As sure as the sun rises, prescription medicine use and total drug spending continue to increase in the U.S.
To better understand how these trends will play out in the near term, the life sciences intelligence firm IQVIA Institute recently dropped a deep dive on medicine usage patterns backed by findings from 2024.
Last year saw total U.S. prescription medicine use rise by 1.7%, which came out to a staggering 215 billion days of therapy on daily doses, according to IQVIA’s Understanding the Use of Medicines in the U.S. 2025 report.
Along with the uptick in usage came a significant spending rise, with the U.S. market (at net prices) growing 11.4%, up from the 4.9% increase recorded in 2023. IQVIA found that the 11.4% increase in net spending represented a $50 billion increase—to $487 billion in aggregate spending—driven by 31 key high-growth products. In all, the firm said 2025 marked a year of “historic growth” only surpassed by 2021’s COVID vaccine push.
The group of growth drivers was largely made up of popular GLP-1 agonist medicines for diabetes and obesity and drugs that won significant label expansions into large populations, or drugs that established themselves as “backbone therapies,” IQVIA noted.
Only three of those 31 meds are newer launches that hit the market in 2023 or 2024. Those were Roche’s age-related macular degeneration treatment Vabysmo, Sanofi and AstraZeneca’s respiratory syncytial virus (RSV) antibody Beyfortus and Novartis’ multiple sclerosis therapy Kesimpta. IQVIA also spotlighted AbbVie’s Skyrizi as the highest contributor of immunology spending growth, largely in its psoriasis indication.
GLP-1 drugs on their own accounted for 29% of the spending growth in 2024, IQVIA found.
Elsewhere, the last five years have seen several prominent drugs—such as AbbVie’s Humira—fall off the patent cliff, giving room for copycat drugs to take a bite of the market. The impact of recent losses of exclusivity totaled $77.5 billion, most of which was driven by biologics and biosimilars rather than small molecules facing generic rivals.
It’s a factor that is only expected to increase in the near-term, as blockbusters such as Amgen’s bone meds Prolia and Xgeva and Johnson & Johnson’s immunology star Stelara—and several others—face the impacts of biosimilar competition in 2025. Looking out a few years, oncology mainstays like Merck’s Keytruda and Bristol Myers Squibb’s Opdivo are expected to lose their exclusivity near the end of the decade.
Five-year forecast
Over the next five years, IQVIA expects a widening gap between list price spending, which is expected to grow annually between 5% to 8%, and manufacturer net revenues, which are slated for 3% to 6% average annual growth. All in all, total net spending in 2029 should reach more than $600 billion.
Oncology and obesity products are expected to continue to lead the growth, IQVIA said. More than 100 new drug launches and label expansions in oncology are anticipated through 2029, IQVIA pointed out, prompting an expected $165 billion in oncology spending through 2029.
Obesity, however, is a bit of a trickier case to forecast given “a wide range of scenarios” that could play out on the reimbursement side. Still, IQVIA’s “optimistic” base case estimates $60 billion in 2029 net spending on obesity meds.