Originally published by our sister publication Specialty Pharmacy Continuum

By Marcus A. Banks
The 2024 total U.S. drug market reached $821 billion in 2024, according to presentation from IQVIA’s vice president of industry relations, Doug Long, MBA, at Asembia’s AXS25 Summit, in Las Vegas.

This will be the final time Mr. Long delivers the annual industry outlook presentation at the AXS25 Summit, due to his retirement in May. Asembia’s chief strategy officer, Thom Cohn, MS, gave Mr. Long a lifetime achievement award at the start of his talk, and Mr. Long concluded his remarks by noting that he and his wife have done everything on their bucket lists.

Now he is offering free advice to others on how they can meet all their bucket list goals, too, in a role Mr. Long jokingly called “bucket list coordinator.”

In between receiving his award and saying farewell, Mr. Long noted that the U.S. pharma market grew in income by 10% last year alone, with almost 80% of that increase coming from greater volume rather than price adjustments or new market entrants. (All figures in the talk come from IQVIA market research, which Mr. Long noted in a disclaimer had not been approved by IQVIA management.)

'A Presidency Unlike Any Other'

The first quarter of 2025 showed signs of continued pharma growth; and yet, what Mr. Long called “a presidency unlike any other in modern times” makes the future uncertain. That phrase came courtesy of Mr. Long’s IQVIA colleague, Luke Greenwalt, MBA, the vice president and lead of IQVIA’s Market Access Center of Excellence. Mr. Greenwalt spoke at the Asembia meeting as well.

“What’s a hot topic? Tariffs are a hot topic,” Mr. Long said in his remarks. The U.S. pharmaceutical market is highly dependent on supplies of active pharmaceutical ingredients from other countries, Mr. Long said, with any tariffs necessarily adding to industry costs because those ingredients are imported.

The tariffs may have mixed effects; Mr. Long added that some U.S. drug manufacturing sites are underutilized and could, for example, be ramped up to produce more domestic generic drugs. And given that Trump administration tariff policy shifts frequently, he said, it is difficult to predict the ultimate impact on pharma industry profitability. (For more on the tariffs outlook, see our recent coverage here.)

One trend that is clear, Mr. Long said, is retail pharmacy closures; he said 2,700 pharmacies have shut their doors in the last two years, leaving 16 million Americans in a pharmacy desert. This is due to many factors, including cyberattacks and because filling glucagon-like peptide-1 (GLP-1) prescriptions can be unprofitable at the retail level, Mr. Long said. The top four fastest-growing drugs in 2024, per IQVIA, were all GLP-1 agonists.

Although not cited by Mr. Long, a 2024 Drug Channels blog post by Adam Fein offered some insights into those tight GLP-1 profit margins. It’s partly due, Mr. Fein noted, to the fact that “wholesalers’ largest cus-tomers ... receive the deepest sell-side discounts” for GLP-1 agonists, with smaller retailers left with far less beneficial reimbursement. As a result, “any pharmacies are receiving [GLP-1] prescription reimbursements that are below their cost of goods.”

“Hep C was a tsunami; this is a super tsunami,” Mr. Long said of the GLP-1 market, which is causing payors to impose tight access controls that limit the reach of the medications.

“The patient journey is getting more complicated,” Mr. Long concluded, calling for payors and manufacturers to focus on boosting access to specialty and traditional drugs alike.

Mr. Long reported no relevant financial disclosures beyond his stated employment.