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November 06, 2025
If 2025 proved anything, it’s that pharmacy benefits don’t stand still. From the rise of GLP-1 medications and biosimilars to growing scrutiny of pharmacy benefit managers (PBMs) and the spread of pharmacy deserts across the country, this past year brought in a wave of change. Each and every one of these shifts has affected how employers manage costs, access, and care, while challenging consultants to keep pace, anticipate change, and guide clients through uncertainty.
As we look back, one theme stands out: transformation. What began as a year of shortages and uncertainty ended with innovation, regulation and a renewed focus on health equity. Here’s a look at the moments that defined 2025 and what they mean for 2026.
Few drug classes captured attention like GLP-1s in 2025. From Zepbound and Wegovy to Ozempic and Mounjaro, demand surged for both diabetes and weight management.
Looking Ahead Oral GLP-1s and next-generation therapies (like CagriSema) are on the horizon, promising broader applications, new challenges for benefit design and continued market disruption.
PBMs faced more scrutiny in 2025 than ever before.
Consultant Takeaway This was the year transparency stopped being optional. Navigating PBM contracts, clarifying rebate flows and advocating for member-focused models became essential for protecting employer plans and participants alike.
After years of anticipation, biosimilars fully entered the mainstream.
2026 Outlook More biosimilars are on deck, particularly as patents expire for blockbuster drugs like Trulicity. Employers should prepare for continued shifts in formularies, contracting and member education.
Pharmacy closures reached crisis levels in 2025, creating “pharmacy deserts” and limiting access, especially in rural and minority communities. The impact extended far beyond convenience, influencing medication adherence and overall health outcomes.
Action Steps Using workforce analytics to identify at-risk populations will help tailor benefit strategies and improve equity in care delivery.
Global trade tensions and new tariffs affected pharmaceutical supply chains, heightening concerns over drug shortages and pricing volatility. While impacts were moderate in 2025, employers and consultants will need to monitor policy developments closely in 2026 and prepare for potential disruptions to availability and cost.
Telehealth and direct-to-consumer pharmacy models such as LillyDirect and NovoCare gained traction throughout 2025. These channels offer convenience and access, but also introduce new challenges in safety, utilization management and benefit integration. As the lines between clinical care, retail and digital platforms blur, consultants will play a key role in ensuring plan design keeps pace.
Oral GLP-1s and next generation therapies (like CagriSema) are on the horizon, promising broader applications, new challenges for benefit design and continued market disruption.
It could be argued that pharmacy benefits have never evolved this quickly or this publicly. The past year exposed the tension between cost and care, transparency and control, innovation and access. It also reminded us that behind every regulatory update or drug launch are real people trying to get the medications they need.
In 2026, expect to see:
Final Thoughts 2025 challenged us to rethink pharmacy benefits. In effect, we’ve learned to embrace innovation, push for transparency, and design plans that balance fiscal responsibility with human need. As we transition into 2026, staying proactive and informed will be essential. With changes in the pharmacy landscape showing no signs of slowing, our capacity to adapt quickly and guide clients with clarity will define success in the year ahead. Armed with insight, data, and collaboration, we can help clients and members thrive, regardless of what lies ahead.
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