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As we transition to 2025, several key issues from 2024 will continue to impact the pharmacy benefit landscape, along with a few new developments. GLP-1 medications, which have become a major trend driver, will remain a force in the industry, with oral formulations making progress towards approval. Although there was consideration for federal reform of pharmacy benefit managers (PBMs) in December’s lame duck session of Congress, no legislation was passed. Reform proposals are expected to persist in 2025, and employers’ fiduciary responsibilities will be further addressed in the courts.
National CooperativeRx finalized a new PBM contract in 2024 and was able to allow improvements to begin for early signers in October. January 1, 2025, all member groups will benefit from the new pricing and updated terminology in the contract.
While pharmacy trend expectations for 2025 are projected to be in the high single to low double digits, National CooperativeRx has managed to beat industry trend for 2024. We have successfully navigated changes related to insulin, Humira, and associated rebate credit dynamics, while offering management solutions for GLP-1 medications.
In 2025, highly anticipated FDA approvals are expected, including new therapies, first-time approvals for certain diseases, approvals with clinical improvement over existing therapies, new dosage forms, and expanded indications. As always, National CooperativeRx is on watch and will navigate in our members’ best interests. We are investigating additional GLP-1 management options and look forward to Stelara biosimilars to help control and offset cost increases. All of our existing industry-leading oversight activities continue.
Predictions regarding the new administration remain uncertain. While healthcare may not be the primary focus, with trade, immigration, tax cuts, and the economy potentially taking precedence, it is also possible that PBM reforms, direct-to-consumer advertising, and other healthcare issues could be prioritized. National CooperativeRx will continue to monitor developments and keep members and partners informed.
The issue of employers’ fiduciary obligations gained attention in 2024, with several lawsuits filed. The first, targeting Johnson & Johnson, is expected to see action in early 2025. In response, National CooperativeRx has developed a document outlining how we support plan sponsors in fulfilling these obligations. We plan to release an updated version of this document in 2025.
The increasing focus on pharmacy benefits led to a surge in employers exploring PBM services for 2025. National CooperativeRx saw 319 opportunities in 2024, compared to a five-year average of 178. We not only turned down some opportunities, but also had to decline groups looking to implement at the last minute. Ultimately, 60 new groups joined the Cooperative, representing over 66,000 lives, with a projected savings of nearly 50% compared to their prior spend.
This trend of employers reassessing their PBMs is expected to continue, as a recent industry survey revealed that one-third of employers plan to review their PBMs and seek better options for 2026. Employers, especially those in for-profit coalitions driven by brokers or consultants, are increasingly seeking independent solutions. National CooperativeRx is poised to offer these employers the independent, expert solution they need.
The growth and success of National CooperativeRx is made possible by its members, partners, and staff. Recent growth has allowed us to recognize staff contributions and provide new opportunities as we look to position the Cooperative for 2025. We are planning more thought leadership, more oversight for our members, continuation of our new 20-minute webinar series on important industry topics, and more outreach to our members and partners. As we look ahead to 2025, we do so with heavy hearts, remembering our colleague Tim Hogan, who passed away unexpectedly and was excited about his own outreach plans for the coming year.
Despite the challenges that lie ahead in the pharmacy benefits landscape, National CooperativeRx is in a strong position to navigate this ever-changing marketplace. We stand ready to help our members and partners provide a solution focused on the fiduciary obligations of plan sponsors. For over 20 years, the Cooperative has been committed to acting in the best interests of patients and plan sponsors, and we look forward to continuing this mission in the year ahead.
