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Understanding the U.S. Return
Details behind the steady rise in treatment and utilization, and the role of the COVID-19 vaccine on volume and behavior
Jun 18, 2021
As cases of COVID-19 across the United States continue to decrease and as vaccination rates increase in many parts of the country, recovery is quickly becoming a reality. People are once again seeing loved ones, inviting friends over for dinner, and even beginning to travel. This return to a “pre-COVID-19 normal” – or maybe more aptly, a return to familiar – is a moment almost 16 months in the making.
But as the pandemic continues to recede in our rearview mirrors, our attention is naturally pulled to the future, both the immediate and the distant. Our healthcare system weathered a generational shock, and the impact on patient access and utilization, physician engagements, and even on how and where we take care of ourselves as people (not just as patients) has been nothing short of transformative.
Back in early 2021, we established a framework for thinking about the impact of COVID-19 on the U.S., and specifically on the health system and life sciences companies (Exhibit 1). One of the more remarkable signals of disruption was the conclusion that we missed almost one billion diagnosis visits in 2020 as result of COVID-19; one billion meaningful interactions and potential inflection points in patient journeys that should have happened, but didn’t (Exhibit 2).
Exhibit 1: Levers of pressure and areas of acute impact for system and life sciences companies in the U.S.
Exhibit 2: Expected versus Actual diagnosis visits in 2020
As we’ve discussed, these missed visits represent a wide range of patients – chronic, acute, children, adults – not all of whom are “waiting in the wings.” For example, total prescriptions for pediatrics were still down 25% as of June 2021; this is largely due to the absence of illness transmission in traditional places like schools, camps, and other activities.
So, the size of the bolus of patients ready to return (and certainly there is one) is not completely known. But what is clear is that specialties have work to do to, not just to manage an influx of patients but also to ensure that those interactions make up for lost time.
So, who is coming back?
This month, we dug into who is making the most progress at recovering these “lost” engagements – in both visits and treatments. Unsurprisingly, those who faced the sharpest decline are the among the hungriest.
By the end of 2020, the cumulative decline in claims from 2020 baselines ranged from -29% to -7% across key specialties, with pediatrics seeing the greatest decline and psychiatrists seeing the least. As schools closed and stress rose, its unsurprising these two specialties fell at the ends of the gamut, with total prescription volume following suit. (Exhibit 3)
Exhibit 3: Cumulative claims and NBRx percent change from 2020 baselines
Now, we can look at the first 21 weeks of 2021 against the same time frame in 2020 (which is almost an even split between pandemic and non-pandemic) and see who is closing the gap fastest. (Exhibit 4)
Exhibit 4: Percent change in claims and NBRx, Weeks 1-21 2020 v. 2021
Ophthalmology, dermatology, and OB/GYN are the outliers – with the greatest increase in claims and new-to-brand prescriptions (NBRx) so far; ophthalmology claims increased by 26% and 29%, respectively, and dermatology claims increased by 24% and 26%, respectively. As many procedures typically performed by these specialties are considered elective and non-emergent, these specialties were hard-pressed during lockdowns.
The Role of the Vaccine in the Return
Also new this month is a deep dive into the impact of the COVID-19 vaccine – which has now reached 54% of the U.S. population aged 18+ – on prescription volume and prescribing behavior across specialties. It is this latter point that deserves particular attention, as specialists outside the normal vaccine environment (e.g. primary care physicians (PCPs)), have taken on the role of vaccinator, at least for now.
COVID-19 vaccinations have had a tremendous impact on the volume of prescriptions in 2021. Total prescription (TRx) levels in 2021 have reached and surpassed 2019 levels of TRx in the same time frame. However, if COVID-19 vaccines are excluded, the 2021 TRx level has only approached 2019 levels in recent weeks. This is especially evident in branded TRx, as all new COVID-19 vaccines are branded products. (Exhibit 5)
Exhibit 5: Weekly total brand and generic prescriptions, 2019-2021
Specialties known for their roles in preventative and public health, such as primary care, are among the largest writers of COVID-19 vaccines. In fact, NBRx written by PCPs have been above 2019 levels for nearly 10 weeks due entirely to COVID-19 vaccines. (Exhibit 6)
Exhibit 6: Weekly NBRx written by PCPs, 2019-2021
But other specialties are entering the mix – in particular, OB/GYNs, cardiologists, and oncologists. Through May 2021, 13% of OB/GYN NBRx are for COVID-19 vaccines, along with 9% of cardiologist NBRx. An even higher percentage – 50% – of oncologist retail NBRx are for COVID-19 vaccines. (Exhibit 7)
Exhibit 7: Weekly NBRx written by key specialties with and without COVID-19 vaccines, 2021
As these specialists carefully weighed how to deliver and continue care for patients, at least one barrier to vaccination – the need for an additional appointment and all that comes along with it (arranging time off work, childcare, eldercare, the availability of a PCP’s office, etc.) – was removed. Healthcare providers optimized face-to-face interactions with patients to ensure one side of the health outcomes equation was tipped in their favor.
Interestingly, this behavior in oncologists can, in fact, be traced back to 2020 when the 54% increase in NBRx in oncology was due almost entirely to vaccines. (Exhibit 8)
Exhibit 8: Weekly retail NBRx written by oncologists, 2019-2021
This additional focus on keeping patients as healthy as possible during the pandemic has potentially opened the gate to a more holistic care regimen, regardless of provider specialty.
Monitoring the Impact of COVID-19 on the Pharmaceutical Market
This monthly report provides an overview of policy guidelines and key trends impacting the US pharmaceutical market.