The Impact of COVID-19 on Regular Health Screenings, Mail-Order Dispensing

Pharmacy Times® interviewed Mathew Reynolds, PhD, IQIVA, vice president of real-world evidence at IQVIA, on how the COVID-19 pandemic has affected regular health screenings, mail-order dispensing volume, and home infusions based on the findings of a recent paper published with the National Pharmaceutical Council on how the COVID-19 pandemic has affected real-world data and research.

Matthew Gavidia: With COVID-19 causing disruptions in regular health screenings, what long-term implications does that have for incidence rates of chronic conditions?

Matthew Reynolds: Well, with the term long-term, we'll find out. But theoretically, I think we can see months at a clip with huge drops in usage of things, like mammograms and pap smears and colonoscopies. I think from February to April, we saw 80% to 90% less of those screenings used than pre-pandemic.

So, a lot of people weren't going in, and it's not because they didn't want to, or they just didn't feel like it, they could not get into these clinical sites. Even once they could, there's the reticence of the pandemic and potentially getting COVID-19 that many of them didn't want to. So, they moved to remote telehealth or just not going through with those assessments.

What will it do to the incidence? I do expect that we are going to see this false low incidence of disease for earlier in 2020, not due to any real change in the disease, but due to the lack of identification of the disease and then a large increase in incidence in the end of 2020.

Part of that's going to be delayed screenings, some of it could be the lack of catching something early and actually having full blown disease. I would expect that if that plays out, the cases that we do see—we'll likely see an increase—will be likely more severe than or more progressed than we would have if we had caught them early through the typical ways of preventative screening.

So, I think for those chronic conditions, we'll likely see a bit of an increase, and the cases that we do see may very well be more severe, and I can't say what gradient that will be, and it could vary by disease as well, but epidemiologically I expect that that's likely what will happen.

On the flip side, you ask about chronic diseases, but I do want to note that for infectious diseases, we've actually seen a drop for a number of infectious diseases. There's been some benefit to everything we've been doing in the pandemic: wearing masks, social distancing, washing our hands, which you'd think would be a normal thing we do, but we got people walking around with bottles and cleaning profusely.

We've seen a huge drop in flu—we didn't really have a true flu season this past year. [Respiratory syncytial virus] and other respiratory conditions in kids dropped to almost null, and I mean even things like sexually transmitted diseases, they're at a big low.

I do expect that as we open back up, we'll see these things pop back up. But one takeaway here is that many of the things we did to limit the transmissibility and severity of COVID-19, they work, and maybe some things here we should be doing routinely even post-pandemic that will improve our general health.

Matthew Gavidia: For our last question, what type of long-term changes might the pandemic have on mail-order pharmacy dispensing volume and the use of home infusion products?

Matthew Reynolds: Good question. There's absolutely been a change in the use of mail order versus a retail pharmacy. When it's easier, it's oftentimes cheaper. I think oftentimes co-pays are waived when you get these mail orders. So, I would expect that for just the utility and the ease on a patient, we will likely see a lot of that stay.

In fact, I think even pre-pandemic there was a large push to get people to go on to mail order subscriptions for their medications, but this pandemic sort of forced that issue, and so there’s been drastic increases. I would expect a lot of that will stay, more for the chronic meds. I don't think for acute meds, obviously, because you don't need to have that refilled routinely.

But then there's probably also some patients who like to go to the pharmacy, so I would expect we'll see the rise in the mail order pharmacy stay. It'll probably drop some, but it will remain most likely well above the levels that we had previously. Once you get on there, it's unlikely if it's chronic, that you're going to be coming back off of the mail order pharmacy.

With the home infusions, it's been just a number of home infusion companies that have really kind of come to the table here and are really pushing this now, and a lot of the clinical sites and such were really were forced into using home infusions because they couldn't have patients come to the office, and they had to get their care.

So, working with the home infusions, it seems to be a mix of pros and, I don't want to say cons, but concerns. So, in the pandemic, and this is probably more short term, but having the health care workers in there helping with infusions and such potentially put them at risk, potentially more risk than having a patient come into a clinical site—that's debatable.

The safety of a home infusion versus having infusions in the clinical site, if something does go wrong, and from what I read, once a day there's some sort of reaction in a clinical site, and I don't know whether that's across 100 patients or 50 patients or hundreds of patients, but still, at least once a day there's some sort of safety issue due to an infusion reaction. So, having that patient in a clinical site that can be dealt with very quickly by qualified clinical staff, there's definitely a plus for that.

Now, how does that fair when they're doing it at home? I haven't seen that there's been a huge issue yet, but I don't know, I haven't seen a broad assessment of this either on the flip side if a patient can get it done at home, they don't have to drive to a clinical site and they don't have to spend 3 to 4 hours out of their house, and they can actually do this from the comfort of the home.

Are they going to be more persistent? Are they going to be more satisfied? Are they going to be more engaged with their therapy? I would expect the answer’s yes, but I don't, again, have the definitive conclusions from it.

So, I think given that the home infusions are here, it's going to be a question of how do they win back or pull it back into the clinical sites. Again, much like some of these other things here that the pandemic has impacted, I expect that they'll drop some from the levels that they currently are being utilized, but I don't expect that there'll be a full return to normal. This, again, could vary by the type of patient, the type of therapy, and so on and so forth. So, I do expect that both of these increases will remain, and they'll drop most likely some, but not all the way to pre-pandemic levels.