What happens when two consecutive years of double-digit drug spending growth collide with a wave of pricing legislation, executive orders, and policy turbulence? On the latest episode of Astonishing Healthcare, host Justin Venneri welcomes Michael Kleinrock, Director of Research Development at the IQVIA Institute for Human Data Science, back to the show to find out and unpack the findings from IQVIA&#x27;s 2026 Medicine Use Trends Report. The headline number is hard to ignore: net drug spending in the U.S. reached $606 billion in 2025, a 10.6% increase year over year, following a 14.4% jump the year before. But the story behind that figure is far more interesting. Michael and Justin dig into what&#x27;s driving growth (hint: it&#x27;s not just GLP-1s), why the roughly $670 billion gross-to-net gap matters so much, and why list price still shapes what patients pay even though &quot;nobody pays it.&quot; They also explore the uneven reality of the biosimilars market, the trade-offs created by the IRA&#x27;s Medicare out-of-pocket cap, prescription abandonment, and where spending is headed through 2030. Please note: IQVIA Institute will be hosting a webinar on July 14th, 2026, featuring a star panel, including past Astonishing Healthcare guest John O&#x27;Brien, CEO, National Pharmaceutical Council, Murray Aitken, Executive Director at The IQVIA Institute for Human Data Science, Stacie Dusetzina, Professor, Health Policy &amp; Ingram Professor of Cancer Research, Vanderbilt University Medical Center, and others, to discuss this year&#x27;s report. Related Content AH071 - A Look at What&#x27;s Really Driving Drug Spend, and How it Impacts Us, with IQVIA&#x27;s Michael Kleinrock Beyond the Rebate: How Executives Can Better Manage Pharmacy Spend AH105 - The Perfect Storm Driving the Future of Drug Pricing, With Josh Golden For more information about this episode and its transcript, please visit Judi Health Insights.

AH110 - Inside the 2026 U.S. Medicine Use Trends Report with Michael Kleinrock

The Astonishing Healthcare Podcast

# Full Transcript

**Podcast:** The Astonishing Healthcare Podcast

## Participants

- **Justin Venneri** (Judi Health)
- **Michael Kleinrock** (IQVIA Institute)

## Transcript

You're listening to Astonishing Healthcare, the podcast hosted by Judi Health, focusing on the biggest issues affecting healthcare consumers, benefits plan sponsors, and health plans. We're covering how things truly work or don't in the U.S. healthcare system and pharmaceutical supply chain, and we're doing it in an astonishingly efficient way. Hello, and thank you for joining us for another episode of the Astonishing Healthcare Podcast. Today, I'm excited to have Michael Kleinrock from IQVIA back in the studio with me.

Almost exactly a year after episode 71, when we covered your 2025 Use of Medicines Report. So, here we are, Michael, talking about your latest U.S. Medicine Use Trends Report for 2026. We'll be talking about the forces shaping drug spending and patient access, forces changing how people access the report, as the case may be, because that's even a little different. GLP-1 growth, the widening gap between listed net prices, policy-driven distortions. There's a ton packed into this one, I think, if it goes the way we expect it to.

But, you know, with scripted, unscripted stuff, you never know which twists and turns these conversations will take. Michael, thanks for joining me again in the studio. Yeah, thanks for having me. And yeah, this should be fun. It was fun last year, and a lot that we had uncertainties about then were clearer on, and there's new ones this year. So, let's get to it. Before we get into it, a little bit of background in case anybody hasn't heard you before, doesn't know about you, your team at IQVIA, what you do there. Give us a little quick information.

Sure. The IQVIA Institute is a research-based part of IQVIA. IQVIA is a very large company that serves the life sciences sector globally. We operate in over 100 countries and 90,000 employees. We have thousands of colleagues running clinical trials as outsourced resource for sponsors. We have colleagues who are essentially outsource sales reps for drug companies, and we have thousands of my colleagues that I've worked here 27 years now.

So, thousands of them who do data and analytics and services for governments, payers, providers, and pharmaceutical companies to better understand the use and spending on medicines in all of its attributes. So, whether that is the volume of medicine shipped, how it's being dispensed, whether prescriptions are being used or abandoned, what the list prices of them are, how those are translating into out-of-pocket costs, again, in over 100 countries with varying pieces of data available.

And my team's work focuses on all of that. It's hard to focus on everything, but we have a number of reports, particularly our global use of medicines and our U.S. use of medicines that really profile the U.S. in detail. And that U.S. report in a little bit less detail i...

AH110 - Inside the 2026 U.S. Medicine Use Trends Report with Michael Kleinrock

Transcript

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AH110 - Inside the 2026 U.S. Medicine Use Trends Report with Michael Kleinrock

Transcript

Built for investment professionals

Every day you wait, your competitors are findingedge in conversations you're not hearing.

Every day you wait, your competitors are finding
edge in conversations you're not hearing.