How Competition, Access, and Reimbursement Will Shape the Next Wave of Innovation

In a video interview with Pharma Commerce, Murray Aitken, executive director of the IQVIA Institute for Human Data Science, explains the extensive process behind developing the “Global Use of Medicines Outlook Through 2029” report. The creation of this comprehensive resource spans several months and integrates proprietary IQVIA datasets, including the MIDAS (Market Intelligence Data Analytics Solution), market prognosis, and forecast link tools. The report combines robust data analytics with global expert insights to produce a holistic view of the pharmaceutical landscape.

Aitken emphasizes that a key part of the process involves gathering input from IQVIA’s network of experts across the world, each bringing localized perspectives on evolving trends in medicine use, access, and policy. These expert insights are then synthesized by an internal analytics team responsible for compiling the vast volume and value data.

In terms of metrics, the report estimates that 3.6 trillion defined daily doses of medicines were consumed globally in the past year. Additionally, the worldwide expenditure on medicines is projected to be approximately $1.8 trillion at list prices in 2024. Aitken notes that while there are some data gaps, IQVIA’s methodology includes filling in missing information using statistically sound models and expert validation.

The ultimate goal of the report is to provide all healthcare stakeholders—governments, policy makers, pharma executives, and researchers—with a clear, data-driven understanding of where medicines are being used, how frequently, and at what cost. Aitken concludes by expressing pride in his team’s efforts and the value the report brings in shaping discussions around global health policy, drug affordability, and resource allocation.

He also comments on how pharma companies should revise their market access and pricing models to align with the evolving landscape; strategies manufacturers should adopt to balance investment in innovation with lifecycle management in order to maintain sustainable growth; how the competitive landscape will evolve within these high-impact therapeutic areas, the role patient access and reimbursement play in shaping adoption; what he anticipates for the biosimilar adoption curve in key markets over the next five years; and much more.

A transcript of his conversation with PC can be found below.

PC: The report identifies obesity, oncology, and immunology as key contributors to global spending growth through 2029. How do you see the competitive landscape evolving within these high-impact therapeutic areas, and what role will patient access and reimbursement play in shaping adoption?

Aitken: So obesity is the one that obviously gets a lot of public attention. This area is going to be very competitive very quickly. We have two companies competing there now, but we see a very extensive pipeline of new mechanisms, new formulations, new indications being developed for not only GLP-1s, but again, many other mechanisms as well. We can see 173 molecules in active development in the pipeline. They're not all going to make it to market, but enough will to make this a highly competitive marketplace. We should also recognize that currently, most of these obesity drugs are not reaching the patients who will benefit the most from them, so we've still got this big opportunity to help patients with weight loss who will benefit from it, in terms of reduced incidence of diabetes, cardiovascular disease, and many other diseases as well.

Reimbursement is still a barrier in this case, I'm confident that we have enough clinical data coming through showing the efficacy, benefits, and value of these medicines that we will see reimbursement opening up over the next several years. I also see so much competition coming through the pipeline that we'll see prices being reduced from their current levels, and those two might happen simultaneously. This is going to be a very dynamic space. It's a big market, but more importantly, it's a transformational therapy area, and I think we're only seeing the very beginnings of what impact that will have.

In the case of oncology, this is already by far the largest therapy area, and we expect that growth will continue. We can see about 100 new oncology drugs will be launched over the next five years. It's become very competitive. It's also become very much a precision medicine area. That brings some complications—the need and reimbursement for diagnostics, in addition to the therapeutics, is something that in some parts of the world is still very much a problem. There's still significant unmet need. We're going to see continued demand for these new drugs.

The other dynamic, though, is that we are seeing the loss of exclusivity beginning within the next five years, particularly of pembrolizumab, which is the largest oncology drug. We expect that will lose exclusivity in the 2028, 2029, 2030 period, so we are forecasting actually a slowdown in the growth rate in spending on oncology medicines, partly driven by that loss of exclusivity. In fact, we're forecasting that on a global basis, growth will fall under 10% by 2028-2029, and even less in in the important US market. There are some dynamics playing out there.

In terms of immunology, we still have significant unmet need. It's a competitive market, but we are seeing the impact of the losses of exclusivity of some of the larger leading products, such as adalimumab, that's also bringing down the growth rate in spending on these medicines. It's also heightening the competitiveness in this space, the need for companies to bring forward evidence that differentiates their drugs, perhaps in narrower sub populations, rather just at the overall market level.