Overview

Marketplace Competition

Influences of marketplace competition shape the status quo. The last few years have led to higher scrutiny for PBMs (pharmacy benefits managers) due to high drug prices, access and control, which is anticipated to continue in 2025. PBM competition fosters further transparency, differentiating themselves from the largest PBMs and encouraging innovation. Anti-PBM bills drive change within the pharmacy supply matrix, including pricing terms, exclusive networks and other revenue streams.

Pipeline Growth Persists

Pipeline growth persists for both specialty and non-specialty drug categories. The pipeline growth of transformative drugs will impact pharmacy costs while delivering potentially life-changing results. Biosimilars are expected to hit the market in 2025, including Stelara®, hoping to offset the rising inflation of currently branded specialty products. GLP-1 utilization continues to rise for diabetes and obesity. Gene therapies are moving beyond rare diseases to more common ailments afflicting the general population, such as macular eye degeneration and knee osteoarthritis.

Artificial Intelligence in the Pharmacy Space

The use of artificial intelligence (AI) in the pharmacy space will be more pronounced in 2025, aimed at enhancing efficiencies, outcomes and cost mitigation. For pharmacy, this may lead to drug development shifting from repurposing drugs to developing new drugs, increasing accuracy and productivity in clinical trials and personalized healthcare. Additionally, the market may continue to explore uncoupling various PBM offering components by replacing them with vendors to accomplish the tasks; the 2025 implementation of the Blue Shield of California model is an example.

What Employers Should Know

Approved Cellular and Gene Therapy Products | FDA;
The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large
group of CML experts – PMC
PBM reform: A closer look at state legislation this year; The state of PBM regulation in the states ; Chart Source: FactSet
Median Drug Prices For Rare Diseases Hit $300K In 2023, Report Highlights Lack of Clear Rationale Behind Escalating Drug Prices — TradingView News
What will be the key trends in AI innovation in the Pharmaceutical Industry in 2025?
How AI and Data Analytics Are Transforming the PBM Industry: A Look at Predictive Modeling, Risk Stratification, and Personalized Care

Employee Benefits Team