Assessing HCP-Visit Fallout: COVID’s Ultimate Impact on New Drug Entrants

Pharmaceutical Executive, Pharmaceutical Executive-09-01-2022, Volume 42, Issue 9

Tracking the pandemic’s influence on brand awareness and prescribing efforts in light of decline in physician visits and fewer diagnoses—and what these dynamics, still unsettled post-pandemic, might mean for future launches.

Patients are returning to doctors’ offices, but not at the same rates prior to the COVID-19 pandemic. During the pandemic, in-person visits to healthcare professionals (HCPs) saw a dramatic reduction. This resulted in fewer diagnoses, which inevitably led to a reduction in the number of new prescriptions and therapy starts.

During this same time period, however, drug companies launched a higher-than-average number of new products. With fewer patients to prescribe to, many products struggled to gain attention and recognition. Even as HCP visits return to close to pre-pandemic levels, patients are being diagnosed further along in their illnesses then they normally would be, which is altering the therapies being prescribed to them.

Murray Aitken, a Pharmaceutical Executive Editorial Advisory Board member, is the executive director at IQVIA Institute for Human Science. According to data on HCP visits and how it’s impacting the pharma industry and new product launches, the last two years have been very interesting, he says.

A record number of launches

On one hand, COVID didn’t slow down the number of new drugs and therapies being introduced by pharma companies. This is because new product launches are determined by factors such as getting submitted and then approved by FDA. The process of drug development, regulatory approval, and then launching a drug continued while HCP visits were still low.

Murray explains that there’s been a bit of a drop-off in the number of new product launches this year compared to the last two years (71 launches in 2020 and 76 in 2021, compared to 33 so far in 2022), but those were record-breaking outputs, respectively, so that isn’t unexpected.

Even while FDA was handling pandemic-related issues, it continued to approve drugs. However, while new therapies continued to be released, that didn’t mean that the launches weren’t impacted by the low HCP visits. It’s likely that these consequences will continue to affect the industry in the coming years.

Due to the decrease in HCP visits, there was a decrease in diagnoses and new prescription and therapy starts. This means that drugs being launched during this time period had fewer opportunities to get prescribed than they normally would have, which may have created a backlog of new products for doctors to learn about and test on their patients.

This is one factor that is impacting new drug launches, although Aitken explains that it’s difficult to compare the performance of just-approved treatments on an annual basis. “Uptake curves are also a function of the quality and the nature of the drugs that get launched in any particular year,” he says. “How many of them are orphan drugs, or have very narrow indications? That’s very hard to compare year-to-year. The mix of the drugs being prescribed could be a part of the reason why the level of first-year sales is overall trending lower for more recent 2021–2022 launch cohorts.”

This doesn’t mean that manufacturers are shying away from new drug launches. According to a report from IQVIA, the number of new products launched in the coming years will continue to be higher than the average during the previous decade. Over the next five years, 300 drugs are expected to be introduced to the market, with the trends favoring specialty, niche, and orphan drugs. Also, it is expected that $196 billion will be spent over the next five years due to these launches.

Because of the backlog, however, companies are rethinking their launch strategies in light of the disruption to the typical ways that drugs are launched, explains Aitken. “This includes the role of in-person congresses, the role of key-opinion reactions during meetings, and educational forums, as well as in office detailing,” he says. “All those things come together as part of the launch plan, and all of those have been disrupted significantly during the last two-and-a-half years.”

Due to the backlog of medicines launched during the pandemic, along with new medicines currently being launched, pharma companies need to be aware of certain logistical issues. For example, doctors often learn about new drugs and treatments through various promotional and education drives. These events could start to stack up on top of each other, notes Aitken.

While the record number of launches during the past two years would have caused this issue regardless, COVID likely made the problem worse. “Already, the level of competition for mindshare among key opinion leaders and prescribers generally has been increasing over the past few years,” says Aitken. “The pandemic accentuated that phenomenon as well.”

According to IQVIA BrandImpact, in-person detailing is only at 66% of its pre-pandemic baseline. In June 2022, 65% of primary care details were in-person, with 35% being remote.

The industry is still recovering

HCP visits still haven’t returned to their pre-COVID levels. IQVIA is analyzing the data surrounding these visits, including how they changed during the pandemic and where the numbers are now. In order to do so, it created a baseline by taking the average number of HCP visits during January and February of 2020 and comparing the numbers against that figure. The data include both in-person visits and virtual sessions as well, which have seen a significant increase post-pandemic.

Not surprisingly, the numbers significantly decreased during the initial months of the pandemic in 2020. While they eventually started to go back up, they sharply decreased again when the Delta variant struck. Since then, the numbers have been trending upward.

Unfortunately, the recovery hasn’t been complete, and HCP visits are currently only at 90% of the pre-pandemic baseline. “It’s a little higher than that for specialty visits, but it’s a little lower for primary care,” Aitken says. “We’re also tracking oncology separately and that’s in the middle. We’re still at a lower-than-pre-pandemic level, and the mix has clearly changed and remote detailing is now about one-third of the total details. That differs by specialty; oncology has a low level of virtual visits, whereas some of the other HCPs have more details being delivered virtually as opposed to in person.”

While the numbers are close to pre-pandemic levels, they are still down. This includes elective procedures, along with general and specialist office visits. While they had started to recover in 2021, the numbers remained relatively flat throughout 2022.

During the pandemic, there were a large number of foregone HCP visits. According to the data, many of these visits have yet to be made up, and the industry is still recovering from these missed visits.

Meanwhile, therapy starts continue to trend below the baseline as well. The number of new brand subscriptions briefly jumped up to 98% of the baseline earlier this year but has since fallen to about 86%. Aitken points out that the number has been moving around but has yet to go above the 100% mark. This suggests that there are still patients avoiding HCP visits and, as a result, aren’t getting diagnosed. Aitken finds this concerning, as it shows there is a continuing disengagement of patients from the healthcare system. The number of continuing prescriptions for ongoing or chronic conditions has remained steady, however, and even rose to 2% above the pre-pandemic baseline. That is one of the few statistics that hasn’t dropped below the baseline, even as new prescriptions continue to lag.

“We continue to see healthcare visits and initiations of prescriptions operating at a level lower than the baseline,” Aitken says. “It does suggest that we’ve moved backward with both patient care as well as HCP detailing (virtual and in-person). We haven’t made up for all of the lost activity that was acute at the beginning of the pandemic. The recovery has been less in oncology in terms of HCP, particularly in-person visits.”

The effect on prescriptions

It’s still unclear what impact the previous years will have on new prescriptions. One of the concerns is that many patients put off going to the doctor during the pandemic, which means that diagnoses were delayed. When patients finally return to the doctor, a number of them will be further along with their illnesses than they normally would have been. This could have an impact on the sorts of treatments that doctors prescribe, since patients tend to require more serious drugs and therapy the further along their conditions have progressed. So far, however, the data doesn’t show an increase in stronger or more advanced drugs being prescribed.

Aitken explains that IQVIA has a panel of community-based oncologists that it surveys on a monthly basis. One of the questions that is regularly asked is how many of their new patients are presenting as metastatic and whether the ratio of metastatic to non-metastatic cases among new patients is changing over time. So far, the results have been a “mixed bag.” While the numbers appear to be trending slightly upward in some cancer areas, Aitken describes the trends as “not hugely dramatic.”

He notes that there are difficulties in tracking this data, however. There is a lot of variation in the ways that doctors choose what drugs to prescribe, and the progression of the condition is only one aspect. For example, a doctor treating a patient with rheumatoid arthritis needs to determine when to start administering monoclonal antibodies, and not all doctors make the same decisions.

“We’ve not yet been able to put our finger on that, partly because different doctors practice medicine differently, so what drugs get prescribed first isn’t always the same,” says Aitken. “I don’t think anyone is expecting that patients presenting with more advanced disease will not be treated more aggressively or be quicker to get to steroid treatments, COPD, respiratory, or monoclonal antibodies if they’re starting with methotrexate for rheumatoid arthritis. Doctors would be quicker to get to the more advanced cancer therapies for the more advanced metastatic disease.” Still, the data has yet to show significant trends in this area, and these concerns are still considered “more conceptual” at this point.

Long-term impact

It’s clear that the events of 2020 through 2022 had a significant impact on HCPs and the pharmaceutical industry at large. In the early stages of the pandemic, drug companies were in the spotlight and received increased attention, which brought along many new investors. In early 2022, however, the spotlight shifted and the pharmaceutical industry saw a significant drop in investor interest.

According to IQVIA, spending on existing treatments decreased during the pandemic due to the disruptions it caused. Meanwhile, most of the growth was unsurprisingly centered around the development of COVID vaccines and other treatments.

Despite this, the impact of the pandemic is expected to be relatively muted in the long term. According to the data, it is likely that the greatest area of scrutiny over the next five years will be the pricing and value of both new and existing medicines. As is the case with several other factors, this was exacerbated by the pandemic, but the trend was already underway before COVID.

Ultimately, the pandemic does not seem to have significantly impacted the wider trends in medicine. For new product launches, the goal continues to be to provide new treatments to people living in low-income or difficult-to-reach markets. Oncology and immunology continue to be the two leading therapy areas across the globe and are projected to grow by about 10% by 2026. This growth is expected to come from new treatments and medicines. The field of neurology is also forecasted to see growth, as new therapies for Alzheimer’s, Parkinson’s, and other rare neurological diseases continue to be of interest to drug developers.

It’s still unclear when HCP visits will return to pre-pandemic levels. Based on the data, it appears that potential patients who put off going to the doctor during the pandemic are not planning on making up those missed visits. How this will impact long-term diagnoses is unclear.

In regard to new product launches, the main impact appears to be in how HCPs will become aware of new treatments and begin prescribing them. Due to the record number of launches over the past two years, professionals are facing a backlog of new therapies that they need to be educated on.

“A new drug with clear and distinctive clinical benefits is still going to find the patients who will benefit from it,” says Aitken. “It’s always the ones in the middle, with less differentiation or less clear clinical evidence, that are going to struggle, particularly with the disruption in the normal go-to-market strategies.”

Mike Hollan is Pharm Exec’s Editor. He can be reached at mhollan@mjhlifesciences.com.