10 Fast Facts About the Pharmacy Benefits Industry

There’s one absolute in pharmacy benefits that we can all rely on: The landscape will continue to evolve. Our pharmacy benefit experts gathered the top 10 things to know about the latest industry developments to help you create sustainable solutions for your clients.

Download these Pharmacy Benefits Industry Fast Facts to share with your clients.

Plan sponsors face a growing expensive trend for diabetes medications

1) From 2021 to 2022, GLP-1 spending rose from $55M to $107M — a 40% year-over-year increase.

2) Ozempic® alone represents 4% to 5% of total plan cost for the average client.

3) Diabetes treatments account for 18% of the total gross cost for pharmacy plans.

4) Eli Lilly, Novo Nordisk, and Sanofi will avoid owing hundreds of millions of rebate dollars after insulin price cuts.

Yusimry announcement may impact the gross-to-net bubble

5) Anti-inflammatory medications and dermatologic agents like Humira®, Cosentyx®, Stelara®, and Taltz® represent about 27% of the gross cost for plan sponsors.

6) At least 11 biosimilars are expected to launch in 2023, and the result of these products hitting the market will be substantially lower net cost.

7) Cost Plus Drugs will offer a Humira® biosimilar online for $570 plus fees, but swapping products may impact the overall value of the pharmacy benefit.

Pharmacy benefit experts are watching legal battles and federal regulators

8) Two lawsuits bring specialty medication cost coverages to the courts. AbbVie and J&J filed suit against vendors using assistance programs.

9) The FTC issued compulsory orders to three group purchasing organizations as part of their probe into the six largest pharmacy benefit managers.

10) Senators introduced the Pharmacy Benefit Manager Reform Act — one of multiple pending bills targeting PBMs.

See behind the curtain to understand what’s behind the latest lawsuits, attack ads, and market disruptions. 

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