Top Drug Trends Shaping Your Benefits

Staying informed about the latest drug trends is essential for optimizing pharmacy benefit plans. At National CooperativeRx, we monitor industry trends and trends within our membership to offer actionable insights to help plan sponsors make informed decisions.

Antidiabetic Drugs

No discussion on pharmacy trends would be complete without mentioning glucagon-like peptide 1 agonists (GLP-1s), which have become dominant players in diabetes and weight management. In 2024, Ozempic and Mounjaro were the top two contributors to total spend within the Cooperative, while other GLP-1s in this class showed flat or negative trend. Overall spend on antidiabetic drugs has increased by only 5.5%. This modest rise is largely due to insulin list price reductions, which offset the increased utilization of GLP-1s.

Anti-Obesity and ADHD Drugs

The use of GLP-1 drugs in weight management drove spend in the anti-obesity and ADHD category. In 2024, Wegovy had the highest spend among anti-obesity drugs, but Zepbound showed the highest trend and is on track to surpass Wegovy in 2025. While savings were generated from the generic launch of the ADHD medication Vyvanse, this category still saw a substantial increase in trend due to demand.

Plan Sponsors May Want to Consider: Adjusting preferred brand and tier-2 cost-sharing structures based on GLP-1 medications. Implementing a copay or coinsurance of $150 or 15%, to match pharma-funded coupon value, can help manage costs while maintaining access to these high-demand therapies. Additionally, adjusting plan accumulations such as deductibles and/or out-of-pocket maximums can optimize manufacturer assistance opportunities.

Medical Devices

Continuous glucose monitors (CGMs) such as Dexcom and disposable insulin pumps, like Omnipod, continue to gain traction. Dexcom is approved for patients with diabetes, particularly patients with intensive insulin regimens or those who have trouble managing their blood glucose. However, its off-label use for general wellness purposes has risen due to social media influence. While some may see benefits, it has not been FDA-approved for these purposes. Meanwhile, Omnipods, which were previously covered under medical benefits, are now primarily distributed through the pharmacy channel, contributing to trend increases.

Plan Sponsors May Want to Consider: Implementing utilization management for CGMs and insulin pumps. National CooperativeRx offers this at no additional cost through our Advanced Criteria Updates program. Enrollment is simple—plan sponsors complete a one-time form, and our in-house clinical team handles the rest, ensuring appropriate utilization through ongoing oversight.

Migraine and Antiviral Drugs

The migraine drug class, once a low-cost category dominated by generics, has evolved significantly with the rise of calcitonin gene-related peptide (CGRP) inhibitors such as Nurtec, Ubrelvy, and Qulipta.

HIV prevention and treatment drugs, including Biktarvy, Truvada, Descovy, and Apretude, also remain significant cost drivers, with the latter three requiring Affordable Care Act-mandated no-cost coverage for members. Additionally, Paxlovid, the COVID-19 treatment, transitioned from government-funded to plan-paid coverage.

Plan Sponsors May Want to Consider: Adding utilization management for CGRP inhibitors ensures appropriate quantities and more cost-effective therapies are tried first. This is another area our Advanced Criteria Updates program provides value by promoting appropriate utilization.

Gastrointestinal Agents

Gastrointestinal (GI) drugs are a growing category, driven by the shift from medical to pharmacy benefits and expanded treatment options like Skyrizi, Tremfya, Entyvio, and infliximab. On a positive note, the shift from medical to pharmacy helps plans avoid paying for significant facility/administration charges.

Plan Sponsors May Want to Consider: Participating in the CVS True Accumulations program since many of these GI drugs are specialty and coupon value can be tracked using exclusive specialty. This ensures only true patient cost-share is applied towards deductibles and/or out-of-pocket limits. Additionally, enrolling in PrudentRx helps maximize plans’ ability to use manufacturer assistance to offset member cost-share expenses.

Biosimilars

The biosimilar market continues to grow, with Humira biosimilars making a significant impact. In April 2024, brand Humira was removed from the CVS Caremark formulary, leaving only the Humira biosimilar for adalimumab products. Since then, almost all our patients have transitioned to the biosimilar, resulting in a significant reduction in list price and savings to plan sponsors, net of rebates.

Stelara biosimilars are expected to enter the market in 2025, with potential list price savings near 80%. While the overall impact on our Cooperative may be smaller than the Humira biosimilar transition—due to Stelara’s volume being approximately 3.5 times lower—certain plans and patients could still see significant savings. We expect these biosimilars to be added to formularies, most likely by October.

Revlimid/Lenalidomide

Revlimid and its generic, lenalidomide, are specialty drugs used to treat blood and lymphatic cancers, and both have significant year-over-year trend increases. Lenalidomide was launched in 2022, but savings have been gradual due to production restrictions placed on the manufacturer. Initially, the manufacturer was limited to producing only a certain percentage of the total supply each year, leading to a slower release of the drug. However, once these production restrictions are lifted in 2026, we expect a slower trend and more substantial cost reductions for lenalidomide.

Dermatologicals

This class includes drugs for psoriasis and eczema, but we included food allergies, hives, and asthma, due to product overlap. Expanding indications for Dupixent and Xolair and the high demand for Skyrizi and other biologics for psoriasis, contribute to trend increases. However, the trend in this class was just 6% in 2024, reflecting the effectiveness of our clinical team’s efforts to manage this category.

Plan Sponsors May Want to Consider: Reviewing provider networks. The Cooperative has seen greater demand for high-cost products from private-practice or independent dermatology clinics. However, it is important to keep in mind balancing access with potential cost savings. Additionally, the Cooperative clinical team is developing a home phototherapy program that plans will be able to consider in the coming months. This will offer patients alternatives to biologics and provide significant savings. Stay tuned for an official announcement.

National CooperativeRx remains committed to staying proactive and identifying strategic plan design opportunities to help plan sponsors navigate emerging drug trends effectively.

Please contact your National CooperativeRx account representative to discuss which strategic considerations align with your plan’s goals.