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…
What you need to know about market trends as the specialty pipeline expands and biosimilars reshape the cost picture. Get the report below.
The pipeline for specialty and advanced therapies continues to expand. Gene therapies, targeted oncology treatment, and high-cost biologics are expected to significantly affect pharmacy benefits over the next decade. Employer-sponsored health plans should start preparing now for how they are going to handle these costs. The specialty market was $92.5 billion in 2023 and could…
Biologic drugs are medicines that come from living organisms, like genes and proteins. Biologics make up about 5% of U.S. prescriptions, but more than 50% of total prescription drug spending in the country. Biosimilar drugs are biologic drugs that are highly similar compared to their reference products, which are existing biologics. Biosimilars are not exact…
Direct-to-consumer (DTC) pricing for medications is making a splash. With DTC, drug manufacturers sell medications directly to patients instead of through a retail pharmacy or pharmacy benefit manager (PBM). This is a shift from the traditional pharmacy model. Some drugs, including those for weight management, now have a DTC model. Eli Lilly & Co. and…
What’s ahead in the GLP-1 market in 2026 The obesity rate has been increasing over time in the U.S. From August 2021 to August 2023, about 40% of American adults were considered obese. A recent study shows that these rates will continue to rise for about 20 more years. Complications related to obesity include heart…
From IRA implementation to the impacts of AMP Cap and biosimilar adoption, here are five market trends Gateway Health Partners is keeping an eye on as we head into 2026 and how we’re helping clients stay ahead as the market continues to evolve.
A recent headline announcing plans to transition commercial clients to a “rebate-free” model, passing previously negotiated drugs savings directly to members at the point of sale, marks yet another potential shift in the pharmacy landscape. The new proposed model underscores how quickly the industry is continuing to evolve and could reshape how plan sponsors, payers, employers, health plans, and health systems define value in 2026…
Beyond Diabetes and Obesity: The Expansion of GLP-1 Medications Glucagon-like peptide-1 (GLP-1) medications have revolutionized the treatment of diabetes and obesity, but their impact is rapidly broadening. Recent research and regulatory approvals reveal that GLP-1s may offer hope for a range of other health conditions, some of which might surprise you. Metabolic dysfunction-associated steatohepatitis (MASH)…