The pharmacy benefit landscape is evolving rapidly, and 2025 is proving to be a pivotal year. Rising drug costs, increased demand for transparency, and the emergence of new therapies are pushing plan sponsors to rethink how they manage their pharmacy benefit. At MedOne, we’ve identified the following five key trends that are reshaping the PBM space and what they mean for your organization.
1. Active Management: The End of “Set It & Forget It”
Gone are the days when pharmacy benefits could be placed on autopilot. Today’s environment demands a hands-on, data-driven approach. Plan sponsors must work closely with their brokers and PBMs to continuously evaluate claims data, identify cost drivers, and implement strategies that align with their organizational goals.
This doesn’t mean a one-size-fits-all solution. Every organization has unique needs, and success depends on tailoring benefit strategies accordingly. Whether it’s adjusting formulary design, implementing utilization management tools, or exploring alternative funding models, proactive management is essential for long-term sustainability.
2. Visibility & Transparency: Your Data, Your Way
The foundation of any effective pharmacy benefit strategy is access to data. Without it, plan sponsors are flying blind. That’s why “transparency” is more than a buzzword. It’s a necessity.
At MedOne, we believe in “Your Data, Your Way.” Plan sponsors should have full access to their claims data in formats that are easy to analyze and act upon. But transparency doesn’t stop at data access. Understanding how your PBM earns revenue—whether through spread pricing, rebate retention, or other mechanisms—is critical. These financial incentives can influence formulary decisions and ultimately impact member health outcomes.
The goal? Align PBM incentives with what truly matters: better health outcomes, lower net costs, and a high-touch, high quality member experience.
3. GLP-1 Strategy: Balancing Access & Oversight
GLP-1 medications, originally developed for diabetes, have surged in popularity due to their effectiveness in weight management. But with high demand comes high cost, and plan sponsors are feeling the pressure.
Most PBMs now require prior authorization (PA) for GLP-1s, but not all criteria is created equal. It’s vital to understand how these drugs are being covered and why they’re driving spend. If your plan covers GLP-1s for weight loss, consider pairing that coverage with a wellness program. MedOne partners with Tria Health to ensure members are set up for long-term success. These medications are most effective when combined with routine changes, member support, nutritional counseling, and lifestyle coaching.
4. Biosimilars: A New Era of Savings
The biosimilar market is gaining momentum, and 2025 is a breakout year. With blockbuster drugs like Humira and Stelara losing patent protection, plan sponsors have a golden opportunity to reduce costs through the use of biosimilars.
New-to-market medications like Yusimry and Otulfi offer lower net costs without compromising clinical outcomes. But success depends on agility. PBMs must be able to pivot quickly, update formularies, and guide members through transitions seamlessly.
At MedOne, we take a hands-on approach to biosimilar adoption, ensuring a smooth member experience that prioritizes maximum savings. And with more high-cost drugs set to go off-patent, this trend is just beginning.
5. Net Cost Focus: Looking Beyond the Rebate
Rebates have long been a focal point in pharmacy benefit discussions, but they don’t tell the whole story. A high rebate on an overpriced drug isn’t a win if that drug shouldn’t have been on the plan in the first place.
That’s why we encourage plan sponsors to focus on net cost, the true bottom line after accounting for discounts, rebates, and administrative fees. A net cost approach ensures every dollar is spent wisely, avoiding short-term illusions of savings and promoting long-term plan sustainability.
2025 is a year of transformation in PBM. From embracing biosimilars to rethinking GLP-1 coverage, plan sponsors have more tools—and more responsibility—than ever before. The common thread across all five trends? Intentionality. Success in today’s pharmacy benefit landscape requires active engagement, transparency, and a relentless focus on value.
At MedOne, we’re here to help you navigate this evolving landscape with clarity and confidence. Talk with a member of our team to learn more: info@medone-rx.com.