispensed prescriptions by method of payment,20192024Notes:Enrollment numbers based on Medicare and Medicaid enrollment stati

93、stics from the Centers for Medicare and Medicaid Services.Uninsured population based on Centers for Disease Control and Prevention percentages applied to the total population.Commercial enrollees are derived from the total population minus the uninsured and those covered under Medicare or Medicaid.E

94、xcludes COVID-19 vaccines and therapeutics.MEDICINE USEMedicaid enrollment dropped 7%in 2024 and prescriptions declined 5%resulting in an average 10 per enrollee in the yearSource:IQVIA National Prescription Audit,Centers for Medicare&Medicaid Services,National Center for Health Statistics,U.S.Censu

95、s Bureau,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|113,2373,2583,3213,4173,4883,5591,9602,0632,1112,1922,3102,4427107237758408668223112792672552352462019202020212024202320222019 2020 20212024202320222019 2020 2021202420232022Adjusted prescriptions(Mn)Number of enrollees(Mn)TRx per enrolle

96、eMedicareMedicaidCash/assistanceCommercial8,0007,0006,0005,0004,0003,0002,0001,00004030201001801501209060300Exhibit 7:Notable trends in medicine use in 2024MEDICINE USENotable shifts and impacts in medicine use occurred across therapy areas in the U.S.in recent yearsSource:IQVIA Institute,Apr 2025.I

97、mmunology drug use reached 1.4Bn days of therapy in 2024,up 72%from 2019.Treatment of Crohns disease and ulcerative colitis accounted for 30%and 15%of growth,respectively.Use of antibacterials in WHOs“Reserve”group intended as last-choice options has grown 42%since 2019.Total antibacterial days of t

98、herapy reached 2.5Bn in 2024,down 3%from pre-pandemic levels.Use of targeted cancer treatments has grown 14%since 2019.Oral treatments that patients can administer themselves account for more than one-third of use.Flu vaccinations in 2024 reached the lowest levels since 20162017.Vaccination levels a

99、re 1538%lower compared to 2019 across a range of adult and pediatric vaccines.Per capita prescription opioid use down 69%since the peak in 2011 returning to levels last seen in 1999.Opioid-involved overdose deaths declined nearly 30%in 2024 compared to 2023.Nearly 2Mn obesity GLP-1 agonist prescript

100、ions were filled in December 2024,4x the number in December 2023.Obesity GLP-1 per capita use is not correlated with obesity prevalence.Growing use of immunology treatmentsRising use of last-choice antibacterialsGrowing use of novel oncology medicinesFalling levels of vaccinationsCombatting the opio

101、id overdose epidemicIncreasing use of novel obesity drugs12|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and SpendingExhibit 8:Top 30 therapy areas by defined daily doses(DDDs)2024(Bn)and%growth from 2023Notes:Defined daily doses(DDDs)are based on WHO

102、definitions where each medicine is assigned a volume of medicine per day(see Methodology).Prescription medicines only.Excludes COVID-19 vaccines and therapeutics and OTC medicines.MEDICINE USEMost therapy areas had limited growth in days of therapy in 2024,with a few exceptions including obesity at

103、more than 50%growthiqviainstitute.org|13GrowthHypertensionLipid regulatorsMental healthDiabetesGastrointestinalAnti-ulcerantsPainOphthalmologyDermatologicsOther CNSAsthma&COPDHematologicsContraceptionEpilepsy/ParkinsonsThyroidSex hormonesADHDOncologyBPHVitamins&MineralsAllergyCorticosteroidsAntibact

104、erialsOther cardiovascularGenitourinaryObesityInfectious diseaseOsteoporosisImmunologyAntigout -1.1%-3.0%-2.6%-2.9%-0.2%-0.8%-1.0%-2.2%-0.4%0.5%2.4%0.3%3.3%0.1%2.3%9.9%1.9%2.3%1.6%18.0%3.0%2.3%0.1%3.0%0.5%13.2%51.1%3.4%1.6%10.8%42.3 23.0 18.3 14.0 11.2 10.4 9.6 8.0 7.4 6.7 6.6 5.5 5.4 4.9 3.6 3.4 3.

105、3 3.2 3.1 3.0 2.7 2.6 2.5 2.4 1.8 1.7 1.6 1.5 1.40.7 Days of therapy growth was limited across most therapy areas in 2024,with growth averaging 4%across the top 30 though obesity,sex hormones,genitourinary,immunology and dermatologics all had growth of 10%or higher.The largest therapy areas by volum

106、e had low growth over the prior year with hypertension and mental health flat as higher growth in recent years subsided,lipid regulators growing just 2%following average growth of 9%annually from 2020 to 2023,and diabetes continuing to grow but slowing driven by GLP-1 agonists and SGLT2 inhibitors(E

107、xhibit 11).Obesity days of therapy grew 51%in 2024 driven by high uptake of GLP-1 agonists,including the launch of Zepbound(tirzepatide)a GLP-1/GIP agonist in December 2023.Immunology medicine use grew 11%as more patients across a broader range of autoimmune and inflammatory diseases gain access to

108、novel medicines to treat these often-debilitating conditions.Use of dermatologics grew 10%primarily from increasing use of topical corticosteroids for a variety of skin conditions,though increasing use could lead to an increase in adverse effects.4 The use of sex hormones increased 18%in 2024 driven

109、 by increased use for menopause,gender-affirming care,and other hormonal imbalances.Source:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Mar 2025.Immunology medicines are used to treat a broad range of autoimmune and inflammatory diseases that can severely impact a patients quality of li

110、fe and day-to-day activities.In the last decade,26 novel immunology medicines have launched in the U.S.and 16 in the last five years,5 and two-thirds of novel immunology medicines receive label expansions after initial approval frequently into new indications or patient populations(e.g.,pediatrics).

111、6 Immunology medicine use grew by 585 million DDDs,or 72%,from 2019 to 2024 to 1.4 billion days of therapy in 2024.Rheumatoid arthritis,which accounts for 23%of medicine volume,has had little growth since 2019,contributing only 6%to the growth over the period.Growing treatment of inflammatory bowel

112、disease(IBD),including Crohns disease and ulcerative colitis,particularly with biologic therapies,has contributed 45%of the growth since 2019 as more patients gain access to these disease-modifying therapies.Risankizumab(Skyrizi),an inhibitor of IL-23,launched in 2019 is the product with the highest

113、 contribution of growth,contributing 22%of 595 million additional days of therapy driven by significant growth in psoriasis where it accounts for 76%of growth.Dupilumab(Dupixent),an inhibitor of IL-4 and IL-13 signaling thereby reducing inflammation,contributed 18%of the volume growth,primarily from

114、 its use in atopic dermatitis but additional approvals in chronic rhinosinusitis and asthma have also contributed significantly.Exhibit 9:Immunology defined daily doses(DDDs)(Mn)and contribution to growth by disease,2019 vs.2024Notes:Disease shares derived from IQVIA claims data applied to product l

115、evel volumes and aggregated.Immunology medicines include medicines for autoimmune and inflammatory diseases.MEDICINE USEUse of medicines is growing across immunology,with Crohns disease and ulcerative colitis contributing most to growthSource:IQVIA National Sales Perspective,IQVIA MIDAS Disease,Dec

116、2024;IQVIA Institute,Mar 2025.All others1,3958111%3%Chronic rhinosinusitisUlcerative colitisPsoratic arthritis AsthmaAtopic dermatitisRheumatoid arthritisPsoriasisAnkylosing spondylitisCrohns disease201920241,5001,2009006003000Immunology DDDs by disease(Mn)Contribution to growth since 2019+585MnDDDs

117、8%11%15%30%6%7%13%6%+72%14|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending The treatment of Crohns disease has evolved over the last decade as new medicines have been approved,and novel mechanisms of action have been introduced,with total new

118、 prescriptions(NBRx)up 74%in 2024 from 2019.In 2019,45%of new patients starts for Crohns across all lines of therapy were for tumor necrosis factor(TNF)inhibitors and 37%for corticosteroids,with just 18%for other targeted therapies.The use of TNF inhibitors in Crohns has declined as more novel treat

119、ment options have been made available,in particular risankizumab,an IL-23 inhibitor,and upadacitinib,a Janus kinase(JAK)inhibitor,which were approved for Crohns disease in 2022 and 2023 respectively,accounted for 27%of all new starts across all lines of therapy in 2024.The introduction of adalimumab

120、 biosimilars did contribute to a modest increase in the TNF inhibitor share in 2024 particularly in second and third lines of therapy as patients were likely switched from the originator product.The IL-23 inhibitors and JAK inhibitors have seen the largest gains in second line and later,where drugs

121、that inhibit both IL-12 and IL-23(instead of only IL-23)have seen declines in shares.Exhibit 10:Share of line of therapy new patient starts in Crohns disease by mechanism of actionNotes:New to Brand(NBRx)prescriptions are those where the patient had no prescription of the medicine in the prior year

122、and includes nave patients as well as those who switch from another drug or add a new drug to their existing regimens.For each patient,the Line of Therapy Library identifies their first fill of each drug within a pre-defined market,and sequences them in order by date to capture patient progression t

123、hrough lines of therapy.“IL-12 and IL-23 inhibitors”inhibit both receptors while“IL-23 inhibitors”inhibit the IL-23 receptor only.MEDICINE USETreatment of Crohns disease has shifted to newer treatment options in IL-23 and JAK inhibitorsSource:IQVIA Libraries Line of Therapy Library,Dec 2024;IQVIA In

124、stitute,Apr 2025.iqviainstitute.org|15TNF inhibitorsCorticosteroidsIL-12 and IL-23 inhibitorsIL-23 inhibitorsJAK inhibitorsAll others2019202020212022202420232019202420191st LoT2nd LoT3rd+LoT202420192024100%90%80%70%60%50%40%30%20%10%0%100%90%80%70%60%50%40%30%20%10%0%Crohns all LoT NBRx by mechanism

125、LoT NBRx share by mechanism,2019 vs 2024 In 2024,456 million prescriptions were dispensed to treat diabetes,up 33%from 2019 levels and growing on average 6%annually over the last five years.The largest growth has been in newer generation therapies,predominantly GLP-1 agonists and SGLT2 inhibitors wh

126、ere prescriptions in 2024 were four-fold and three-fold higher,respectively,than 2019 levels.GLP-1 agonists now account for 17%of prescriptions,up from 6%in 2019 and SGLT2s have grown from 5%in 2019 to 14%in 2024.DPP-IV inhibitor use has declined significantly,down 30%in 2024 from 2019 levels and ac

127、count for a smaller share of prescriptions.Nearly half of diabetes prescriptions in 2024 were for traditional therapies,including metformin and sulphonylureas,and have lower growth compared to newer generation therapies but are still up 10%form 2019.Metformin accounts for over 75%of traditional diab

128、etes therapies.Insulins,which have received significant attention related to out-of-pocket costs(Exhibit 32),accounted for 15%of diabetes prescriptions in 2024,down from 20%in 2019 as insulin use has declined 3%over the period.Exhibit 11:Adjusted diabetes prescriptions by typeNotes:Adjusted prescrip

129、tion counts are adjusted for length of prescription and re-aggregated(see methodology).MEDICINE USENewer diabetes therapies have seen significant growth since 2019,with GLP-1 use in 2024 up 4-fold since 2019Source:IQVIA National Prescription Audit,Dec 2024;IQVIA Institute,Mar 2025.DPP-IV inhibitorsS

130、GL T2 inhibitorsTraditional diabetes therapiesInsulinsOther newer generation therapiesGlucagonAll diabetesGLP-1 agonists20192019202020212022202320242024342Mn456Mn100%90%80%70%60%50%40%30%20%10%0%450400350300250200150100500Share of diabetes prescriptions by type,2019 vs.2024Diabetes prescriptions by

131、type indexed to 2019(2019=100)58%47%6%17%5%14%8%4%3%3%20%15%0.2%0.2%-1%7%6%-7%3%33%2%28%5-year CAGR16|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending In December 2024,1.9 million GLP-1 agonist prescriptions for treatment of obesity were fille

132、d,nearly four times the number filled in December 2023.On average over 220,000 patients started treatment each month in 2024 with an obesity GLP-1 agonist more than doubling the average nearly 99,000 that started treatment each month in 2023.Most prescriptions(83%)for obesity GLP-1s in 2024 were for

133、 patients continuing on therapy and the average number of days of therapy for new patients in 2024 was 231 days.Patients using these novel treatment options do not have profiles that correspond with those in the U.S.who have the highest prevalence of obesity.Males account for nearly half of those wi

134、th obesity in the U.S.but only 24%of the 15.5 million obesity GLP-1 prescriptions in 2024 were filled by males,whereas 76%were filled by females.Additionally,more than half of prescriptions were filled by patients between the ages of 40 and 59,who account for just one-third of people with obesity in

135、 the U.S.These disparities between utilization of GLP-1 agonists for obesity and the demographics of those living with obesity highlight gaps in care and underutilization of these novel treatments in certain populations.Exhibit 12:Obesity GLP-1 agonist prescriptions by type and share by gender and a

136、geNotes:Obesity GLP-1 agonist prescriptions are for products approved by the FDA specifically for obesity and do not reflect off-label use of GLP-1 agonists approved for diabetes.MEDICINE USEMost obesity GLP-1 prescriptions are for patients continuing therapy and use by age and gender is not aligned

137、 with prevalenceSource:IQVIA National Prescription Audit:New to Brand,Dec 2024;CDC National Health and Nutrition Examination Survey,Aug 2023;IQVIA Institute,Mar 2025.iqviainstitute.org|1776%51%24%49%CBRxNBRxUnder 19Female40 to 5920 to 3960 and overMaleJan 2020Apr 2020Jul 2020Oct 2020Jan 2021Apr 2021

138、Jul 2021Oct 2021Jan 2022Apr 2022Jul 2022Oct 2022Jan 2023Apr 2023Jul 2023Oct 2023Jan 2024Apr 2024Jul 2024Oct 2024Monthly obesity GLP-1 agonist new andcontinuing prescriptions2,000,0001,750,0001,500,0001,250,0001,000,000750,000500,000250,0000GLP-1 TRxEpidemiologyGLP-1 TRxEpidemiologyShare of obesity G

139、LP-1 agonist prescriptions by age andgender compared to prevalence,2024(n=15.5Mn prescriptions)1%14%25%27%57%33%17%27%A variety of risk factors have been shown to contribute to obesity,including limited physical activity,eating patterns,stress,and genetics,among others.7 When comparing levels of var

140、ious measures of health and well-being across 3,001 counties in the U.S.with the prevalence of obesity in those counties,there are strong correlations between these variables.The percent of physically inactive people is the most highly correlated with the level of obesity in a community,as higher de

141、grees of physical inactivity lead to more adults living with obesity.Higher levels of food insecurity and poverty can also contribute to higher levels of obesity.Obesity is well established as a risk factor for Type 2 diabetes and county level data shows a significant relationship between the two,wi

142、th higher levels of diabetes occurring in counties with higher levels of obesity.While many of these health and well-being measures are strongly correlated with obesity in communities across the U.S.,the per capita use of GLP-1 agonists for obesity is not correlated with the level of obesity.As the

143、use of these novel obesity treatments continues to grow,it will be important to ensure the patients and communities who need these treatments most are able to access them.Exhibit 13:County level obesity prevalence compared to physical inactivity,diabetes,food insecurity,poverty level,and obesity GLP

144、-1 per capita useNotes:Obesity GLP-1 agonist prescriptions are for products approved by the FDA specifically for obesity and do not reflect off-label use of GLP-1 agonists approved for diabetes.MEDICINE USEWhile a range of health and well-being measures are correlated with obesity prevalence,GLP-1 p

145、er capita use is notSource:IQVIA National Prescription Audit,Census Bureau,Dec 2024;County Health Rankings and Roadmaps,IQVIA Institute,Mar 2025.504540353025201510R=0.5807R=0.4901R=0.0091R=0.2548R=0.2941%adults with obesity%physically inactive10203040506030252015105%adults with obesity%food insecure

146、102030405060252015105%adults with diabetes10203040506050403020100%adults with obesity%in poverty10203040506090,00080,00070,00060,00050,00040,00030,00020,00010,0000%adults with obesityTRx per 100,000 population102030405060Obesity vs.physical inactivityObesity vs.diabetesObesity vs.food insecurityObes

147、ity vs.obesity GLP-1 per capita use%adults with obesityObesity vs.poverty level18|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending Antibacterial use declined to 2.5 billion days of therapy in 2024,down 2.2%from 2023 and 3.2%below 2019 levels.D

148、espite lower volumes of antibacterials utilized in the U.S.,there is growing concern about antimicrobial resistance as rates of antimicrobial-resistant infections increased throughout the pandemic and remained high in 2022.8 The WHOs Access,Watch,Reserve(AWaRe)classification is a tool to assist with

149、 antibacterial stewardship.Access antibacterials are narrow spectrum and those with lower resistance potential;Watch antibacterials are broader-spectrum and those with higher resistance potential;and Reserve are“last resort”options that should be reserved for multidrug-resistant infections.The WHO s

150、et a target that 60%of antibacterial prescribing at a country level should be in the Access category.9 Over the last five years,Access antibacterials have accounted for more than 70%of antibacterials use in the U.S.and use of Watch antibacterials has declined 15.8%,both positive trends for stewardsh

151、ip.However,use of Reserve antibacterials has grown 42.2%over the same period,highlighting a need for continued vigilance.As levels of bacterial infections increased following the pandemic,prescriptions across age groups returned to baseline levels,though levels in adults 65 and older have risen to m

152、ore than 10%above baseline.Exhibit 14:Antibacterial defined daily doses(DDDs)(Mn)and prescriptionsNotes:Defined daily doses(DDD)are based on WHO definitions where each medicine is assigned a volume of medicine per day(see methodology).Molecule forms assigned to WHO Access,Watch,Reserve(AWaRe)categor

153、ies based on 2023 Web Annex C of The selection and use of essential medicines available from:https:/www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.04.Prescriptions by age based on prescriptions unadjusted for length of prescription.Index baseline based on the 2018 and 2019 average prescription

154、s in each month to adjust for seasonality of usage.Monthly indices are aggregated into quarterly averages.MEDICINE USEUse of antibacterials overall has declined since 2019,although those in the WHOs Reserve group have grown 42%Source:IQVIA National Sales Perspective,IQVIA National Prescription Audit

155、,Dec 2024;WHO Access,Watch,Reserve(AWaRe)classification of antibiotics for evaluation and monitoring of use,Jul 2023;IQVIA Institute,Mar 2025.iqviainstitute.org|191314181815132,5802,2442,5542,1392,4332,4987656246606336616431,8021,6061,8771,4921,7561,836AccessWatchReserveTotalUnder 19206465+Total1401

156、2010080604020Antibacterial prescriptions by age group indexed to 2018/2019 levels20245-yeargrowth-3.2%42.2%-15.8%1.9%20232019202020212022BaselineQ2 2020Q3 2020Q4 2020Q1 2021Q2 2021Q3 2021Q4 2021Q1 2022Q2 2022Q3 2022Q4 2022Q1 2023Q2 2023Q3 2023Q4 2023Q1 2024Q2 2024Q3 2024Q4 2024Baseline 100=2018/2019

157、average TRx by monthAntibacterial DDDs(Mn)by WHO AWaRe classification Prescription opioid volume declined in 2024 for the 13th consecutive year after peaking in 2011.In 2024,use of opioids declined by 5.0%to 84 billion morphine milligram equivalents(MMEs),with per capita levels down 69%from the peak

158、 in 2011 and dropping back to levels of use seen in the year 1999.These decreases in volume have been driven by changes in clinical usage,regulatory and reimbursement policies,and progressively more restrictive legislation enacted since 2012,including class-wide guidance from FDA in 2016.Naloxone ca

159、n be used to reverse an opioid overdose if provided in time and is encouraged for people to carry who are at risk or know someone who is at risk of overdose.10 Over-the-counter naloxone was made available in 2023,making this life-saving drug more accessible and accounting for 37%of naloxone volume i

160、n Q4 2024.This likely does not account for all naloxone volume as it is frequently distributed through non-traditional channels which may not be captured in this data.Preliminary data from the Centers for Disease Control and Prevention on the number of opioid-involved overdose deaths shows a signifi

161、cant decline in 2024,down 29%through October compared to the 12 months prior.Overdose deaths declined in all but five states Alaska,Montana,Nevada,South Dakota,and Utah highlighting the continued need for public health interventions.11Exhibit 15:Prescription opioid use overall,opioid reversal medica

162、tion volume,and opioid-involved overdose deathsNotes:Analysis is based on opioid medicines for pain management and excludes those medicines used for medication-assisted opioid use dependency treatment(MAT)or overdose recovery.Opioid medicines are categorized and adjusted based on their relative inte

163、nsity to morphine,called a morphine milligram equivalent(MME),consistent with methods defined by the Centers for Disease Control and Prevention(CDC).Prescription data is through the retail channel only.Drug overdose deaths may involve multiple drugs and therefore may be included in more than one cat

164、egory.RUNNING SECTION HEADERPer capita prescription opioid use has declined to levels last seen in 1999 and overdose deaths declined a remarkable 29%in 2024Source:IQVIA Xponent,IQVIA National Prescription Audit,Dec 2024;IQVIA Institute,Mar 2025;Centers for Disease Control and Prevention,Mar 2025.Dis

165、pensed MME per capita9008007006005004003002001000200020022004200620082010201220142016201820202022MAT Oct 20241994199619982000200220042006200820102012201420162018202020222024Q1 2019Q3 2019Q1 2020Q3 2020Q1 2021Q3 2021Q1 2022Q3 2022Q1 2023Q3 2023Q1 2024Q3 2024Number of overdose deaths100,00080,00060,00

166、040,00020,0000700,000600,000500,000400,000300,000200,000100,0000-29%2024 MME per capita level247Morphine Milligram Equivalents(MME)per capita,19932024Quarterly opioid reversal agentprescription/OTC volume,20192024Opioid-involved overdose deaths,2000Oct 2024Any opioidSynthetic opioidsPrescription opi

167、oidsHeroinNaloxone OTCOpioid reversal Rx-69%20|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending The first treatment for HIV zidovudine,a nucleoside reverse transcriptase inhibitor(NRTI)was approved in the U.S.in 1987,six years after the first

168、published report of cases of AIDS in five gay men in Los Angeles.12 In 2024 over 440 million days of therapy of HIV medicines were provided to patients,up 57%from 25 years ago.Nearly four decades after the first NRTI was made available in the U.S.,significant advancements have been made in the medic

169、ines used to treat HIV,improving efficacy,reducing side effects and pill burden,and moving into prevention.NRTIs consistently account for over one-third of days of therapy,though use for pre-exposure prophylaxis(PrEP)could account for a significant portion of current use as NRTIs are the primary opt

170、ion for PrEP.Protease inhibitors,integrase inhibitors,non-nucleoside reverse transcriptase inhibitors(NNRTIs),and varying combinations of all of these have been used successfully and accounted for significant portions of use throughout the last 25 years.Integrase inhibitor and NRTI combinations were

171、 first launched in 2014 and now account for 37%of use and are recommended as first line treatment options for newly diagnosed HIV patients.13 Advancements in treatment have contributed to lower pill burdens for patients who were required to take on average nearly four pills per day of therapy in 200

172、0 compared to just one pill in 2024.Assuming continued funding and research,new treatment options for HIV will continue to evolve,as the median time from launch to peak utilization for molecules launched in the last 25 years before they are superseded is four years.Exhibit 16:HIV defined daily doses

173、(DDDs)by mechanism and average pills per day of therapy,20002024Notes:Defined daily doses(DDDs)are based on WHO definitions where each medicine is assigned a volume of medicine per day(see methodology).RUNNING SECTION HEADERNRTIs are still a mainstay in HIV treatment,although new combinations have l

174、ed to lower pill burdens for patientsSource:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|21DDDs(Mn)All othersProtease inhibitorNNRTICYP3A inhibitor#Protease inhibitorCYP3A inhibitor#Protease inhibitor#NRTIIntegrase inhibitor#NNRTINNRTI#NRTICYP3A inhibitor#Int

175、egrase inhibitor#NRTIIntegrase inhibitorIntegrase inhibitor#NRTINRTI 20002002200420062008201020122014201620182020202220242000200220042006200820102012201420162018202020222024HIV DDDs by mechanism543210450400350300250200150100500Average pills per day of therapyPills per DDDPills per DDD While the tota

176、l number of days of therapy of cancer treatments in the U.S.remains unchanged over the last five years,the medicines that account for this volume have shifted.Use of both targeted and hormonal cancer treatments has grown 14%since 2019,while use of older cytotoxic medicines has declined 8%.Among targ

177、eted oncologics,the biggest drivers of growth are monoclonal antibody PD-1/PD-L1 inhibitors,which have nearly doubled in use over the last five years and accounted for 19%of targeted oncology days of therapy in 2024,and small molecule protein kinase inhibitors,particularly Brutons tyrosine kinase(BT

178、K)and CDK4/6 inhibitors which have grown 69%and 58%respectively since 2019.Hormonal treatments have grown significantly over the last five years driven by increasing treatment of prostate cancer.Over half of growth is attributed to leuprorelin,which was approved for advanced prostate cancer treatmen

179、t in 2022 rather than just for palliative care.Oral treatments that patients can administer themselves accounted for 37%of use across all classes in 2024 but are a larger share in both targeted oncologics(46%)and hormonals(65%),providing more readily available treatment options that patients can tak

180、e at home.Exhibit 17:Oncology defined daily doses(DDDs)by class and formNotes:Defined daily doses(DDDs)are based on WHO definitions where each medicine is assigned a volume of medicine per day(see methodology).Other forms include dermatologics used for treatment of skin cancers.MEDICINE USEUse of bo

181、th targeted and hormonal cancer treatments has grown over 13%since 2019,and oral medicines account for 37%of useSource:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Apr 2025.1,5971,5291,5421,5191,5231,4666516626766987277402952872973003213362,5432,4782,5152,5182,5712,54258%71%35%52%37%22%

182、65%46%4%7%0%3%DDDs(Mn)CytotoxicsInjectableOralOtherHormonalsTargeted oncologicsTotal3,0002,5002,0001,5001,0005000100%90%80%70%60%50%40%30%20%10%0%Share oncology DDDs by form,202420245-yeargrowth-0.1%13.9%13.7%-8.3%20232019TotalCytotoxicsHormonalsTargeted oncologics202020212022Oncology DDDs by class2

183、2|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending Contraception is characterized by a variety of different types ranging from more traditional routine contraception,which must be periodically taken,such as oral pills or long-acting injectable

184、s,to longer-term options,such as intrauterine devices(IUDs),or on-demand options,such as emergency contraception.Routine contraception use fell to 4.1 billion days of therapy in 2024,down 1%from the prior year and 12%from 2019,which could be the result of many factors including the rise of misinform

185、ation about contraception.14 Long-term contraceptive devices,which must be inserted or implanted by a healthcare provider,have also been declining,with 1.4 million devices provided to patients in 2024,down 6%from 2023,although these devices can be effective for many years.While more traditional form

186、s of contraception have been declining,alternative methods have been on the rise in more recent years.On-demand contraception,which includes emergency contraceptive pills “the morning-after pill”and contraceptive gels that are used prior to intercourse,has been growing driven by emergency contracept

187、ive pills whose use has grown 87%since 2019.Declines in prescription contraception could be associated with increasing interest in permanent contraception(i.e.,tubal ligation and vasectomy),which has increased to varying degrees following the Supreme Court ruling in Dobbs v.Jackson in June 2022 depe

188、nding on state policies regarding reproductive rights.15Exhibit 18:Contraception volumes by type,20192024Notes:Defined daily doses(DDD)are based on WHO definitions where each medicine is assigned a volume of medicine per day(see methodology).Contraception types are based on product descriptions and

189、EphMRA New Form Codes(NFC)assigned to each product.MEDICINE USEUse of more traditional forms of contraception including pills and devices are declining while on-demand options have grownSource:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Apr 2025.iqviainstitute.org|234,6284,4794,3944,31

190、44,1384,0933.63.95.67.17.67.51.71.61.61.51.51.4DDD Millions5,0004,5004,0003,5003,0002,5002,0001,5001,00050002019 2020 2021 2022 2023 20242019 2020 2021 2022 2023 20242019 2020 2021 2022 2023 2024Routine contraception#of devices(Mn)2.01.81.61.41.21.00.80.60.40.20.0Long-term contraceptive devices#of d

191、oses(Mn)876543210On-demand contraceptionOralVaginal ringLong-acting injectablePatchIUDImplantEmergencycontraceptionGel Influenza activity in the current 20242025 season is at historic levels,the highest seen in the last decade with an estimated nearly 97 million cumulative cases through mid-March 20

192、25.The number of cases in the current season is 38%higher than the same period in the prior season and 50%higher than the pre-pandemic average.The current season is 7%higher than the previous peaks which were in the 20172018 season and 20192020 season.The Centers for Disease Control and Prevention r

193、eports this is the first“high severity”season since 20172018 and the hospitalization rate is the highest observed since the 20102011 season.16 Contrasted with the increased number of cases is the significantly lower level of influenza vaccinations in the U.S.in the current season.Vaccinations were 9

194、%lower in the current season through February 2025 than the 20232024 season.Influenza vaccinations fell to 107 million through February 2025,levels last seen in the 20162017 season a concerning trend as influenza vaccines have shown effectiveness at reducing the risk of severe influenza and are the

195、best tool to prevent influenza and potential severe complications.17Exhibit 19:Estimated cumulative number of U.S.influenza cases and total flu vaccinations by seasonNotes:IQVIAs FAN(Flu/Cold/Respiratory Activity Notification Program)modeling draws on a combination of diagnostics information from of

196、fice-based medical claims,prescription claims from retail pharmacies,and deliveries of over-the-counter medications to establish estimates of diagnosed and treated populations.Flu vaccinations include those distributed through both retail and non-retail channels and do not reflect returns or unused

197、product.MEDICINE USEFlu cases have reached historic levels in the current flu season while flu vaccinations are the lowest since 20162017Source:IQVIA Consumer Health FAN,week ending 3/15/2025;IQVIA National Sales Perspective,Feb 2025;IQVIA Institute,Apr 2025.103106124134137163147143118107202320243 S

198、sn Avg(2016/17,2017/18&2018/19)2024202520152023120100806040200Flu vaccinations per season(Mn)Aug10Aug24Sep7Sep21Oct5Oct19Nov2Nov16Nov30Dec14Dec28Jan11Jan25Feb8Fab22Mar8Mar22Apr5Apr19May3May17May31Jun14Jun28Jul12Jul2620202021201920202015201620162017201720182018201920242025202320242021202220222023Esti

199、mated cumulative number of influenza cases(Mn)-9%24|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending For decades,influenza vaccines have been the only vaccines available and recommended for seasonal respiratory viruses.The onset of the COVID-1

200、9 pandemic and subsequent accelerations in vaccine development have resulted in COVID-19 launched in late 2020 and respiratory syncytial virus vaccines launched in mid-2023.With these new vaccines and novel vaccine modalities(e.g.,messenger RNA)has come a significant degree of vaccine hesitancy,limi

201、ting the number of people receiving these vaccines.18 RSV vaccines are recommended for all adults ages 75 and older and those 6074 at increased risk of severe RSV,as well as pregnant women.19 In the first respiratory illness season the RSV vaccine was available(Aug 2023Feb 2024)10.1 million vaccines

202、 were administered to adults,and this fell 65%to 3.5 million provided thus far in the current season (Aug 2024Feb 5).Since launch,14.7 million RSV vaccines have been administered to adults,however there are more than 25 million adults over the age of 75 in the U.S.and 57 million ages 6074,highlighti

203、ng significant gaps in vaccination.COVID-19 vaccines transitioned to the commercial market in 2023 and a federal government program providing free vaccines to the uninsured ended in Aug 2024.20 COVID-19 vaccinations declined 11%to 28 million in the current season from 32 million in the prior,as pati

204、ents must now use insurance or pay out-of-pocket.Exhibit 20:Monthly retail and long-term care respiratory syncytial virus and COVID-19 vaccines(Mn),Aug 2023Feb 2025Notes:COVID-19 and RSV vaccinations captured here are based on transactions processed through pharmacy dispensing systems in chain andin

205、dependent pharmacies,food stores,mass merchants and long-term care.MEDICINE USEVaccinations for other respiratory viruses declined significantly in the 20242025 respiratory season compared to the prior yearSource:IQVIA National Prescription Audit,Feb 2025.iqviainstitute.org|253,0002,5002,0001,5001,0

206、005000Aug 2023Sep 2023Oct 2023Nov 2023Dec 2023Jan 2024Feb 2024Mar 2024Apr 2024May 2024Jun 2024Jul 2024Aug 2024Sep 2024Oct 2024Nov 2024Dec 2024Jan 2025Feb 2025Aug 2023Sep 2023Oct 2023Nov 2023Dec 2023Jan 2024Feb 2024Mar 2024Apr 2024May 2024Jun 2024Jul 2024Aug 2024Sep 2024Oct 2024Nov 2024Dec 2024Jan 20

207、25Feb 202516,00014,00012,00010,0008,0006,0004,0002,0000AugFeb=3.5MnAugFeb=10.1MnAugFeb=28.2MnAugFeb=31.8MnRSVCOVID-19-65%-11%Routine adult and pediatric vaccinations shown here on average represent 98%of all vaccine volume in the U.S.excluding seasonal vaccines for influenza,COVID-19,and RSV vaccine

208、s with the other 2%of volume composed of travel vaccines and other non-routine vaccines,such as rabies and monkeypox vaccines.Annual pediatric vaccines,which had been slowly rising since a low in 2020,declined 6%in 2024 compared to the prior year and were 13%below 2019,while the pediatric population

209、 has remained stable.21 According to KFF the percent of parents who have delayed or skipped vaccinations for their children has increased to 17%in 2025,up from 9%in 2021.22 Adult vaccinations,which had been increasing since 2021,declined 11%in 2024 from the prior year and were 21%below the 2019 leve

210、l.Vaccination rates can vary across states for a variety of reasons including administration policies.States that allow pharmacists to prescribe and administer vaccines independently or through a standing order have been shown to have higher vaccination rates than states with protocols or physician

211、prescriptions required.23 Demographics,reimbursement,and access to providers and pharmacists who can administer vaccines are important factors that impact vaccination rates and developing strategies that incorporate these factors are critical in ensuring public health and health equity.24Exhibit 21:

212、Number of vaccines given annually for routine vaccines by age group excluding seasonal vaccines(Mn),20192024Notes:Pediatric vaccines include vaccines for haemophilus influenzae type b(Hib),hepatitis A,hepatitis B,HPV,poliovirus,pneumococcal,rotavirus,varicella and the combo vaccines for measles-mump

213、s-rubella(M-M-R),DTaP/hepatitis B/polio and DTaP/Poliovirus/Hib/Hepatitis B Vaccine.Adult vaccines include vaccines for shingles,pneumococcal,and Tdap.Adult and pediatric vaccines are retail and non-retail.List and age group based on a review of CDCs U.S.Vaccines webpage:https:/www.cdc.gov/vaccines/

214、hcp/vaccines-us/?CDC_AAref_Val and the FDA label for vaccines not included on CDCs list.Where vaccines are approved for both pediatric and adult,pack size and volume were used to distinguish between adult and pediatric.MEDICINE USEBoth adult and pediatric vaccinations declined in 2024,with pediatric

215、 vaccinations at levels last seen during the pandemicSource:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Mar 2025.574943495145585052535451PediatricAdult201920202021202220232024201920202021202220232024-6%-11%26|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care

216、,Patient Access,and Spending Across a range of common routine vaccinations provided to both children and adults,vaccinations have declined between 15%and 38%over the last five years.The measles,mumps,and rubella(MMR)vaccine is recommended for all children with the first dose given around age one.MMR

217、 vaccinations were nearly two million lower in 2024 compared to 2019,down 22%,as vaccination coverage among kindergartners has dropped from 95.2%in the 20192020 school year to 92.7%in the 20232024 school year.25 This trend also comes when the U.S.is experiencing one of the worst measles outbreaks in

218、 25 years and two deaths have been confirmed,the first in the U.S.from measles in a decade.25 Human papillomavirus(HPV)vaccinations have declined 15%since 2019 though remained stable since 2020.Cervical cancer incidence rates have been increasing in young adults,26 a concerning trend given HPV vacci

219、nes have been shown to be highly effective at preventing the virus and cervical and other cancers caused by HPV.27 Pneumococcal and shingles vaccines,which are primarily used to prevent severe disease in older adults,were near historic levels in 2023 but declined significantly in 2024,down 20%and 38

220、%,respectively,from 2019 levels.Exhibit 22:Number of vaccines given annually for selected vaccines(thousands),20192024Notes:Measles,mumps,and rubella(MMR)vaccines include those in combination with varicella.Pneumococcal vaccines include those for both adult and pediatric populations.Shingles vaccine

221、s do not include pediatric vaccines intended for the prevention of chickenpox.MEDICINE USEVaccination levels are 1538%lower compared to 2019 across a range of adult and pediatric vaccinesSource:IQVIA National Sales Perspective,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|275,6104,5834,8504,6

222、334,7804,7608,7276,3037,0406,9787,0046,800MMRHPV201920202021202220232024201920202021202220232024-22%-15%15,18813,69511,31212,99113,3789,35217,77016,34512,47516,21316,50214,257PneumococcalShingles201920202021202220232024201920202021202220232024-20%-38%28|Understanding the Use of Medicines in the U.S.

223、2025:Evolving Standards of Care,Patient Access,and Spending Patient out-of-pocket costs in aggregate reached$98Bn in 2024,an increase of$6Bn,with most of the increase in non-retail drugs.Medicare out-of-pocket costs were flat in 2024 compared to 2023,as Medicare Part D redesign began being implement

224、ed,while patients with other pay types experienced high growth.The average amount paid out-of-pocket per retail prescription has slightly increased from$9.64 in 2019 to$9.82 in 2024,with increasing out-of-pocket costs for branded drugs as generics continue to decline.More than 90%of all prescription

225、s have a final out-of-pocket cost below$20,and 1%of prescriptions have costs above$125.The share of prescriptions with no patient out-of-pocket costs has been rising,particularly in Medicare,while the number of prescriptions costing patients over$125 has also been rising.Across all pay types,1.6%of

226、patients reached annual out-of-pocket costs above$2,000,but 3.1%in Medicare largely due to benefit design.Fewer Medicare patients paid over$3,500 for prescriptions in 2024 as patient cost sharing in the catastrophic phase was eliminated,and those paying over$2,000 annually will likely see significan

227、t savings in 2025 from out-of-pocket caps.Average diabetes out-of-pocket costs have increased since 2022 driven by GLP-1s,even as insulins have continued to decline.Average patient out-of-pocket costs for obesity GLP-1 agonists are more than double the costs for diabetes GLP-1s,due to differences in

228、 list prices and insurance coverage.Insulin out-of-pocket costs have declined significantly saving patients over$600Mn in aggregate in 2024,although some patients,primarily uninsured,still pay high costs.Average inhaler out-of-pocket costs have declined 18%since 2019 to$16.22,but 13%of patient payme

229、nts remain above$35 and an additional$672Mn could be saved with costs capped at$35.Patient out-of-pocket costsFewer Medicare patients paid over$3,500 for prescriptions in 2024 as patient cost sharing in the catastrophic phase was eliminated,and those paying over$2,000 annually will likely see signif

230、icant savings in 2025 from out-of-pocket caps.iqviainstitute.org|29 Patient out-of-pocket costs increased by$6Bn in 2024 to a total of$98Bn,up 6.5%over 2023 and 25%over the last five years.Growth in 2024 was driven mostly by non-retail out-of-pocket costs,which grew by$4.4Bn,or 18%,in 2024,while ret

231、ail out-of-pocket costs grew by$1.7Bn,or 2.4%.Retail and non-retail out-of-pocket costs have contributed equally to five-year growth,both growing$9.8Bn over the last five years,with retail out-of-pocket costs increasing an average 3.1%annually and non-retail increasing an average 4.6%annually.As mos

232、t prescriptions are dispensed as generic drugs and individual prescription costs fall,overall out-of-pocket costs have risen,driven by population changes,increasing use of medicines,the mix of medicines used,and offset by use of manufacturer coupons.Exhibit 23:Aggregate patient out-of-pocket cost fo

233、r medicines dispensed in retail and non-retail settings,US$BnNotes:Retail OOP based on LAAD sample prescription data,grossed up to NPA adjusted prescriptions normalizing for 90-day prescription dispensing Non-retail estimates based on CMS NHE for personal healthcare excluding retail prescription dru

234、gs.IQVIA estimates of non-retail drug(modified by estimates of rebates and offset by applying the estimated net cost of insurance and typical channel markups)with CMS PHC OOP%applied to those amounts.PATIENT OUT-OF-POCKET COSTSPatient out-of-pocket costs in aggregate reached$98Bn in 2024,an increase

235、 of$6Bn,with most of the increase in non-retail drugsSource:IQVIA LAAD Sample Claims Data,CMS National Health Expenditures,Dec 2024;IQVIA Institute,Mar 2025.6060636468701918222424297978858892982024202320222020 2021 2019Out-of-pocket non-retailOut-of-pocket retail Out-of-pocket costs rose in aggregat

236、e for commercially-insured patients,Medicaid beneficiaries,and those who paid cash while Medicare out-of-pocket costs were relatively flat,likely driven by Medicare Part D redesign starting in 2024.Commercial insurance out-of-pocket costs,which account for 53%of overall patient out-of-pocket costs,r

237、ose 7%in aggregate in 2024 and 34%over five years from increased volume and shifts in the mix of prescriptions to those carrying higher costs.Medicare out-of-pocket costs rose in aggregate by$325Mn(1.2%)in 2024 as Medicare Part D redesign went into effect,but by more than$6.4Bn(31%)over the last fiv

238、e years driven by increased volume as well as shifts in the mix of prescriptions.Uninsured patients account for 17%of overall patient out-of-pocket costs and paid$17Bn in 2024 for only 3%of prescriptions.Cash out-of-pocket costs increased 11%in 2024 but have declined,in aggregate,3%over five years,p

239、rimarily from declines in volume and the number of people uninsured.Medicaid patients account for 12%of prescriptions and 1%of patient out-of-pocket costs,as most of their costs are waived as a result of benefit design.Exhibit 24:Out-of-pocket costs by method of payment,US$BnNotes:Out-of-pocket(OOP)

240、costs estimated based on prescription volumes and observed OOP costs.OOP costs were projected from a sample in the IQVIA LAAD sample claims data to a national estimate using national adjusted prescriptions.Method of payment is determined based on the most common or mode pay type in recorded claims.C

241、ash method of payment includes those where patients used no insurance,including those who received some assistance from charities,foundations,or other programs.PATIENT OUT-OF-POCKET COSTSMedicare out-of-pocket costs were flat in 2024 compared to 2023 while other pay types experienced high growthSour

242、ce:IQVIA LAAD Sample Claims Data,CMS National Health Expenditures,Dec 2024;IQVIA Institute,Apr 2025.30|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and SpendingCommercialMedicaidMedicareCash/assistanceCash/assistance1 year%OOP changeper pay typeMedicai

243、dCommercialMedicareOut-of-pocket costs by method of payment US$bnOut-of-pocket costs in 2024$98Bn+11.3%+1.2%+12.7%+7.3%2024605040302010020192020202120222023181739521121271%53%17%29%Overall,average out-of-pocket costs were flat in 2024 compared to 2023,with average prescription costs rising from$9.64

244、 in 2019 to$9.82 in 2024 across all products and all payers.Uninsured patients paying with cash saw the highest costs in 2024 across all products,growing from$47.55 to$48.45,with brand prices up significantly from$86.95 in 2019 to$130.18 in 2024,while generic prices have dropped by$2.45 per prescrip

245、tion.Medicare average prescription costs dropped from$6.19 to$5.28 as brand costs increased$1.51 and generic costs declined$1.31 but were used more often.Average commercially-insured patient prescription costs increased from$7.92 to$8.01 as brand costs rose from$20.02 to$25.07 over five years;brand

246、costs remain low for commercial patients primarily due to the use of coupons to offset higher list prices.For generics,costs across all payers have declined,while for brands,costs for commercially-insured and cash-paying patients grew in 2023 and 2024,primarily driven by increased use and higher out

247、-of-pocket costs for GLP-1 agonists in both diabetes and obesity(Exhibit 30).Exhibit 25:Average final out-of-pocket cost per retail prescription by product type and method of payment,20192024Notes:Includes paid claims only.Prescriptions and costs normalized to 30 days.PATIENT OUT-OF-POCKET COSTSThe

248、average amount paid out-of-pocket per retail prescription has slightly increased from$9.64 in 2019 to$9.82 in 2024Source:IQVIA LAAD Sample Claims Data,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|31201920202021202220232024201920202021202220232024201920202021202220232024All productsBrandGener

249、icCommercialMedicaidMedicareCash/assistanceAll payers$20.02$25.07$0.65$0.31$23.32$24.83$23.38$28.69$86.95$130.18$7.92$8.01$0.41$0.22$6.19$5.28$9.64$9.82$47.55$48.45$42.15$39.71$5.79$5.18$0.37$0.21$3.79$2.48$7.46$6.95 Over 79 million prescriptions 1%of the total were filled in 2024 with a final out-o

250、f-pocket cost above$125,and more than 14 million prescriptions with an out-of-pocket cost over$500.While 93%of all prescriptions across all payers have an out-of-pocket cost under$20,this drops to 74%of prescriptions for those paying cash,while 6%of prescriptions cost above$125 for these patients.Fo

251、ur percent of brands have a final out-of-pocket cost over$125,with Medicare beneficiaries exposed to higher prescription costs and 7%of brand prescriptions having an out-of-pocket cost over$125.Cash paying patients have significantly higher costs for brand prescriptions,with 14%having out-of-pocket

252、costs greater than$125,likely leading to higher abandonment of brands among these patients.While relatively few patients fill prescriptions at higher cost levels,abandonment rates are also known to be higher,and therefore those prescriptions may be underrepresented as they may have been abandoned du

253、e to cost(Exhibit 36).A rising number of prescriptions are now dispensed with a$0 payment by the patient(Exhibit 27)and amount to 54%of all branded prescriptions and 46%of all product prescriptions in 2024.These zero cost prescriptions are driven by a combination of factors,including patients reachi

254、ng out-of-pocket maximums,receiving coupons (some of which lower costs to zero),or by benefit designs,which provide free products in certain classes or from Medicaid.Exhibit 26:Distribution of prescriptions by out-of-pocket cost in 2024Notes:Includes paid claims only.Prescriptions and costs normaliz

255、ed to 30-days.PATIENT OUT-OF-POCKET COSTS93%of all prescriptions have a final out-of-pocket cost below$20;1%of prescriptions have costs above$125Source:IQVIA LAAD Sample Claims Data,Dec 2024;IQVIA Institute,Mar 2025.32|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Pat

256、ient Access,and Spending93%1%74%4%Medicaid Cash/assistanceCommercial Medicare All payers 0%50%60%70%80%90%100%40%30%20%10%0%50%60%70%80%90%100%40%30%20%10%All prescriptions:brands and genericsBrands only$500+$250-$499.99$125-$249.99$75-$124.99$50-$74.99$40-$49.99$30-$39.99$20-$29.99$10-$19.99$0.01-$

257、9.99$0 Benefit designs across all types of insurance include circumstances where a patient has zero out-of-pocket costs for individual prescriptions due to reaching out-of-pocket maximums for a year,no cost-sharing for preventative drugs,or use of coupons which bring patient costs to zero.The share

258、of prescriptions with zero costs has been rising across all pay types with 46%of all prescriptions in 2024 costing patients$0 compared to 32%in 2019.Medicare has seen the largest growth in the share of$0 prescriptions,growing from 31%in 2019 to 56%,primarily driven by increased utilization of generi

259、c hypertension and cholesterol medicines,which frequently have no patient costs.In commercial insurance,29%of prescriptions were filled with no cost in 2024,up from 25%in 2019,including a mix of patients reaching out-of-pocket maximums,as well as those using coupons with a$0 copay.Additionally,the n

260、umber of prescriptions costing patients more than$125 has also been rising across all pay types except Medicaid,primarily driven by growing use of high-cost branded drugs.Medicare has seen the most growth in high-cost prescriptions over the last five years,averaging 23%growth annually,though growth

261、slowed in 2024 to 5%as patient cost-sharing was eliminated in the catastrophic phase,limiting patients cost exposure over the year.Exhibit 27:Share of prescriptions with$0 out-of-pocket cost and number of prescriptions over$125 out-of-pocket by pay typeNotes:Includes paid claims only.Prescriptions a

262、nd costs normalized to 30-days.PATIENT OUT-OF-POCKET COSTSThe share of prescriptions with no patient out-of-pocket costs has been rising,particularly in MedicareSource:IQVIA LAAD Sample Claims Data,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|33Cash/assistanceCommercialMedicareAll payersMedi

263、caidMedicareCommercialCash/assistanceMedicaid2019202020212022202320242019202020212022202320249080706050403020100Number of prescriptions(Mn)100%90%80%70%60%50%40%30%20%10%0%Number of prescriptions over$125Share of prescriptions with$0 OOP cost Across all patients,1.6%reach annual out-of-pocket costs

264、above$2,000 and 7.7%pay more than$500 out-of-pocket for prescriptions.In Medicaid,74%of patients have no annual out-of-pocket costs for prescriptions,with less than 1%of patients paying more than$500 out-of-pocket for prescriptions.In 2024,Medicare Part D patient cost-sharing was eliminated in the c

265、atastrophic phase as a result of the Inflation Reduction Act(IRA),and out-of-pocket costs will be capped at$2,000 annually starting in 2025.28 As a result of changes in 2024,fewer Medicare patients paid more than$3,500 in out-of-pocket costs though 1.4 million(3.1%)still reached prescription out-of-

266、pocket costs over$2,000.In Medicare,15%of patients pay more than$500 out-of-pocket the amount where cost-sharing starts for patients with standard coverage under Medicare Part D and patients become responsible for 25%of costs.In commercial coverage,1.3%of patients pay more than$2,000 and 7.4%pay mor

267、e than$500.For the millions of seniors who become Medicare eligible each year,the cost exposure difference as their insurance changes can be a significant shock as seniors have higher cost exposure than the commercially-insured.Exhibit 28:Patients by annual prescription out-of-pocket cost in 2024Not

268、es:Patients who filled at least one prescription in our sample were included.Patients were grouped into cohorts by method of payment and costs aggregated in the year.PATIENT OUT-OF-POCKET COSTSAcross all pay types,1.6%of patients reached annual out-of-pocket costs above$2,000,but 3.1%in MedicareSour

269、ce:IQVIA LAAD Sample Claims Data,Dec 2024;IQVIA Institute,Mar 2025.34|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending22%25%Medicaid Commercial Medicare All payers$2,000-$3,499.99$1,500-$1,999.99$1,250-$1,499.99$1,000-$1,249.99$750-$999.99$400

270、-$499.99$300-$399.99$200-$299.99$50-$99.99$100-$199.99$1-$49.99$0 235Mn45Mn114Mn40Mn1.6%3.7Mn3.1%1.4Mn1.3%1.4Mn0.3%105k0%50%60%70%80%90%100%40%30%20%10%$3,500+$500-$749.99 13%74%More Medicare patients have been facing costs above$2,000 per year over time as drug costs have risen and historic benefit

271、 design had costs mitigated but not capped in the catastrophic phase.In 2024,the implementation of Medicare Part D redesign from the Inflation Reduction Act(IRA)began to phase in,with the elimination of patient cost-sharing in the catastrophic phase,and more of these patients falling into total annu

272、al prescription out-of-pocket costs from$2,000 to$3,500.In aggregate,high-cost Medicare patients paid$6.5Bn in out-of-pocket costs in 2024,down from$7.0Bn in 2023,with most of the reduction in those patients above$3,500 annual spend.This pattern highlights that some of these patients also benefited

273、from insulin price cuts,which lowered their costs unrelated to the benefit design changes.Overall Medicare out-of-pocket costs rose in 2024 to$27.1Bn from$26.8Bn in 2023(Exhibit 24),indicating that while high-cost patients had their aggregate costs fall$500Mn,other patients costs rose by$200Mn which

274、 was volume-driven as average costs declined(Exhibit 25).If all Medicare patients who paid more than$2,000 in total out-of-pocket costs for prescriptions in 2024 had their out-of-pocket costs capped at$2,000,patients would have saved on average$2,092.Exhibit 29:Number of patients in Medicare with an

275、nual prescription out-of-pocket costs$2,000+,20192024Notes:Patients who filled at least one prescription in our sample were included.Patients were grouped into cohorts by method of payment and costs aggregated in the year.PATIENT OUT-OF-POCKET COSTSFewer Medicare patients paid$3,500 for prescription

276、s in 2024 as patient cost sharing in the catastrophic phase was eliminatedSource:IQVIA LAAD Sample Claims Data,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|351,8412,3432,6162,8853,1413,1051,7692,0652,5753,0423,8903,4223,6104,4075,1915,9277,0316,52820192020202120242023202220192020202120242023

277、2022Total Medicare retail OOP by patient annual OOP,US$MnNumber of patients with annual prescription OOP$3,500+$2,000$3,499.99$2,000$3,499.99$3,500+Total641,395763,172767,509896,9211,000,3621,056,731170,735212,544234,986308,403386,943343,467 Average out-of-pocket costs for diabetes prescriptions hav

278、e had varying trends over the last five years across modalities,contributing to an overall increase across all therapies of$6.55 from 2019 to 2024 with the majority of the growth in the last two years.The largest driver of this increase is the growing utilization and high cost of GLP-1 agonists,part

279、icularly in 2023 and 2024 where the average out-of-pocket cost jumped from$39.17 in 2022 to$52.32 in 2023 and remained high in 2024 at$52.37.SGLT2 inhibitors,which have also seen growing use(Exhibit 11)have also been contributing to increased out-of-pocket costs in diabetes with a 47%increase over t

280、he last five years,though the average out-of-pocket costs for these therapies is 41%below that of GLP-1 agonists.Declining insulin out-of-pocket costs have offset some of the increases in these newer generation therapies,with the average cost declining$11.40 from 2019 to 2024,though insulin use has

281、also been declining.Across all patients,benefit design changes,manufacturer and Inflation Reduction Act out-of-pocket caps,manufacturer price cuts,and the availability of biosimilars are contributing to falling insulin costs,down 41%over the last five years.Exhibit 30:Diabetes average out-of-pocket

282、costs by modality,20192024Notes:Includes paid claims only.Prescriptions and costs normalized to 30 days.PATIENT OUT-OF-POCKET COSTSAverage diabetes out-of-pocket costs have increased since 2022 driven by GLP-1s,even as insulins have continued to declineSource:IQVIA LAAD Sample Claims Data,Dec 2024;I

283、QVIA Institute,Mar 2025.36|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and SpendingGLP-1 agonistsDPP-IV inhibitorsSGLT2 inhibitorsInsulinsAll therapiesOther newergeneration therapiesTraditional therapies$33.42$53.37$27.07$33.21$21.06$30.89$27.65$16.25

284、$12.45$19.00$6.81$6.75$3.14$2.90201920202021202220242023 Average out-of-pocket costs for obesity GLP-1 therapies are generally higher than for the diabetes versions of the same molecule,generally as a result of differences in insurance coverage.For patients paying for obesity GLP-1s with commercial

285、insurance,the average out-of-pocket cost was$101 in 2024,just 12%of the$856 cash-paying patients paid,and over 2.5 times more than patients using the drugs for diabetes.Medicare patients by law are unable to use their insurance for obesity medicines unless the use is for another approved comorbidity

286、,such as cardiovascular risk prevention.Prior to the approval of these drugs for those other uses,these patients were paying directly rather than using their insurance,and some of this payment pattern persists,depending on the diagnoses the patients present with.Formulary coverage and cost-sharing m

287、odels along with complex patterns of comorbidity in cardiometabolic diseases are resulting in a complex mix of issues either preventing access to novel GLP-1s for obesity or presenting patients with widely varying costs.Despite significant cost exposure and access barriers,millions of patients have

288、begun taking GLP-1 therapies for obesity,often with a higher-than-average patient out-of-pocket cost.Exhibit 31:GLP-1 average out-of-pocket costs by indication and method of payment,20192024Notes:Method of payment is transaction-level.Patients may typically be a Medicare or commercially insured pati

289、ent,but instead pay cash depending on plan coverage for their medicine.Medicare legal prohibition on obesity drug reimbursement does not prevent individuals from choosing alternative payment methods.PATIENT OUT-OF-POCKET COSTSAverage patient out-of-pocket costs for obesity GLP-1s are more than doubl

290、e costs for diabetes GLP-1sSource:IQVIA LAAD Sample Claims Data,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|37201920202021202220232024201920202021202220232024Antidiabetic GLP-1sObesity GLP-1sCommercialMedicaidMedicareCash/assistanceAll payers$41.06$101.26$6.26$0.73$74.45$117.73$60.67$112.30

291、$391.73$856.38$28.05$38.86$1.41$0.57$40.56$51.99$33.32$51.32$218.51$676.94 The average out-of-pocket cost for a months supply of insulin has declined across all pay types,reaching$16.01 for all payers in 2024 compared to$27.36 in 2019.Patients without insurance have seen average insulin out-of-pocke

292、t costs cut in half since 2019,with significant declines in 2023 and 2024 as manufacturer out-of-pocket caps of$35 went into effect.Uninsured patients still face significant costs though with average costs of over$70 in 2024 which is likely understated due to patient abandonment of high-cost prescri

293、ptions.Insurance design influences what patients pay for insulin,with 45%of cash-paid prescriptions costing those patients more than$35 compared to 12%of insulin prescriptions for commercially insured patients.An IRA cap of$35 on out-of-pocket costs of insulins for Medicare patients that went into e

294、ffect in 2023 has reduced the share of insulin prescriptions over$35 from 29%in 2019 to just 9%in 2024.Out-of-pocket caps for insulins of$35 per month from the IRA and major insulin manufacturers have reduced aggregate out-of-pocket costs for insulins 45%over the last five years.Patients saved nearl

295、y$681Mn in 2024 compared to prices paid at the peak in 2020.A small portion of patients,primarily the uninsured and commercially insured,still pay more than$35 for insulin prescriptions and may not be aware of manufacturer programs that could lower their insulin costs.Exhibit 32:Insulin average out-

296、of-pocket costs,share of prescriptions with costs$35,and aggregate out-of-pocket costs by prescription final out-of-pocket costNotes:Includes paid claims only.Prescriptions and costs normalized to 30 days.Does not reflect initial cost exposure.Values may not sum due to rounding.Final out-of-pocket c

297、ost reflects the final patient responsibility after insurance and the use of coupons or other assistance for cash or commercial patients.Savings calculated as out-of-pocket cost minus$35 per month for prescriptions costing above$35.Savings could be offset in future if lower-cost prescriptions have h

298、igher costs.PATIENT OUT-OF-POCKET COSTSInsulin out-of-pocket costs have declined significantly,although some patients,primarily uninsured,still pay high costsSource:IQVIA LAAD Sample Claims Data,National Prescription Audit,Dec 2024;IQVIA Institute,Mar 2025.38|Understanding the Use of Medicines in th

299、e U.S.2025:Evolving Standards of Care,Patient Access,and Spending4204084914895765894945133913402412138648666365363271701,778 1,7861,5181,3651,1449712019 2020 20212024202320222019 2020 2021202420232022201920202021202420232022Insulins average finalout-of-pocket costs Insulins%of prescriptionswith OOP$

300、35Total OOP costs by final OOPcost per prescription,US$Mn$35 capped$35 excess cost$3560%50%40%30%20%10%0%CommercialCashMedicareAll payers$27.36$16.01$24.28$19.19$27.44$14.22$148.60$70.72 The average monthly out-of-pocket cost for an inhaler has declined across all pay types,reaching$16.22 for all pa

301、yers in 2024 compared to$19.67 in 2019.Uninsured patients paying cash face the highest out-of-pocket costs for inhalers at over$75 per month.Inhaler prescriptions paid with cash represent only 1%of all prescriptions,likely a result of abandonment as more than 26%of prescriptions are abandoned at pri

302、ces over$75.Insurance design influences what patients pay for inhalers,with 45%of cash-paid prescriptions costing those patients more than$35 compared to 16%of cash-paid prescriptions across all medicines.Among insured patients,commercially insured patients are less likely to pay over$35 for an inha

303、ler than Medicare patients,with 10%of commercial inhaler prescriptions over$35 compared to 19%of Medicare prescriptions.Three of the largest inhaler suppliers have announced out-of-pocket caps of$35 a month for inhaler prescriptions for uninsured and commercially insured patients going into effect b

304、y January 1,2025.29 However,these caps will likely not address the high costs paid by some patients covered by Medicare plans.Exhibit 33:Inhaler average out-of-pocket costs and share of prescriptions with costs$35Notes:Includes paid claims only.Prescriptions and costs normalized to 30 days.Does not

305、reflect initial cost exposure.PATIENT OUT-OF-POCKET COSTSAverage inhaler out-of-pocket costs have declined 18%since 2019 to$16.22,but 13%of patient payments remain above$35Source:IQVIA LAAD Sample Claims Data,Dec 2024.iqviainstitute.org|392019 2020 20212024202320222019 2020 2021202420232022Inhaler a

306、verage final out-of-pocket costs Inhaler%of prescriptionswith OOP$35All drugs%of prescriptionswith OOP$3570%60%50%40%30%20%10%0%CommercialCashMedicareAll payers$19.67$16.22$22.99$15.75$22.57$18.69$76.86$75.172019 2020 202120242023202270%60%50%40%30%20%10%0%40|Understanding the Use of Medicines in th

307、e U.S.2025:Evolving Standards of Care,Patient Access,and Spending4161531982902413686285681089348.735.129.40.75.78.300.611207054.343.329.41.26446346186275915887387206376295905087157927767857636722,0972,1462,031 2,0411,9441,7672019 2020 2021 2022 2023 2024Commercial MedicareMedicaidCash/assistanceComm

308、ercial MedicareMedicaidCash/assistanceTotal OOP costs by final OOPcost per prescription,US$MnTotal inhaler prescriptionsby final OOP cost,Mn,2024Total OOP costs by final OOPcost per prescription,US$Mn,202416%$35 capped$35 excess cost$35$35 capped$35 excess cost$35$35Total Rx$35 Aggregate out-of-pock

309、et costs paid by patients for inhaler prescriptions were relatively flat from 2019 to 2023 at nearly$2Bn annually,however total costs dropped to nearly$1.8Bn in 2024,down 16%from 2019.Over two-thirds of out-of-pocket costs are linked to the 13%of prescriptions that cost patients more than$35.Three o

310、f the largest inhaler suppliers have announced out-of-pocket caps of$35 a month for inhaler prescriptions with some going into effect June 1,2024,and the remainder January 1,2025,although these caps are limited to uninsured and commercially-insured patients.29 If costs were capped at$35 for all pati

311、ents,they would save$672Mn:$241Mn in commercial plans,$368Mn in Medicare,and$62Mn for cash-paying patients(typically the uninsured).In 2024,there were 14.5 million inhaler prescriptions costing more than$35,although this is down 31%(6.6 million)from 2019,despite an increase in the total number of in

312、haler prescriptions.Patients spent$856Mn in commercial plans,$810Mn in Medicare,and$93Mn when paying cash,and per prescription savings would average$43 in commercial,$44 in Medicare,and$110 for cash.The$35 out-of-pocket cap could benefit patients needing these life-saving medicines especially if app

313、lied to all patients,including those with Medicare coverage.Exhibit 34:Number of inhaler prescriptions with final out-of-pocket cost above and below$35 and potential savings if costs were capped at$35,US$MnNotes:Values may not sum due to rounding.Prescriptions in retail pharmacies were adjusted to c

314、onsistent 30-day prescription lengths for cost and volume comparison purposes.Final out-of-pocket cost reflects the final patient responsibility after insurance and the use of coupons or other assistance for cash or commercial patients.Savings calculated as out-of-pocket cost minus$35 per month for

315、prescriptions costing above$35.Savings could be offset in future if lower-cost prescriptions have higher costs.PATIENT OUT-OF-POCKET COSTSAggregate inhaler out-of-pocket costs declined 16%since 2019 and an additional$672Mn could be saved with costs capped at$35Source:IQVIA LAAD Sample Claims Data,Na

316、tional Prescription Audit,Dec 2024;IQVIA Institute,Mar 2025.iqviainstitute.org|41 Across all payers 27%of new prescriptions go unfilled primarily due to medicines not being covered by payers,but over one-third go unfilled in Medicaid with a larger contribution from rejections of prior authorizations

317、.Patients starting new therapy abandoned 96 million prescriptions at pharmacies in 2024 with increasing frequency as costs rise.Over half of new prescriptions for novel medicines go unfilled,and only 29%of patients remained on therapy for a year.Average fill rates for new medicines can vary across t

318、he country,with states in New England tending to have higher average fill rates for new medicines,while the Southwest has below average fill rates.Obesity savings program spend for commercial prescriptions grew 390%in 2024,while diabetes declined 47%likely as prices declined or products had better c

319、overage under patients plans.In 2024 only 28%of obesity GLP-1 prescriptions were filled,while 62%were rejected by payers,and 10%abandoned by patients as payers continue to place controls on use due to high costs.While generics are generally preferred,over 25%of new generic claims are rejected by pay

320、ers two years after generic entry limiting generic uptake and savings to patients and the health system.The historic pattern of rapid and deep generic erosion and price reduction may not be continuing as generic uptake is lower for generics entering in the last five years compared to those entering

321、1020 years ago.Biosimilars have seen varying degrees of uptake across molecules though overall biosimilars launched to date account for only 24%of competitive molecule volume.Benefit design impacts on patient accessThe historic pattern of rapid and deep generic erosion and price reduction may not be

322、 continuing as generic uptake is lower for generics entering in the last five years compared to those entering 1020 years ago.Patients prescribed a new medicine by their healthcare provider may not fill those prescriptions,and while cost and patient behavior is often a factor,coverage rejections by

323、payers are a larger driver of unfilled prescriptions.Overall,27%of written prescriptions are not filled due to payer rejections and abandonment by patients.The unfilled rate includes 34%in Medicaid,24%in Medicare,and 28%in commercial insurance.Payer rejections may be driven by formulary decisions,fa

324、ilure to satisfy prior authorization requirements,refilling too soon or exceeding volume limits,but nearly half of those rejections are overcome either by the patient switching to a secondary insurer,paying cash,or adding a coupon.Payers rejected 16%of written new prescriptions in 2024,with the majo

325、rity of these rejections driven by medicines not being covered on formularies.Patient abandonment overall averaged 10-12%across pay types reflecting more consistent responses to cost exposure across patients,with variations consistent with benefit design differences across insurance types.Cost-drive

326、n abandonment is understood to impact patients with fixed copays less than those with coinsurance in high-deductible health plans or standard benefit Medicare Part D.Exhibit 35:Pharmacy claim status for brand and branded generics new written prescriptions,2024Notes:Claim status based on 30 day lookf

327、orward period.New payers include secondary insurers and the patient paying cash with or without a coupon or other form of assistance.Percentages reflect changes in aggregate new prescription claims across all brand and branded generic products.BENEFIT DESIGN IMPACTS ON PATIENT ACCESSAcross all payer

328、s 27%of new prescriptions go unfilled but over one-third go unfilled in Medicaid primarily due to payer rejectionsSource:IQVIA Libraries Payer Control Library,Dec 2024.42|Understanding the Use of Medicines in the U.S.2025:Evolving Standards of Care,Patient Access,and Spending100%-27%12%84%-11%73%Rej

329、ected all payersAbandonedFilledFilledNBRxAbandonedbypatientTotalapprovedNBRxApprovalby newpayerRejectedby originalpayerWrittenNBRxAll payersCommercialMedicaidMedicareWritten butunfilled 27%Rejected allpayers 16%24%10%66%12%16%72%n=49.8Mnn=13.4Mnn=41.2Mn14%10%76%The number of prescriptions written an

330、d transmitted to pharmacies by doctors,either by traditional paper,phone or electronically,for a variety of reasons exceeds the number that patients filled by 10%,the most common reason being the cost of the prescription,with the effect rising as costs rise.Of prescriptions with a final cost above$2

331、50,54%are not picked up by patients as compared with 7%of patients who do not fill when the cost is less than$10.Of the 96 million new-to-product prescriptions abandoned in 2024,41 million were abandoned when costs were under$10,including zero cost prescriptions,while the remaining 55 million were a

332、bandoned at greater rates as costs rise.Many traditional insurance plans with a fixed copay design include brand copays of less than$30 for preferred products,with abandonment of 13%or less.This can be compared to a non-preferred brand copay of$75 with an abandonment rate of 26%or higher.Benefit des

333、igns that inherently expose patients to costs use this patient behavior relating to costs to encourage the use of lower-cost medicines but can equally result in patients not receiving necessary medicines.Some therapy areas where branded products are often more costly at list prices,including oncology and immunology,have notable rates of abandonment exceeding 30%for the pharmacy-dispensed medicines