Experts say COVID-19-affected drug market rebounding

As the first surge of the COVID-19 pandemic hit in the spring, the headlines began heralding the need for more robust and secure supply chains and warning about critical drug shortages. At that point, there was only so much that pharmaceutical companies could do, but a recent analysis by the Healthcare Distribution Alliance, the national organization representing primary pharmaceutical distributors, provided a positive perspective on the industry's performance during the pandemic's first 90 days.

The report, titled "The First 90 Days: US Biopharmaceutical Finished Goods Supply Chain Response to COVID-19," was prepared by Deloitte and highlighted the shift of drug distributors' operations owing to COVID-19. It called the supply chain "resilient and effective." Even so, the report acknowledges that more actions are needed by the industry to address the next ripple effect from the pandemic.

On the same day, Oct 26, in a webinar titled, "The US Pharmaceutical Market During COVID-19," IQVIA Vice President of Industry Relations Douglas Long described how a temporarily disrupted prescription market was trending back toward normal. IQVIA, a Durham, North Carolina, company, focuses on health information technology and clinical research.

Drug Rx orders returning to normal

A burst of telehealth services, restructured allotment strategies for drugs, introduction of new drugs like remdesivir, and drug production changes were just a few of the solutions that experts noted in this disrupted market. According to the Deloitte report, more than 60% of drug shortages were related to COVID-19 treatments, and more than 83% of all drug shortages had alternatives during the first 90 days of the pandemic.

"From a social sentiment perspective, consumer-perceived supply disruptions were highest for analgesics, antivirals, antibiotics, diabetes and cardiovascular drugs, and drove high levels of conversations on digital media," the authors write, referencing the results of keyword data mining in popular internet forums. "Signals for other drug categories showed either moderate or low perceived disruptions."

In a similar vein, Long's prescription growth data showed a decline followed by recovery. A surge of stockpiling in March led to a period of negative prescription growth in April and May, from -0.3% to -6.7% when looking at adjusted rates (which convert 90-day orders to three 30-day ones) or between -5.6% to -12.0% when looking at unadjusted rates. Long called this the "depletion period," not because prescriptions went unfilled, but because they were unneeded after March's extra orders.

By the week of Jun 12, the depletion period ended and the market began to show growth again. The adjusted trends even show that the most recent 4-week average is above 2019 levels, although the unadjusted basis remains a little lower.

An adapting manufacturing and distribution market

According to Long, the number of new drug launches through August was comparable to last year, but COVID-19 has affected companies' products and methods.

Launch environments and priorities changed, some drugs had new barriers to overcome (like how the multiple sclerosis drug Zeposia [ozanimod] needs recent lab work-ups), and some drugs adapted to new customer needs (like how Biohaven collaborated with Cove telehealth services to make Nurtec ODT [rimegepant]—orally disintegrating tablets for migraine—its first branded product).

For all the talk about disrupted supply chains, Long adds, the biggest changes haven't been caused by export limitations or factory shutdowns but the shift in shipping from ocean liner to air freight. According to Long, some of the supply chain's largest pain points during the pandemic have been transportation logistics and corporations pivoting to adapt. Also, patient demand led to more e-scripts and home delivery of medications.

To help with this, some companies looked into technology and data management to improve visibility and tracking, the Deloitte report says, and products shifted. Eight out of 10 top drug manufacturers announced clinical trials for potential COVID-19 treatments or testing. Four of the top 10 drug companies started developing vaccine candidates within the first 90 days.

Some revelations about the market, however, have been in the works for a while. According to Long, three therapy areas—oncology, immunology, and diabetes—are responsible for more than 60% of positive absolute growth in the United States and 40% of the recent launches.

"There [were] 34 launches between 2017 and 2019 in oncology, 7 autoimmune, 2 in diabetes. And the other category that's showing good growth is anticoagulants. In fact, the second-leading dollar product in the marketplace after Numera is Eliquis [an anticoagulant]," he says.

Return to 'normal' means shortages without change

While the report and the webinar talked about the industry's successes and a return to a new normal, there are still 102 non-COVID drug shortages listed by the US Food and Drug Administration.

To address this and a future in which home delivery services, vaccine distribution, national supply chains, and cumulative supply chain aggravators are likely, the HDA and Deloitte put forth 16 recommendations to "enhance resilience to future disruptions." Increased supply and operation redundancy, data sharing with customers and partners, and developing ways to track future and real-time needs are all parts of a solution.

All 16 suggestions affect manufacturers, 14 affect pharmacies, 12 apply to raw-material suppliers, 8 affect providers, and 3 involve the government/health authorities. The two recommendations included for every stakeholder group were No. 14, "Identify collaboration opportunities with federal, state and local governments," and No. 16, "Develop joint plans to distribute COVID-19 vaccines safely and effectively."

Not addressing the impact of the drug shortages that are likely to occur as we approach a growing surge of COVID-19 would be like ignoring the iceberg in front of the Titanic, says Stephen Schondelmeyer, PharmD, PhD, MPubAdm, co-principal investigator of the Resilient Drug Supply Project (RDSP) at the University of Minnesota.

"The reason we didn't have [more of] a problem with drug shortages during the spring and summer of 2020 was more because we only had a few states—5 to 8—with COVID-19 spikes at a given point in time. It wasn't because the wholesalers and the manufacturers had planned for the pandemic and had the sufficient drugs on hand," he says.

"Now we are facing a period of several months with 30 to 40 states all surging at once. We need to prepare now for predicting and strengthening the nation's drug supply."

The RDSP is part of the Center for Infectious Disease Research and Policy, which publishes CIDRAP News.

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