For years, rising specialty drug costs have been among the most significant challenges facing employer-sponsored health plans. While that challenge remains, new industry data suggests the conversation is evolving. Today’s pharmacy trend story is less about escalating drug prices and increasingly about utilization, treatment patterns, and the growing complexity of managing both specialty and non-specialty medications.
Utilization Has Become the Primary Driver of Specialty Trend
Specialty drug trend remained elevated in 2025 at 10.8%, continuing a multi-year pattern of double-digit growth. What’s notable, however, is what drove that increase. Nearly all of the trend was attributed to greater utilization, while changes in cost per claim contributed very little.
The percentage of members using at least one specialty medication increased from 4.4% in 2023 to 5.5% in 2025, while the number of prescriptions filled per specialty user remained relatively stable. This suggests that spend growth is being driven by more members utilizing specialty therapy, not by existing users consuming significantly more medication.
For plan sponsors, this distinction matters. While negotiating better pricing remains important, utilization management, clinical oversight, and ensuring appropriate therapy selection are becoming increasingly critical to controlling trend.
Biosimilars Are Beginning to Deliver on Their Promise
After years of anticipation, biosimilars are finally making a measurable impact. Overall biosimilar utilization increased from 32.2% in 2024 to 56.3% in 2025, driven largely by rapid adoption of Humira biosimilars and the early market entry of Stelara alternatives. Humira biosimilars alone captured more than 80% market share within two years of launch.
The growth of biosimilars represents one of the most important developments in specialty pharmacy today. However, adoption alone does not guarantee savings. Pricing can vary significantly among products, PBMs, and purchasing channels, making total net cost a more important metric than biosimilar utilization rates alone.
As competition expands across additional therapeutic categories, employers and health plans may benefit from regularly evaluating their biosimilar strategy to ensure it aligns with both clinical and financial objectives.
Inflammatory Conditions and Oncology Continue to Dominate Spend
Despite ongoing market changes, the largest specialty spend categories remain remarkably consistent. Inflammatory disorders accounted for nearly one-third of specialty drug spending in 2025, while oncology represented approximately one-quarter. Together, these two categories made up nearly 60% of all specialty drug spend.
Within inflammatory therapy, significant shifts are occurring. As biosimilars erode utilization of established products such as Humira and Stelara, newer therapies including Skyrizi, Rinvoq, and Dupixent continue to experience strong utilization growth.
These trends reinforce the growing importance of evidence-based formularies, clinical pathways, step therapy programs, and ongoing utilization review to ensure members receive clinically appropriate and cost-effective treatment.
GLP-1s Are Reshaping the Non-Specialty Drug Landscape
Perhaps the most significant shift in pharmacy spending is occurring outside of specialty medications. Historically, non-specialty drug trend was relatively predictable, supported by broad generic utilization and comparatively low costs. That is no longer the case. In 2025, non-specialty trend reached 10.4%, nearly matching specialty trend. Unlike specialty medications, where utilization drove most of the increase, non-specialty trend was fueled by both utilization growth and rising costs per claim.
GLP-1 medications have emerged as a major contributor to this shift. Diabetes remains the largest non-specialty spend category, accounting for more than one-third of spending, while GLP-1 therapies for diabetes and weight loss, such as Mounjaro, Ozempic, Zepbound, and Wegovy now represent four of the top ten non-specialty drugs by spend.
As utilization expands across diabetes, obesity, and emerging indications, plan sponsors face growing pressure to balance access, affordability, and long-term clinical outcomes.
What This Means for Plan Sponsors
The newest trend data points to a larger reality in that managing pharmacy spend today requires a broader approach than simply focusing on drug prices. Successful strategies increasingly include:
• Evaluating utilization patterns and emerging cost drivers.
• Promoting appropriate treatment sequencing and therapy selection.
• Leveraging biosimilar competition through net-cost-focused strategies.
• Validating diagnoses and clinical appropriateness where necessary.
• Using integrated medical and pharmacy data to identify savings opportunities and improve outcomes.
Looking Ahead
Pharmacy costs continue to command attention, but the underlying drivers are changing. Specialty utilization is growing, biosimilar competition is accelerating, and GLP-1 therapies are transforming the non-specialty landscape. At the same time, employers are being challenged to manage rising costs without compromising member care.
As the pharmacy benefit market continues to evolve, organizations that combine clinical expertise, transparency, and data-driven decision-making will be best positioned to navigate future trend and deliver sustainable value for both plans and members.
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Sources
Pharmaceutical Strategies Group (PSG). 2026 Artemetrx State of Specialty Spend and Trend Report: 2025 Results. 2026.
Segal. 2027 Segal Health Plan Cost Trend Survey. 2026.
Evernorth Research Institute. Pharmacy in Focus: The Biosimilar Breakthrough in Adoption and Affordability. 2025.