Report: Global Medicine Use Will Continue to Grow, but U.S. Policies Will Have Impact

by Angela Maas

The use of medicines continues to increase around the world, driven mainly by immunology and oncology drugs, but a new report from the IQVIA Institute for Human Data Science projects that biosimilars and generics likely will slow that growth somewhat over the next five years. As the largest global market, the U.S. will remain a driver of spending on those products, but several policy changes could have big impacts, according to Global Medicine Use Trends 2026.

“Today’s discussion is very timely,” asserted Murray Aitken, executive director of the institute and moderator of a Feb. 25 webinar on the report. “We have an unusually large number of moving parts that are reshaping markets for pharmaceuticals and a lot of discussion around drug pricing,” in particular most-favored nation (MFN) pricing, as well as tariffs and other policy changes.

“And all of that comes on top of…the longstanding discussions that we’ve had for many years about drug availability, accessibility, pricing and the impact that those drugs can have on patients,” he pointed out. “Much of this is a consequence, in a way, of ever-increasing novel therapeutics that become available each year out of the research-and-development pipeline.”

The report highlights five key findings, said Michael Kleinrock, lead research director at the institute and the lead researcher for the report, during the webinar. The first is that the growth outlook, which is at 5% to 8% compound annual growth rate (CAGR), is unchanged, with estimates showing that by 2030, global spending on medicines’ list/invoice prices will hit $2.6 trillion. That growth will be driven mainly by immunology and oncology products, although the report reveals that growth in those areas is expected to begin slowing toward the end of the decade, mainly due to competition from biosimilars.

More specifically, said Kleinrock, over the next five years “we’re going to be seeing some of the…growing impact of biosimilars and generics in a number of key areas, and small molecule patent expiries are pretty big. In fact, in the major developed markets, it’s the largest period of patent expiry impact we’ve seen in history in the next five years.”

Endocrinology, broadly speaking, is expected to grow due to medications in areas like diabetes, obesity and certain cardiometabolic conditions such as metabolic dysfunction-associated steatohepatitis (MASH), previously known as NASH. “Ten years ago, obesity was a billion-dollar market, and it’s expected to be $125 billion by 2030,” he noted.

The second element is that the use of medicine is increasing in most regions around the world, led by China, India, Latin America, and Middle East/North Africa. Only Sub-Saharan Africa is projected to buck this trend, although medication usage in that region is expected to decline less over the next five years than it did the previous five years.

Third, the use of medicines around the world increased by 15% over the past five years and is expected to grow by 16% by the end of the decade, explained Kleinrock. “We’ll get to about 4 trillion defined daily doses across all the medicines used.”

And spending on those drugs increased as well, rising 54% over five years, although that trend is expected to slow to only a 37% increase by 2030.

Finally, the institute is raising the outlook on the U.S. — the world’s largest market — on a net basis 1 percentage point to a 4% to 7% CAGR by the end of the decade. “That’s reflecting the growth of and the increased use of some higher-value therapies,” he explained, noting “that’s still down from 9.4% [net] CAGR in the prior five years. So it’s not an acceleration as much as it is a slight improvement of what we previously modeled, including all of those uncertainties.”

Three Dynamics Are Fueling U.S. Market

The U.S. market, contended Luke Greenwalt, vice president of thought leadership & innovation for IQVIA U.S., “is really a function of three core dynamics. The first one is innovation.” As evidence, he pointed to more than 2,000 products launching in the U.S. over the last 15 years.

“That represents trillions of dollars of research and development from our industry, and it’s truly something that everyone that participates in the industry should be proud of, whether you are directly at a manufacturer or whether you’re in the distribution or in the delivery of care,” he remarked during the webinar. “That has made tremendous gains in the health and well-being of the population here in the U.S. and globally.”

Growth is the second dynamic, said Greenwalt, who noted that for 2024 and 2025 only, “about 25 of the mega blockbuster products account for about 85% of the overall list price revenue growth.”

From 2016 to 2020, “the industry grew at a healthy pace” in the U.S., he said. The invoice CAGR in the U.S. was 4.5% during that period and rose to 11.0%, excluding COVID-19 vaccines, from 2021 to 2025. That more recent time frame had “some of the strongest growth rates that we’ve seen in the U.S. market,” driven by immunology and oncology, with the GLP-1s contributing toward the end of the period.

“That concentrated growth then has led to hyper-competition in the U.S. market and a lot of intensity in regard to how products are being contracted and discounted,” observed Greenwalt, leading to the third dynamic: pressure. That has led “to questions around policy and reforms throughout the entire U.S. health care system,” such as MFN pricing and potential models such as GLOBE, GUARD and GENEROUS. Almost 20 large manufacturers have agreed to MFN pricing agreements with the administration.

Contracting and discounts have led to a larger gross-to-net spread, he said: Net prices were 41% below list prices from 2021 to 2025, up from 37% in the previous time frame, with estimates showing that increasing to about a 46% discount below invoice price by 2030.

“All of these pressures are going to manifest themselves differently,” Greenwalt said, urging close attention to developments within the U.S. market.

The impact of the Inflation Reduction Act (IRA) is only recently beginning to be felt, with more reverberations expected, he said. For instance, limiting the annual out-of-pocket maximum for Medicare Part D beneficiaries to $2,000 starting last year has “greatly sped up the rate of utilization and specialty products in Medicare. And we saw increased spending because of that.”

And the beginning of 2026 saw maximum fair prices for the first round of Medicare-negotiated drugs take effect, resulting in many of their manufacturers lowering their list prices in response.

With respect to tariffs, the U.S. Supreme Court ruled that the International Emergency Economic Powers Act (IEEPA) does not grant the president the power to impose them. But “other mechanisms remain, and this remains controversial,” Greenwalt observed. “So we fully expect this to begin playing out.”

PBM reform, including recent settlements with the Federal Trade Commission, also are part of the dynamic, he stated. “It’s not just pharma that has been pressured with practices and being called out in public policy; it’s also the payer systems in the U.S. as well.”

Another emerging trend in the U.S. is focused on consumers: the growing use of direct-to-patient programs such as TrumpRx.

“The rise of the GLP-1s and the use of direct-to-patient programs here…are uncovering really important questions about how consumers are coming in educated and asking for specific treatments in the physician office. This is going to play a big role over these next five years.”