Navigating today’s dynamic pharma terrain

Pharmacy spend in the U.S. is expected to rise by 11% over 2025.¹ The trend is expected to continue, driven by advancements in treatments for obesity, oncology and other complex conditions. As demand for new pharmaceutical and biotech innovations surges, it can be difficult to tease out associated risks and drawbacks. Some employers find themselves scrambling to reevaluate current coverage options and thinking through new approaches that consider employee interest.

Glucagon-like peptide-1 (GLP-1) medications were originally developed to help manage type 2 diabetes. In 2014, the U.S. Food and Drug Administration (FDA) approved the first GLP-1 for the treatment of obesity.⁵ Since then, demand for and usage of GLP‑1 medications prescribed for weight loss has surged. In 2023, less than 1M patients were on GLP-1s for obesity; that rose to nearly 4M in 2025 and is expected to surpass 19M in 2030.⁶ The problem is coverage for these drugs has significant cost implications for employers:

• The average cost of GLP-1 drugs can surpass $1,000 per month⁷
• UnitedHealthcare claims data shows that less than 50% of GLP-1 users continued to use these drugs after 1 year,⁸ suggesting that long-term benefits of covering these drugs may not be fully realized if adherence remains inconsistent

And while covering GLP-1s may give employers an advantage when attracting and retaining talent, the promise of immediate and long-term ROI is uncertain — hence why over 77% of large employers report that managing GLP-1 costs is a top priority.⁹Developing a thoughtful approach is critical, which can include:

• Setting parameters for coverage like a body mass index (BMI) threshold
• Pairing GLP-1s with a medication utilization management program to improve adherence
• Requiring enrollment in a lifestyle modification program designed to achieve sustained weight loss

In fact, more than one-third of employers who cover weight loss now require participation in weight management coaching as part of GLP-1 coverage — up from just 10% a year ago.¹⁰

Specialty medications — complex medications used to treat chronic or complex conditions like cancer — often require special handling and clinical monitoring and also come at a high cost. In fact, despite making up less than 2% of prescriptions, specialty drugs account for ~55% of total drug spend.¹¹

But while expensive, these drugs are transforming health care and have the potential to offer treatments for patients with rare conditions. These factors, along with increased utilization, contribute to the fact that 80% of surveyed employers are prioritizing specialty drug cost management as they develop their health plan strategies.¹²

There are steps employers can take to help mitigate the impact of specialty medications on their bottom line. They can start by ensuring the medication is being covered by the correct benefit. For instance, there can be a cost difference if the same prescription is covered by medical benefits or by pharmacy benefits. Integrating medical and pharmacy under one carrier can help provide a more comprehensive view into a member’s health status and medication needs. Requiring prior authorizations and clinical oversight can also help ensure that the prescribed drugs are appropriate for the member’s condition and are then being covered by the appropriate benefit.

Biosimilar adoption is another strategy employers can take to help contain costs. A growing number of FDA-approved biosimilar drugs offer significant cost savings compared to the original innovator product — averaging 50% lower while delivering similar outcomes.¹³ Biosimilars are already being used for treatment of cancer, diabetes, eye disorders and inflammatory diseases, with more than 40+ new biosimilars expected to launch by 2027.¹⁴ Employers can work with their PBM to help ensure the lowest net‑cost, clinically appropriate options are being covered, while maintaining continuity of care for members.

Gene and cell therapies — a type of treatment for genetic disorders that corrects, replaces or inactivates faulty genes within a patient’s cells — are also on the rise, with the market projected to top $18.5B in the U.S. by 2033.¹⁵

And while these therapies offer the possibility of unprecedented results, they come at an equally incredible cost: Approved gene therapies can cost $1M–$4M⁴ per person for the drug alone, not including additional treatment-related costs that may be needed. Cell therapies are less expensive but can still cost as much as cell therapy treatments often priced at $400K–$500K¹⁶ Both treatments could have a catastrophic effect on an employer’s budgeted spend.

So, what factors should employers consider when shaping their strategies around these groundbreaking therapies? Purchasing stop-loss insurance can help employers handle these potential “lightning strikes” and other high-cost claims that may be difficult to forecast.

Employers can also look for a carrier that has an established end-to-end approach for managing gene and cell therapies. For instance, UnitedHealthcare’s Cell, Gene and Molecular Therapy Centers of Excellence (CGMT COEs) provide protocols based on the latest treatment findings and results as well as negotiate contractual savings with treatment centers to help with cost predictability. Employers and members see a 30%+ average savings versus claims reimbursed under standard contract terms for ex-vivo, CAR-T¹⁷ and in-vivo¹⁸ therapies with an approved Center of Excellence network provider.

Health care costs continue to rise as specialized treatments proliferate. But employers are not powerless. By working with a carrier that takes a data-driven, cross-benefit and integrated approach to covering and managing newly available treatments and drugs, where pharmacy strategy is tightly aligned with medical care delivery, employers can control overall spend while still providing member coverage to therapies that drive improved health outcomes.