Pharmacy benefits generate significant data in an employer’s health plan. All that information (claims data, fill information, etc.) leaves a trail, but that trail can sometimes not be especially helpful. What’s needed is insight into the data.
In 2024, pharmaceutical expenditures grew 10.2% compared to 2023 and totaled almost $806 billion. In 2025, that number was $915 billion. Also in 2024, 24% of healthcare spend was on pharmacy, and pharmacy spend is growing faster than overall medical costs. In addition, specialty drugs are expected to make up about 60% of drug spend in 2026.
Clinical insight can have a major impact. When pharmacy data is filtered through a clinical lens and paired with transparent, forward-looking financial reporting, organizations move away from reactive cost management. They have a strategy that connects clinical decisions to financial outcomes.
Clinical Trends Currently Shaping Pharmacy Spend
Understanding the forces driving pharmacy costs in 2026 is important. And understanding the patterns behind them is key to managing them.
GLP-1s are having a tremendous impact on spend. A Gallup poll conducted from May 28 to June 5, 2026, showed that the use of GLP-1s for weight loss in the U.S. has almost quadrupled since 2024. That year, GLP-1s accounted for nearly 47% of the total increase in drug spending. And in 2025, GLP-1s made up about 14% of all drug spending. In2025, weight loss drug Zepbound® (tirzepatide) had $13.5 billion in sales and weight loss drug Wegovy® (semaglutide,) had $11.4 billion in sales. (Zepbound is also approved for moderate to severe sleep apnea in adults with obesity. Wegovy is also approved for cardiovascular [CVD] risk reduction in adults with overweight or obesity and CVD and for adults with metabolic-associated steatohepatitis [MASH]). Plan sponsors need to take a position on coverage for these drugs. They need to decide if there will be no coverage, diabetes-only coverage, both diabetes and weight loss coverage, or restricted coverage.
Adoption of biosimilars is also shaping trend. The market is heating up due to a combination of patent expirations, increased competition, and more demand for cost-effective medications. Humira®, a drug that treats several inflammatory conditions including rheumatoid arthritis, plaque psoriasis, Crohn’s disease, and ulcerative colitis, had over $21 billion in sales in 2022. In the U.S, 10 biosimilars for Humira have been approved over the last decade. The first one was launched in 2023. All 10 biosimilars are now on the market and affecting Humira’s market share. Another drug, Stelara®, which treats Crohn’s disease, ulcerative colitis, plaque psoriasis, and psoriatic arthritis, had annual sales of about $6 billion in 2025. Its first biosimilar was approved in 2023, and there are now eight biosimilars for Stelara. All of them are currently on the market, too.
Patent cliffs, many beginning this year, should also be watched. Over the next five years, over $137 billion in brand drug spend will lose exclusivity, creating savings opportunity from generics and biosimilars. For example, Xarelto® is a blood thinner and is expected to go off patent in 2027. Last year, it generated global sales of $2.6 billion.
Oncology and infused specialty therapies continue to drive disproportionate claim costs, especially in the medical benefit. Estimates indicate that specialty drugs make up between 40% to 50% of pharmacy spending, and that percentage is expected to increase. Over the next five years, oncology medicine spending is expected to grow by 75% due to a growing number of cancer cases, expansion of therapies, expansion of access, and personalized medicine. In 2024, the U.S. oncology market size was over $72 billion. By 2034, it is expected to be nearly $212 billion. The increase in spend is expected to affect both the medical and pharmacy benefit as manufacturers expand oral oncology dosage forms and self-injectable therapies that can be administered at home.
Part of that growth reflects a real shift in how cancer is treated. Older, broadly cytotoxic chemotherapies are giving way to newer agents that are more selective and more targeted, and this transition is happening quietly, behind all the attention GLP-1s are getting. New therapies are also meaningfully improving outcomes. One recently approved pancreatic cancer treatment roughly doubled patient survival rates. That progress, however, comes at a cost. Combination regimens that pair multiple therapies push spend higher still. As this space evolves, some patients may shift toward biosimilar options where available, while increasingly targeted therapies could, over time, displace some of those same biosimilars. Without reporting that separates these clinical drivers from the broader spend picture, this trend can go unnoticed for too long.
None of these trends have come out of the blue. Plan sponsors need to stay ahead of them and determine their impact.
Transparent Reporting Is Key
Many plan sponsors receive reporting that confirms what was spent without a clear explanation of why it happened. Aggregated numbers can hide the clinical drivers underneath.
A solution is to combine clinical expertise with detailed, transparent financial reporting. Clients can then see their data clearly: which drug classes are driving trend, what their rebate contracts delivered, and how formulary decisions connect to the numbers they’re seeing. The analysis reflects the client’s interest. Unbiased clinical insight looks different from insight filtered through a vertically integrated relationship.
Transparency changes the pace of decision-making as much as the quality of it. When plan sponsors can see net cost at the drug-class level as payments are made, they no longer have to wait for a scheduled review to act on changes in net cost for a particular drug class. Rather than waiting to see gross costs, net costs, and where dollars are really going, an online reporting tool can surface that picture continuously, drawing from the same underlying data used to build formal reports. That earlier visibility gives clients the information they need to make legitimate, well-supported decisions as quickly as the trend requires.
But getting to that point takes real operational change. Truly transparent contracting among the plan sponsor, the pharmacy benefit partner, and the broader supply chain requires alignment across all three parties. Federal scrutiny of pricing and profit arrangements across the industry has added pressure to make that alignment happen, pushing reporting models toward genuine transparency rather than disclosure that technically satisfies a requirement without changing the underlying incentives.
Building Trust Through Transparency
Transparent reporting also reshapes the relationship between the pharmacy team and the payers, employers, and clients it serves. When rebate data is fully visible and clients can trace how those dollars flow, it builds trust and turns the relationship into a genuine partnership. Decisions become shared rather than delivered. Clients start to recognize that being given the right information is what allows them to make the right decisions in the first place.
That shift depends as much on presentation as on access. Data displayed as a picture that tells a story and builds a clear narrative does far more for a client than a table of raw numbers. It makes information actionable and easy to read, and that clarity is what can strengthen the relationship.
Transparency Versus Data Overload
There’s an important difference between transparency and simply handing over more data. A complete data dump is like the world’s most sophisticated map. It is technically comprehensive, but the reader must interpret, navigate, and translate into decisions on their own. Real transparency works more like a GPS. It takes the same underlying information and turns it into clear direction. In practice, that means taking a large volume of available data and distilling it into a few pages of focused insight rather than presenting all the information at the same time and expecting the client to sift through it to find what matters.
Modeling the Future
Clinical insight is most valuable when it uncovers information ahead of time and not after the fact. Projections and scenario modeling let plan sponsors test formulary decisions against realistic cost trajectories before deciding on a benefit design. For GLP-1s, that means modeling the cost difference between coverage with clinical criteria, tiered coverage, or exclusion, with realistic member impact assumptions for each one. For specialty therapies, it means identifying which members are candidates for biosimilars and projecting the plan savings that could result from the switch. For emerging drug categories like cell and gene therapies, it means understanding the financial exposure before even one catastrophic claim arrives. Modeling is not about predicting the future with complete certainty. Instead, it is about replacing reactive decisions with informed ones.
From Data to Decisions
The plan sponsors best positioned for the year ahead are not necessarily those with the largest budgets. They are the ones that understand what is driving their pharmacy spend, have reporting that makes that picture visible, and work with partners whose clinical expertise translates data into decisions.
When clinical insights connect to clear financial reporting and projections tied to real-world outcomes, organizations are better able to build smarter benefit designs, negotiate with confidence, and manage cost without sacrificing care.
Reach out to Gateway Health Partners to learn how we can help you prepare for what’s ahead. Contact us at [email protected].
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