The Future of Pharmacy Cost Containment in 2025

By Tom Dorsett

The pharmacy industry is in constant flux, and 2025 is no exception. From groundbreaking new medications to evolving treatment approaches and the constant pressure of rising healthcare costs, the forces shaping pharmacy benefits are as dynamic as they are complex. Breaking through these intricate barriers requires a proactive approach from employers, health plans, and providers to ensure sustainable, patient-centered care.

As the industry moves through the first half of 2025, there are three top-of-mind pharmacy trends for professionals to monitor and strategically narrow in on, examining their potential impact on patient safety, total drug spend, and the overall quality of healthcare.

1. Rising costs of GLP-1 medications
   

   Glucagon-like peptide-1 (GLP-1) receptor agonists are an important treatment for chronic conditions like type 2 diabetes and cardiovascular disease. Now, thanks to their growing prominence in pop culture and an increase in compounded versions, the rapid adoption of popular medications like Ozempic has skyrocketed. As with many products, when there is an increased demand for these medications, there is an inevitable increase in cost. This rise comes with a devastating caveat for payers and patients: escalating costs that can risk individual’s medical needs.

In 2025, insurers will likely shift more of the financial burden to patients, leading to higher out-of-pocket costs and insurance deductibles. This shift may reduce medication adherence, worsen chronic conditions, and drive up overall healthcare expenditures.

Recent data highlights that out-of-pocket costs can significantly impact treatment adherence. Affordability is a major barrier for the 62% of adults who use GLP-1 medications to treat chronic conditions, prompting an alarming 22% to note their required medications are “very difficult” to afford. Notably, even with insurance, half of users struggle with the cost.

In 2025, healthcare organizations must prioritize medication affordability and adherence strategies to address these risks. Employers can work with pharmacy benefit managers (PBMs) to design plans that limit out-of-pocket expenses for employees. At the same time, providers can focus on patient education to ensure the safe and effective use of GLP-1 therapies. Some health plans have begun implementing value-based insurance designs, which can reduce copays for high-value medications like GLP-1s, providing broader access and better health outcomes.

2. Wider adoption of biosimilars
   

   As generic GLP-1s continue to rise in cost and decrease in accessibility for the average person, many providers are turning to biosimilars as a solution. Biosimilars—cost-effective alternatives to expensive biologics—offer an opportunity to reduce treatment costs for conditions such as rheumatoid arthritis, cancer, and inflammatory bowel disease. By expanding access to life-saving therapies, biosimilars hold the potential to improve health outcomes while lowering pharmacy benefit costs.

Since 2015, biosimilars have generated nearly $24 billion in savings for patients and the healthcare system by replacing branded biologics. Additionally, patient surveys indicate high satisfaction levels, with 85% of respondents reporting no perceived differences in effectiveness or side effects between the biosimilar and the original biologic, noticing only more dollars in their pockets.

Employers and health plans can capitalize on this trend by incorporating biosimilars into formularies and educating providers and patients directly about their efficacy and safety. Properly implementing these cost-effective drugs can contribute to a more equitable and cost-efficient healthcare system.

3. The polypharmacy challenge
   

   Polypharmacy, or the use of multiple medications by a single patient, continues to rise, pushing medications to become a mainstay in a person’s daily life. For example, 48% of American males born in 2019 are expected to use prescription drugs at some point in their lives, while this figure rises to 60% for females.

This trend poses serious risks to possibly the longest-living generation, including adverse drug interactions, nonadherence, and cognitive impairment. Patients who have adverse reactions to mixed medications may then have to take yet another drug to cancel out the adverse reaction, driving up the “pill burden” among patients and their overall dependence upon medications.

Nonadherence is a major challenge within the context of polypharmacy, particularly among adults aged 65 years and older. A Vanderbilt University study found that 32.6% of older adults who reported cost-related nonadherence (CRN) were in fair or poor health, compared to only 18% of those who adhered to their prescribed regimens. The study also showed that 41.4% of CRN respondents were categorized as extreme polypharmacy patients, taking six or more medications per month, versus 27.2% of compliant respondents. These findings show a clear connection between managing a heavy medication load, difficulty adhering to treatment plans, and declining health outcomes.

In 2025, addressing polypharmacy will require a multifaceted approach. Tools that help providers identify and eliminate unnecessary medications without disrupting workflows are gaining traction. By reducing medication-related risks and improving adherence, these innovations can enhance patient safety and lower overall healthcare costs.

Looking ahead: Strategies for success

As pharmacy benefits shift, providers, payers, and employers must adopt proactive strategies to stay ahead of these trends. Key approaches include:

• Collaborative Care Models: Promoting collaboration between providers, pharmacists, plan sponsors, and PBMs to ensure optimal medication management.
• Technology Integration: Leveraging innovative, AI-driven tools to streamline prescription workflows, monitor patient adherence, and flag potential drug interactions.
• Patient-+Physician Benefit Design: Developing pharmacy benefits that are easy to use, prioritize affordability and access, balancing cost containment with high-quality care.

Health plan sponsors that switch their focus to sustainable, patient-friendly solutions, will stay on top of these developing trends. Tackling challenges like polypharmacy, expanding access to biosimilars, and managing the rising costs of GLP-1 medications will take a collaborative, technology-driven effort. Employers, health plans, and providers need to come together to create a pharmacy benefits system that works better for everyone—one that ensures patients get the care they need without sacrificing quality or affordability. By combining innovation with a commitment to better outcomes, we can build a healthcare system where affordability and quality go hand in hand.

Tom Dorsett has 20 years of experience as a healthcare entrepreneur and business development executive. He founded and exited two successful companies, NuScribe and ePatientFinder, and co-founded RazorMetrics in 2018 to lower drug spend for self-funded employers and health plans.