College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
Am J Health Syst Pharm. 2019 Jul 18;76(15):1105-1121. doi: 10.1093/ajhp/zxz109.
Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2019 in nonfederal hospitals, clinics, and overall (all sectors).
Drug expenditure data through calendar year 2018 were obtained from the IQVIA National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2019 were also reviewed. Expenditure projections for 2019 for nonfederal hospitals, clinics, and overall (all sectors) were made through a combination of quantitative analyses and expert opinion.
U.S. prescription sales in calendar year 2018 totaled $476.2 billion, a 5.5% increase from 2017 spending. The top 3 drugs by expenditures were adalimumab ($19.1 billion), insulin glargine ($9.3 billion), and etanercept ($8.0 billion). Prescription expenditures in nonfederal hospitals totaled $35.8 billion, a 4.8% increase from 2017. Expenditures in clinics in 2018 increased by 13.0% to $80.5 billion. The increase in spending in nonfederal hospitals was largely driven by new products and increased utilization of existing products. The list of the top 25 drugs by expenditures in nonfederal hospitals and clinics was dominated by specialty drugs.
We predict continued moderate growth of 4-6% in overall drug expenditures (across the entire U.S. market). We expect the clinic sector to continue to experience high (11-13%) growth in drug spending in 2019. Finally, for nonfederal hospitals we anticipate growth in the range of 3-5%. These estimates are at the national level. Health-system pharmacy leaders should carefully examine local drug utilization patterns to determine their own organization's anticipated spending in 2019.
讨论影响未来医药支出的历史趋势和因素，并对 2019 年非联邦医院、诊所和总体（所有部门）的药物支出进行预测。
通过 IQVIA 国家销售透视数据库获取截至 2018 年的药物支出数据，并进行分析。还审查了可能影响 2019 年医院和诊所药物支出的新药批准、专利到期和其他因素。通过定量分析和专家意见的结合，对 2019 年非联邦医院、诊所和总体（所有部门）的支出进行了预测。
2018 年美国处方药销售额总计 4762 亿美元，比 2017 年增长 5.5%。支出最高的前 3 种药物是阿达木单抗（191 亿美元）、甘精胰岛素（93 亿美元）和依那西普（80 亿美元）。非联邦医院的处方药支出总计 358 亿美元，比 2017 年增长 4.8%。2018 年诊所支出增长 13.0%，达到 805 亿美元。非联邦医院支出增长主要是新产品的推出和现有产品的使用增加所致。非联邦医院和诊所支出最高的 25 种药物清单主要由专科药物主导。
我们预计整体药物支出（整个美国市场）将继续以 4-6%的速度适度增长。我们预计诊所部门在 2019 年药物支出将继续保持 11-13%的高增长率。最后，我们预计非联邦医院的增长率在 3-5%之间。这些估计是在全国范围内进行的。卫生系统药剂师领导应仔细检查当地药物使用模式，以确定其组织在 2019 年的预期支出。
