Global Medicine Spending to Reach $2.3 Trillion by 2028 as More Patients Get Access to Better Therapies, Says IQVIA Institute Report

Global spending and demand for medicines will increase over the next five years to approximately $2.3 trillion by 2028 as more patients get access to new and better medicines, according to a new report from the IQVIA Institute for Human Data Science titled, “The Global Use of Medicines 2024 – Outlook through 2028.”

This updated projection raises the growth outlook by two percentage points despite lower expectations for COVID-19 vaccines and therapeutics. Overall, global use and spending on medicines is exceeding pre-pandemic growth rates and is expected to continue significantly above these trends through 2028.

“The continued growth in spending is driven by an increase in the volume of medicines, which reflects that more patients globally are getting access to novel medicines with better clinical outcomes,” said Murray Aitken, senior vice president and executive director of the IQVIA Institute for Human Data Science. “Global health systems have demonstrated remarkable resilience in the face of the pandemic, global inflation and regional conflicts, and have moved forward to adopt novel therapies and increase usage overall.”

A few key highlights of the report include:

• Therapy area drivers of medicine use: The volume use of medicine for specific therapy areas has been growing since 2018, with notably high growth in immunology, endocrinology and oncology. These areas of increasing usage have been driven by novel therapies, some first launched several years ago, with their wider adoption having a larger impact than new medicines. In immunology, per capita utilization of products and the type of products used varies across developed countries, with nearly half of immunology biologic volume facing biosimilar competition, leading to increased use. In endocrinology, GLP-1 agonists have seen rapid uptake in both diabetes and obesity, predominantly in the U.S. and other developed markets, raising expectations for future growth with these weight loss breakthroughs. Oncology has seen higher growth in developing regions since 2018, driven by expanded access to traditional chemotherapy, while wealthier countries have been increasing the use of novel targeted therapies.
• Lower expectations for COVID-19 vaccines and therapeutics: COVID-19 continues to have an impact on pharmaceutical markets globally, but at a level much lower than previously estimated. The lower level of vaccinations seen to date and expected through 2028 have resulted in a $200 billion reduction in the eight-year cumulative spending estimates. Countries around the world are now narrowing their priority focus to immuno-comprimised and elderly patients and planning fewer booster shots. As many countries are vaccinating at rates below their pre-pandemic trend, millions are left less protected from preventable diseases.
• Spending and growth by regions and key countries: The global medicine market — using list price levels — is expected to grow at 5–8% CAGR through 2028, reaching about $2.3 trillion in total market size. It is expected that manufacturer net sales will be lower than this due to the impact of confidential rebates, government mandated discounts, and clawbacks. In the U.S. and EU4+UK, list-price growth is projected at 6-9% and 4-7%, respectively, while historic data suggest net payer spending will be about 2-5% for both. Spending and volume growth will follow diverging trends by region. The U.S. market, on a net price basis, is forecast to grow 2-5% CAGR through 2028, an upward adjustment from the prior five-year forecast of -1–2% CAGR. This reflects the improved outlook for novel medicines and the expected early impact from the Inflation Reduction Act. Spending in the five major European countries is expected to increase by $70 billion through 2028, driven by new brands. Latin America, Eastern Europe, and countries in Asia are expected to return to steady growth, outpacing the global market. Japan spending growth is projected to grow -1 to 2% through 2028 as robust brand growth is offset by a shift to annual price cuts.
• Spending in key therapy areas: Oncology and obesity lead growth while immunology spending has slowed due to biosimilar availability and uptake. Many other classes will grow in mid-single digits. Demand for innovative oncology drugs will drive spending in this area to about $440 billion by 2028, more than double the current level, as broader and longer use of therapies – including 100 new drugs expected to be launched during that time – propels a larger share of drug budgets to this area. Global obesity spending is projected to grow 24-27% CAGR, reaching $74 billion in 2028 – up from $24 billion in 2023 – with some scenarios resulting in much higher or lower spending based on countries’ reimbursement decisions, which are evolving rapidly. Immunology growth will slow significantly to 2-5% through 2028 with the arrival of new biosimilars and even with robust volume growth. New therapies in rare neurological disorders, Alzheimer’s and migraine are expected to drive spending growth in neurology.
• Global biotech: Biotech will represent 39% of spending globally and will include both breakthrough cell and gene therapies as well as a maturing biosimilar segment. The spending on global biotech is expected to exceed $892 billion by 2028, with growth slowing to 9.5-12.5% from biosimilar savings. Specialty medicines will represent about 43% of global spending in 2028 and 55% of total spending in leading developed markets. The outlook for next-generation biotherapeutics includes significantly uncertain clinical and commercial successes. Cell and gene therapies register high growth rates driven by wider usage and as many as 50 new therapies over five years, but the high range of scenarios would have them represent 1.5% of global spending in 2028.

About the IQVIA Institute for Human Data Science