The Evolving Pharmacy Benefits Landscape in 2025

The pharmacy benefits landscape continues to rapidly evolve with new developments poised to reshape employer pharmacy benefits strategies in 2025. From clinical innovations and rising specialty drug costs to growing regulatory pressures and new cost models, employers face both challenges and opportunities in the year ahead.

To stay competitive, it is essential to understand the key trends driving these changes. Below, we highlight three critical areas that will impact pharmacy benefits strategies in 2025.

1. PBM Regulation and Upholding Fiduciary Duty in Pharmacy Benefits

Increased regulatory scrutiny on Pharmacy Benefit Managers (PBMs) is reshaping the expectations around transparency and accountability in pharmacy benefits. Federal and state agencies are pushing for more stringent regulations to curb opaque practices and ensure employers and members/patients have greater visibility into how their pharmacy dollars are being spent. Recent class-action lawsuits, like those involving Johnson & Johnson and Wells Fargo, have underscored the risks of inadequate oversight, bringing fiduciary responsibility to the forefront.

Employers are expected to act as fiduciaries when managing pharmacy benefits, which means ensuring their PBM contracts are structured in the best interests of plan members and that all cost drivers are transparent. This responsibility is becoming more critical as regulatory bodies push for enhanced oversight of PBM practices.

Key regulatory developments to watch in 2025 include:

• State-Level PBM Regulations: All 50 states have passed laws related to PBM reform. Targeted areas of legislation include requiring PBMs to only offer pass through arrangements, disclose pricing practices, rebates, and administrative fees. Benefit consultants and employers need to stay informed about these changes to ensure compliance.
• Federal Oversight Initiatives: Recent actions from the Federal Trade Commission (FTC) and other agencies are targeting PBM business models to increase transparency and reduce conflicts of interest. These regulatory efforts are likely to continue gaining bi-partisan support and momentum in 2025 with the change in federal administration.

2. Evolving Clinical Priorities: Weight-Loss Drugs, Specialty Medications, and Biosimilars

Clinical innovation is driving rapid changes in the pharmacy landscape, with specialty drugs, weight-loss treatments, and biosimilars at the forefront. These categories continue to dominate costs, requiring employers to adapt their strategies.

• Weight-Loss Drugs: Diabetes and weight-loss medications like GLP-1s are becoming mainstays in pharmacy benefits. With growing studies highlighting their efficacy and links to broader health conditions like NASH (Non-Alcoholic Steatohepatitis), employers face decisions about whether—and how—to include these treatments in formularies. Incorporating accountability measures, such as app usage and dietitian visits, can help manage costs while driving better outcomes.
• Specialty Medications and Biosimilars: Specialty drugs remain a major cost driver, but the rise of biosimilars is creating opportunities for cost savings. With top PBMs increasingly owning biosimilar manufacturers, formularies are evolving.  As biosimilars are preferred, existing rebate guarantees may be adjusted.   Employers should monitor these shifts closely and consider options like specialty carve-outs or international sourcing to manage costs effectively.

Employers who understand these clinical priorities and adjust their benefit strategies accordingly will be better positioned to deliver value while controlling costs.

Want to learn more about how plans can build a strategic approach to GLP-1s in their pharmacy benefits? Register here for our upcoming webinar, “Managing GLP-1 Costs: Coverage Strategies for 2025.”

3. Net Cost Models in the Spotlight

Innovative pricing models are transforming how pharmacy benefits are structured for plan sponsors. These changes bring both opportunities and challenges for employers as they attempt to navigate the different approaches to achieving lowest net cost.

There is growing interest in new and smaller pass-through PBMs. They operate by passing through all negotiated discounts and rebates, and only charge an administrative fee for their services.  Other, more traditional PBMs have introduced lowest net cost models that manage to one per member per month (PMPM) metric, rather than individual price components.  These models offer plan sponsors predictability for budgeting with a focus on cost reduction and clearer contracts, but might not necessarily be the best fit for all plan sponsors.

Employers who embrace these models should continue to demand transparency to better navigate rising costs and maximize the value of their pharmacy benefits.

The Path Forward for Employers in 2025

The pharmacy benefits landscape in 2025 will demand adaptability, transparency, and informed decision-making. Employers who proactively address evolving clinical priorities, uphold fiduciary duties, and leverage innovative cost models will be best equipped to manage costs while delivering high-quality care.

We explored these trends in greater depth during our February 2025 Pharmacy Outlook Webinar.

This session covered the top five pharmacy benefit trends shaping the year in significant detail and provided practical steps for optimizing pharmacy benefits strategies.

Truveris is a leading digital health company focused on delivering truth and clarity in pharmacy. Truveris’ proprietary technology, coupled with deep pharmacy expertise, helps to build a more efficient market that maximizes choice, accessibility, and prescription drug affordability. Our solutions provide the insight and knowledge to help people lead healthier and more productive lives.