Global medicine spending will reach nearly $1.5 trillion by 2021 on an invoice price basis, up nearly $370 billion from the 2016 estimated spending level. 
 Growth will be driven primarily by newer medicines in developed markets and increased volume in pharmerging markets. The number of new medicines reaching patients will be historically large, addressing significant unmet needs in cancer, autoimmune diseases, diseases of the metabolism, nervous system disorders and others. 
These areas of significant innovation are expected to drive most global spending growth, particularly in developed markets, but will be a key focus of payers and constrained by cost and access controls as well as a greater focus on assessments of value.

The outlook for medicine spending through 2021 is for growth coming off record rates in 2014 and 2015 to a more steady level of 4–7% CAGR over the next five years. Off-invoice discounts and rebates, particularly in the U.S. market, will reduce this invoice-price growth by about 1%. 

European payers are expected to maintain tight constraints on drug spending to bring predictability to their healthcare budgeting processes. 
In the pharmerging markets, broad economic challenges have led to a range of derailed healthcare commitments, including delayed, revamped or cancelled expansion programs—initiatives that may be hard to restart even if economic conditions recover.

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