By Andy Gillespie, PharmD, AVP, Clinical Strategy, SlateRx
As 2025 comes to a close, it’s time to look back at the year and how new therapies, evolving regulatory pressures, and shifting member expectations are reshaping the way plan sponsors should think about benefit design, access, and long-term sustainability.
Three themes consistently rose to the top this year and each one will define where we go in 2026.
1. GLP-1 Weight Management: The Pressure Cooker of Benefit Design
In the history of pharmacy, few categories have impacted plan sponsors like GLP-1 medications. And not only their sheer cost, but the meteoric trajectory of their use. Their clinical impact is real, but so are the financial implications.
Plan sponsors are under immense pressure, from members, employers, and even cultural momentum, to offer coverage for GLP-1s. Yet the moment coverage is turned on, many plans find themselves confronting budget surprises that weren’t on their radar.
We are seeing real-world challenges play out every day:
- Plans starting the year covering GLP-1s for weight loss, only to discover the cost curve is unsustainable, triggering difficult conversations about how to manage costs.
- Employers trying to strike the balance between providing access and protecting the long-term financial health of the plan.
- Members navigating confusion around plan coverage for GLP-1s, especially as advertising fuels direct-to-consumer utilization.
- GLP-1s are being used for more than just diabetes and weight management. This includes Obstructive Sleep Apnea, major adverse cardiovascular event (MACE), Metabolic Dysfunction-Associated Steatohepatitis (MASH), and the list continues to grow.
GLP-1 demand is not slowing down. But with thoughtful design and a clear strategic compass, plans can offer responsible access without jeopardizing financial stability.
2. Biosimilars: A Once-in-a-Decade Savings Opportunity…If You Act Fast Enough
This year brought one of the most meaningful shifts in specialty pharmacy economics: the accelerating emergence of biosimilars.
Over 60 biosimilars across 17 reference biologics are now available, creating competitive pressure unlike anything we have seen before. But the value only materializes when strategies are implemented quickly and deliberately. Having a partner who identifies opportunities and can pivot quickly to the lower-cost alternative makes all the difference in this fast-moving category.
Looking at your benefit plan, you should question what is the net cost of biosimilar strategies that are currently in place. If you can’t get to that number or there is any ambiguity, then that is a reason to look deeper. This year, plan sponsors could have capitalized on several major savings opportunities for reference drugs with first time biosimilars available for Humira and Stelara.
On top of that, the regulatory environment is rapidly accelerating. The FDA recently announced initiatives to streamline biosimilar development, reduce cost barriers, and shorten the time to market.
Looking ahead to 2026, biosimilars are expected for major therapies including:
- Xolair for allergic asthma and chronic hives
- Orencia for moderate to severe rheumatoid arthritis (RA)
- Simponi for inflammatory conditions
- Perjeta for HER+ breast cancer
Each biosimilar represents a new pathway for value, but only if plans are ready with clinical strategies, contracting alignment, and clear direction to guide member utilization. In the world of biosimilars, speed and strategy directly translate to savings.
3. Specialty Drug Growth & Pipeline Risk: The New Normal of High-Cost Care
Specialty drugs continue to drive the majority of pharmacy trend, particularly in oncology and rare disease therapies. As of November 25, the FDA has approved 39 novel drugs so far this year, 14 of which are for cancer treatment.[i] And costs per drug continue to rise as the median launch price for an orphan drug is now more than $300,000 per year.[ii]
Many of these treatments deliver meaningful clinical advancements. But they also introduce extraordinary cost risk with rapidly expanding eligible populations. Every new therapy should be scrutinized through two lenses: clinical value and economic impact for both the plan and members.
That means developing proactive prior authorization criteria, aligning policies to real-world evidence (not just manufacturer messaging), and ensuring plans don’t pay for therapies where the clinical value does not justify the cost.
With dozens of high-cost products in the pipeline and an increasing number seeking accelerated approvals, 2026 will require even more rigor, vigilance, and policy innovation.
Looking Ahead: A Pharmacy Landscape Defined by Choice, Pressure, and Opportunity
The thread connecting all three trends is clear: Plan sponsors are navigating unprecedented complexity, and the fiduciary-focused decisions they make today will shape affordability for years to come.
Whether it’s managing GLP-1 demand, capitalizing on biosimilars, or staying ahead of specialty pipeline, one principle holds true:
You need a partner who sees both the clinical and economic landscape, and acts with your long-term interests at the center.
As we close out 2025 and look toward 2026, our clinical team at SlateRx remains focused on transparency and delivering the right mix of strategies that prioritize lowest net cost, plus member experience, to help clients sustain value in an increasingly dynamic pharmacy market. If you’d like to dive into how these trends may affect your plan in 2026, we’re ready to help. Contact us at clinicalstrategy@slate-rx.com.
[i] FDA. (2025). Novel drug approvals for 2025. U.S. Food & Drug Administration.
https://www.fda.gov/drugs/novel-drug-approvals-fda/novel-drug-approvals-2025
[ii] Beasley, D. (2025, May 22). Prices for new U.S. drugs doubled in 4 years as focus on rare disease grows. Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/prices-new-us-drugs-doubled-4-years-focus-rare-disease-grows-2025-05-22/
