100 Million Scripts Came Through Illegal Online Pharmacies Last Year

Patients obtained nearly 100 million prescriptions through illegal online pharmacies in 2023, according to a report from the IQVIA Institute for Human Data Science.

That figure is up 47% from 2019, and represents about 2% of total prescriptions dispensed in the U.S., according to the report's lead research director Michael Kleinrock.

"People are going to these websites that don't have pharmacy licensing in the U.S.," Kleinrock told MedPage Today. "Maybe [the products] are counterfeit, maybe they're imported from another region."

People are driven there by a host of factors, he said. Maybe the online pharmacy is "offering a price lower than you've been getting on the market, or there's extreme demand, or maybe there's stigma or barriers to accessing the medicine."

"That 2% of overall volume is going through this illegal channel, that's a concern for us," Kleinrock said. "That's another crack in the system."

The most common medicines purchased this way include those that are highly regulated -- such as opioids and drugs for attention deficit-hyperactivity disorder (ADHD) -- and those where patient demand is high and shortages limit supply -- such as ADHD drugs and GLP-1 agonists, according to the report.

In fact, GLP-1 agonists account for an increasing share of drugs sold through illegal online pharmacies, growing from 1.1% in 2019 to over 7% in 2023, the report stated.

That's a concerning trend, as poison control centers received over 2,900 calls related to the GLP-1 agonist semaglutide (Ozempic, Wegovy, Rybelsus) in 2023 -- 15 times the number of calls in 2019, according to the report.

Since the pandemic began, the IQVIA Institute for Human Data Science has been publishing the Health Services Utilization Index, a composite view of many types of health services including patient visits, screenings and diagnostic tests, elective procedures, prescriptions, and vaccinations. These essential components of the health system show how "healthy" it is, Kleinrock said, as levels of utilization ensure that Americans are receiving all the preventive and treatment services that they need.

Overall, the 2023 index fell 3% from the year prior, due to fewer healthcare visits, screening and diagnostic tests, elective procedures, and vaccinations, the report found.

"We're using less of the health system than we did in 2022," Kleinrock said. "There's a degree of disengagement going on ... and that's a little concerning."

While most indicators had a 4% to 6% reduction, new prescriptions were up 4%, driven by the return of historic levels of seasonal respiratory illness following significant disruption through the pandemic, according to the report.

Total retail prescriptions reached 6.9 billion in 2023, about 3% growth from the year prior. GLP-1 agonists (for obesity and diabetes combined) accounted for 16% of prescriptions in 2023, the report found.

Vaccinations, on the other hand, aren't faring so well. Both routine adult and pediatric vaccination rates are below pre-pandemic levels, although adult vaccination rates have improved since 2021, the report found.

Notably, flu vaccination rates in 2023 fell by 17% from the year prior, according to the report.

Telehealth wasn't all that healthy, either, with virtual visits accounting for 5% of total visits in 2023, down from 26% at their peak in April 2020. Still, the figure is up from less than 1% of visits prior to the pandemic, "suggesting a larger role of telehealth post-pandemic," the report stated.

However, one caveat in the report is that "subscription-based telehealth services such as Hims & Hers Health, Ro, and BetterHelp, are paid for by patients out-of-pocket, and do not result in medical claims, potentially leading to an underestimate of the overall impact of telehealth on the health system."

Patients paid $91 billion in out-of-pocket costs in 2023, an increase of $5 billion over the year prior, and most of the increased spend was on retail drugs.

Manufacturers helped offset out-of-pocket costs by providing copay assistance, which totaled $23 billion last year.

While the out-of-pocket figure seems high, most prescriptions (92%) have a final out-of-pocket cost below $20, the report found. Just 1% of prescriptions -- though that translates to 71 million scripts -- cost above $125 out-of-pocket.

Data for the report come from numerous IQVIA sources, including its longitudinal prescription data, which handles nearly 4 billion prescription claims per year, and its medical claims data, which includes more than 205 million patients and over 1.7 billion claims.

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