A quarter-century of pharmacy benefit changes

2000–2025: Big changes, big drugs, big costs for pharmacy benefits

The last 25 years have dramatically transformed the pharmaceutical industry and brought with them profound changes in pharmacy benefits as well. The industry has pivoted from mass market drugs like the blockbuster Lipitor® to smaller, targeted populations with new, more expensive biologics and gene therapies. See how the implications of these changes are impacting pharmacy benefits today. Highlights include:

• The evolution of Pharmacy Benefit Managers (PBMs) from processing claims to managing more complex medications.
• Biologic drugs accounting for 50% of plan sponsors’ total prescription drug spending.
• PBMs have secured significant savings through pharma negotiations such as reducing GLP-1 drug prices by roughly 60%.
• The rise of biosimilars has started to put downward pressure on the prices of certain biologic drugs. However, biosimilar adoption has been slow due to patent protections and other barriers.