The Shifting Pharmacy Landscape in 2025
Polypharmacy, biosimilars, and GLP-1s among the evolving trends likely to play out in the pharmacy benefits space.
The pharmacy benefits industry is gearing up for significant change in the coming years. Projections point to a dramatic surge to $875 billion by 2026, constituting 15.4% of the nation’s healthcare budget.1 As 2025 unfolds, we expect to see several trends play out in the pharmacy industry, including the escalation of medicine costs, rising polypharmacy, the growing use of GLP-1 agonists for obesity, and expanding biosimilar adoption. The changes necessitate innovative strategies to manage costs while upholding care quality.
The polypharmacy conundrum
Polypharmacy, the simultaneous use of multiple medications (typically five or more) by one patient, has become the norm for many Americans, launching them into “pill burden.”2 While essential for managing complex health conditions, the use of multiple drugs can have unintended consequences. Medicines may counteract each other, and the risk of adverse drug reactions rises significantly with each additional prescription. This can lead to hospitalizations and other serious health complications.
Then there’s the hurdle of fragmented healthcare data. Many electronic health record systems don’t provide comprehensive medication histories, leading to redundant prescriptions and increased risks. In 2025, AI-powered tools are expected to analyze pharmacy claims, identify overprescribing patterns, and enable timely interventions. Employers and health plans will likely expand programs focused on deprescribing and improving medication management, which can deliver clinical and financial benefits.
Driving biosimilar uptake
Biosimilars, FDA-approved alternatives to expensive biologics, present significant opportunities for cost savings. As of January, there are 63 FDA-approved biosimilars listed on the FDA’s website.3 These treatments, recognized for their potential to reduce healthcare costs, have gained significant momentum, but their adoption has been uneven.
Some health plans have integrated biosimilars smoothly, while others face obstacles such as provider reluctance and patient skepticism. However, health plans that successfully transitioned patients to biosimilars reported substantial savings. A 2023 report found that while generic and biosimilar prescriptions made up 90% of prescriptions filled in the US, they represented only 17.5% of the nation’s prescription drug spending.4
As 2025 progresses, the industry should expect to see a continued boost in adoption. To follow suit, targeted education for providers and patients is essential. Policymakers may also push for improved pricing transparency and streamlined formulary processes, unlocking further savings without compromising care quality.
Creating equitable access to GLP-1s
GLP-1 agonists, initially prescribed for type 2 diabetes, have surged in popularity due to their effectiveness in weight loss and cardiovascular health. There are now about six million Americans on either Ozempic or Mounjaro,5 two GLP-1s that have been leading the charge in this surge, but their high costs pose accessibility challenges.
In response to rising demand, some insurers have shifted these treatments from drug benefits to medical benefits. This change subjects these drugs to deductibles and coinsurance, leading to a hefty increase in out-of-pocket costs for patients and limiting access to care.
Addressing equitable access to GLP-1s will take a coordinated effort. Employers, health plans, and policymakers need to find practical solutions that tackle the financial hurdles created by shifting coverage structures, ensuring patients who need these medications can afford them. By focusing on tiered benefit structures, aligning coverage with clinical guidelines, and making use of data-driven prescribing tools, stakeholders can work toward a fair balance between managing costs and maintaining access to care.
A call for innovation
Managing pharmacy cost containment and optimizing prescribing practices will remain critical priorities in 2025. Stakeholders across the healthcare ecosystem will need to leverage technology, prioritize education, and develop collaborative strategies to enhance care quality while controlling costs.
Streamlined medication management, expanded biosimilar use, and equitable GLP-1 access are key opportunities for progress. By addressing these challenges with actionable, data-driven solutions, healthcare stakeholders can work toward a more sustainable and patient-centered future—one that balances financial objectives with the delivery of high-quality, accessible care.
Josh Canavan, PharmD, is Head of Pharmacy at RazorMetrics
References
1. U.S. Pharmacy Benefit Management Industry is Rising Rapidly. BioSpace. March 19, 2024. https://www.biospace.com/u-s-pharmacy-benefit-management-industry-is-rising-rapidly
2. Al-mansouri, A.; Ibrahim Hamad, A.; Al-Ali, F.S.; et al. Pill-Burden and Its Association with Treatment Burden Among Patients with Advanced Stages of Chronic Kidney Disease. 2023. Saudi Pharm J. 31 (5), 678-686. https://pmc.ncbi.nlm.nih.gov/articles/PMC10172605/
3. Biosimilar Product Information. FDA. February 6, 2025. https://www.fda.gov/drugs/biosimilars/biosimilar-product-information
4. Report: 2023 U.S. Generic and Biosimilar Medicines Savings Report. Association for Accessible Medicines. https://accessiblemeds.org/resources/reports/2023-savings-report-2/
5. Logan, P. On the Increase in Use of GLP-1s. June 27, 2024. https://medicine.iu.edu/blogs/bioethics/on-the-increase-in-use-of-glp-1s#:~:text=%3Cspan%20style=,/span%3E
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