Institute Report
The Global Use of Medicines 2022
Outlook to 2026
Dec 09, 2021

Summary

The outlook for global spending on medicines has become clearer as the uncertainties of the last two years in a global pandemic have gradually given way to more predictable challenges and opportunities for healthcare systems and policymakers across developed and emerging economies. Healthcare has shown itself to be remarkably resilient during COVID-19, but challenges remain — and evidence-based decision-making is more important than ever.

The largest driver of medicine spending through the next five years is expected to be global COVID-19 vaccinations, which are unprecedented both because of the number of people being inoculated and the speed with which it is expected to be achieved and then repeated with frequent booster shots. But even leaving aside the pandemic, global spending on medicines continues to be driven by innovation and offset by losses of exclusivity and the lower costs of generics and biosimilars.

In this report, we quantify the impact of these dynamics and examine the spending and usage of medicines in 2021 and the outlook to 2026, globally and for specific therapy areas and countries. We intend this report to provide a foundation for meaningful discussion about the value, cost and role of medicines over the next five years in the context of overall healthcare spending.

Key Findings

  • The global medicine market — using invoice price levels — is expected to grow at 3-6% CAGR through 2026.
  • Medicine use and spending trends have been negatively impacted by the COVID-19 pandemic but will be more than offset by incremental spending on related vaccines and therapeutics.
  • Global medicine spending will be lifted by stronger pharmerging market growth through 2026 and offset by slower growth in developed markets caused by losses of exclusivity for original brands.
  • A total of 300 new drugs are expected to be launched over the next five years to 2026, significantly higher than the level seen on average during the past decade, and are expected to skew toward specialty, niche and orphan drugs.
  • New product launches in the next five years will result in $196Bn in new spending, largely offset by reductions in brand spending, with $188Bn due to losses of exclusivity.
  • The two leading global therapy areas — oncology and immunology — are forecast to grow 9-12% and 6-9% CAGR, respectively, through 2026, lifted by significant increases in new treatments and medicine use and offset by the impact of biosimilars.
  • In neurology, many new medicines are expected across a range of diseases, including novel migraine therapies, rare neurological diseases, and the potential for therapies for Alzheimer’s and Parkinson’s disease.

Other Findings


Global spending, including COVID-19 vaccines and therapeutics, to exceed pre-pandemic outlook by $133Bn to 2026

  • The outlook for global medicine spending has shifted considerably in the years 2020 to 2022, but afterward is expected to be similar to the pre-COVID outlook, excluding the spending for COVID-19 vaccines.
  • As a result of lower spending in the near-term, spending is expected to be $175 billion lower over seven years to 2026 than it would have been without the pandemic, excluding the incremental spending on vaccines and therapeutics for COVID-19.
  • The most important drivers of lower spending will be those, often asymptomatic conditions which have had patient engagement disrupted and fail to make up the backlog of previously expected usage and spending.
  • The phased rollout of vaccines and booster shots in the base case estimate will result in $250 billion in incremental spending globally, resulting in a net impact on spending of $133 billion, or about 3% of the cumulative global spend during that period.
  • A rapid first wave of vaccinations, reaching 70% of the world by the end of 2022, was possible with current manufacturing capacity, but is ultimately expected about a year later near the end of 2023.

Global market growth will return to pre-pandemic projections by 2025 despite year-to-year fluctuations

  • While the short-term impact from COVID-19 in 2020 and 2021 has been significant, the long-term impact on growth trends is more muted.
  • Including estimates of higher spending growth from COVID-19 vaccines and lower spending from existing treatments due to disruptions from the pandemic, the five-year CAGR to 2025 is expected to be 4.6%, compared to 4.5% if the pandemic had not taken place.
  • Perhaps the largest uncertainty in the next five years will be the potential impact of economic factors on countries’ budgeting and whether there will be shifts in policies regarding healthcare and medicine spending.
  • It is expected that the pricing and value of medicines will be under increased scrutiny during this period, but this was an event that was already underway in most developed markets and an increasingly key issue in the U.S. market.
  • While the pandemic has dominated much of the past year, the wider trends on the use of medicines continue to evolve relatively unchanged, which offers some hope to the millions living in lower income markets, with their improved health situation largely a result of increased access to medicines.

The use of medicines particularly in pharmerging markets grew in 2020 despite the pandemic but will normalize beginning in 2021

  • The global use of medicines — based on modeling medicine volumes shipped according to defined daily dose assumptions — has been growing for the past decade, driven by pharmerging markets. However, this growth is expected to slow across all markets over the next five years.
  • Despite the pandemic, the use of medicines grew in pharmerging and developed markets in 2020, however usage is projected to fall 3% globally in 2021, returning to pre-pandemic levels, as some of the usage was related to temporary shifts in demand referred to as ‘stockpiling.’
  • Lower-income countries have dramatically lower access to medicine. Access has been declining for the past five years and is expected to remain steady over the next five years, potentially counteracting other policy initiatives to improve health in those countries.
  • It is important to interpret these trends with caution, as chronic diseases drive many days of therapy in developed and pharmerging markets, and treatments for them are often much less common in lower income countries.

The global medicine market - using invoice price levels - is expected to grow at 3-6% CAGR through 2026 to about $1.8Tn

  • Global medicine spending — the amount spent purchasing medicines from manufacturers before off-invoice discounts and rebates — is expected to reach $1.8 trillion by 2026, increasing at a rate of 3–6% per year. This outlook is excluding the separate impact of spending on COVID-19 vaccines modeled separately (see exhibits 3-6).
  • Developed countries — those with upper middle or high incomes — are expected to grow from 2–5% through 2026, similar by comparison to the past five years.
  • The past five years had similar growth globally but had slower contribution from pharmerging and lower income countries than earlier in the decade.
  • The differing impact of the COVID-19 pandemic across countries is expected to impact growth through 2022 before returning to historic patterns as rates of vaccination rise to reduce the risk of further social disruptions.

Oncology, immunology and diabetes growth to slow over the next 5 years while innovation lifts neurology

  • The biggest contributors to the growth in the next five years are oncologics, immunology, anti-diabetics, and neurology — the growth being a result of continuous influx of innovative products and offset by exclusivity losses.
  • Many therapy areas are expected to grow more slowly in the next five years than in the past five, with notable exceptions in neurology driven by rare diseases and Alzheimers. Pain, including migraine treatments, is expected to grow 6–9% through 2026.
  • Lipid regulators, which have been declining steadily since leading product expiries a decade ago, are expected to return to growth, with new therapies for some patients.
Event
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