Viewpoints from Morgan Lee, PhD, MPH, CPH
The pharmacy benefits landscape is no longer as predictable as it once was. As the researcher behind the recent report published by PSG, EPIC’s pharmacy solutions practice, and PSG’s annual four-part report series, I’ve seen firsthand the confluence of challenges employers face: skyrocketing drug costs, innovative new therapies, and constant pressure to maintain affordable access to vital medications for employees.
Our recent report, based on extensive research and analysis of market data, delves into three critical trends reshaping the future of pharmacy benefits. This blog post offers a glimpse into some key findings, but the full report provides a more comprehensive discussion of these market-shaping trends.
The Dawn of Gene Therapy: A Double-Edged Sword
Cell and gene therapies (CGTs) represent a monumental leap forward in medicine, offering the potential to cure previously untreatable diseases. But these life-changing treatments come with eye-watering price tags, often exceeding millions of dollars per patient. The report reveals that 69% of employers consider CGT affordability as a substantial challenge. While awareness of the financial impact is growing, many are still unprepared for the potential financial burden these therapies can place on their plans. The report explores employer strategies for managing this risk. With more CGTs on the horizon, understanding your risk and exploring mitigation strategies is no longer optional – it’s essential.
GLP-1s: Balancing Access and Cost
The rise of GLP-1 drugs has revolutionized the treatment of type 2 diabetes and obesity. However, the popularity of these drugs has also created new challenges for employers. While GLP-1s can offer significant health benefits, their widespread use has led to a surge in pharmacy spending. The report highlights the delicate balancing act employers face: providing access to these vital medications for those who need them while managing the escalating costs. The report explores employer perspectives on obesity as a chronic condition, coverage strategies for GLP-1s, and the growing concerns about GLP-1 affordability. With the GLP-1 landscape constantly evolving, having a robust strategy is crucial to controlling costs and ensuring appropriate utilization.
For more comprehensive insights into developing effective GLP-1 strategies, PSG’s GLP-1 Resource Hub offers extensive research, clinical analyses, and actionable recommendations developed by our industry experts. These resources are designed to help payers make informed decisions about their GLP-1 coverage approaches.
Disruption in the PBM World: Time for Change?
For years, pharmacy benefit managers (PBMs) have been central in managing prescription drug benefits. But the status quo is being challenged. Employers are increasingly dissatisfied with their PBMs, citing concerns about rising costs and a lack of transparency. The report reveals a declining net promoter score for PBMs and a growing desire for change. Employers are actively seeking alternative solutions, from innovative cost models to more transparent rebate and pharmacy network designs. The report explores the drivers of this disruption and examines the potential for new players and strategies to reshape the PBM landscape.
The pharmacy benefits landscape is undergoing a dramatic transformation. Our report goes beyond simply describing these trends; it provides actionable insights and data-driven recommendations to help employers navigate this complex environment. We believe this research, alongside a partnership with the independent consultants at EPIC Pharmacy Solutions, powered by PSG, will empower you to move beyond reacting to changes and proactively shape your pharmacy benefit strategy.
Download the full report from the form on this page today to gain a deeper understanding of these critical pharmacy benefit trends and prepare your organization for the future.
EPIC offers this material for general information only. EPIC does not intend this material to be, nor may any person receiving this information construe or rely on this material as, tax or legal advice. The matters addressed in this document and any related discussions or correspondence should be reviewed and discussed with legal counsel prior to acting or relying on these materials.
Contact the Author
Morgan Lee, PhD, MPH, CPH, Senior Director, Research & Strategy | EPIC Pharmacy Solutions, powered by PSG | Contact Morgan via phone or email.
DOWNLOADABLE RESOURCES
Fill out this short form to download your report on the 3 Critical Trends Shaping Employer Strategies you need to know to navigate the new pharmacy benefit landscape.
“*” indicates required fields
