If 2025 proved anything, it’s that pharmacy benefits don’t stand still. From the rise of GLP-1 medications and biosimilars to growing scrutiny of pharmacy benefit managers (PBMs) and the spread of pharmacy deserts across the country, this past year brought in a wave of change. Each and every one of these shifts has affected how employers manage costs, access, and care, while challenging consultants to keep pace, anticipate change, and guide clients through uncertainty.
As we look back, one theme stands out: transformation. What began as a year of shortages and uncertainty ended with innovation, regulation and a renewed focus on health equity. Here’s a look at the moments that defined 2025 and what they mean for 2026.
GLP-1 Medications: From Shortages to New Frontiers
Few drug classes captured attention like GLP-1s in 2025. From Zepbound and Wegovy to Ozempic and Mounjaro, demand surged for both diabetes and weight management.
- Shortages Resolved: The FDA removed key GLP-1s from the shortage list, ending the era of compounded alternatives and stabilizing supply.
- New Indications: Zepbound became the first drug approved for obstructive sleep apnea, while Wegovy gained expanded cardiovascular indications — and, notably, FDA approval for the treatment of MASH (Metabolic Dysfunction-Associated Steatohepatitis), a progressive liver disease previously known as NASH. This new indication opens the door for broader therapeutic use and coverage for patients with metabolic liver disease.
- Market Shakeups: Head-to-head trials showed Zepbound’s superior weight loss efficacy, influencing both prescribing patterns and payer coverage.
- Formulary Changes: CVS Caremark and other PBMs adjusted preferred drug lists, impacting member access and cost-sharing.
Looking Ahead
Oral GLP-1s and next-generation therapies (like CagriSema) are on the horizon, promising broader applications, new challenges for benefit design and continued market disruption.
PBM Reform: Transparency Under Pressure
PBMs faced more scrutiny in 2025 than ever before.
- Congressional Action: Several bills sought to increase transparency and accountability, though sweeping reform stalled in committee.
- FTC Investigations: The Federal Trade Commission spotlighted spread pricing, rebate structures and the role of PBMs in pharmacy closures.
- Legal Battles: Employer fiduciary responsibilities came under review, with lawsuits and court decisions reshaping governance expectations.
Consultant Takeaway
This was the year transparency stopped being optional. Navigating PBM contracts, clarifying rebate flows and advocating for member-focused models became essential for protecting employer plans and participants alike.
Biosimilars and Generics: Expanding Access, Lowering Costs
After years of anticipation, biosimilars fully entered the mainstream.
- Humira and Stelara: Market adoption accelerated, offering measurable cost savings and expanded indications.
- Insulin Biosimilars: New approvals increased options for diabetes management — though price caps limited dramatic savings.
- Generics: The launch of generic Victoza and Byetta opened new opportunities for cost containment.
2026 Outlook
More biosimilars are on deck, particularly as patents expire for blockbuster drugs like Trulicity. Employers should prepare for continued shifts in formularies, contracting and member education.
Pharmacy Deserts and Health Equity
Pharmacy closures reached crisis levels in 2025, creating “pharmacy deserts” and limiting access, especially in rural and minority communities. The impact extended far beyond convenience, influencing medication adherence and overall health outcomes.
- Consultant Strategies: Employers increasingly leaned on mail-order, telepharmacy, biosimilars and wellness programs to bridge access gaps.
- State Policy: Arkansas’s PBM law set a precedent for protecting local pharmacies, and other states are closely watching its effect.
Action Steps
Using workforce analytics to identify at-risk populations will help tailor benefit strategies and improve equity in care delivery.
Trade Policy and Drug Pricing
Global trade tensions and new tariffs affected pharmaceutical supply chains, heightening concerns over drug shortages and pricing volatility. While impacts were moderate in 2025, employers and consultants will need to monitor policy developments closely in 2026 and prepare for potential disruptions to availability and cost.
Digital Health and Direct-to-Consumer Pharmacy
Telehealth and direct-to-consumer pharmacy models such as LillyDirect and NovoCare gained traction throughout 2025. These channels offer convenience and access, but also introduce new challenges in safety, utilization management and benefit integration. As the lines between clinical care, retail and digital platforms blur, consultants will play a key role in ensuring plan design keeps pace.
Looking Ahead to 2026
It could be argued that pharmacy benefits have never evolved this quickly or this publicly. The past year exposed the tension between cost and care, transparency and control, innovation and access. It also reminded us that behind every regulatory update or drug launch are real people trying to get the medications they need.
In 2026, expect to see:
- FDA Approvals: More specialty drugs, gene therapies and expanded indications for GLP-1s, including continued research into metabolic and liver diseases.
- PBM Reform: Continued legislative and regulatory activity around transparency and fiduciary responsibility.
- Market Disruptors: The rise of direct-to-consumer models and retail models reshaping access and pricing.
- Health Equity: A strong focus on data-driven strategies to close gaps and improve outcomes.
Final Thoughts
2025 challenged us to rethink pharmacy benefits. In effect, we’ve learned to embrace innovation, push for transparency, and design plans that balance fiscal responsibility with human need. As we transition into 2026, staying proactive and informed will be essential. With changes in the pharmacy landscape showing no signs of slowing, our capacity to adapt quickly and guide clients with clarity will define success in the year ahead. Armed with insight, data, and collaboration, we can help clients and members thrive, regardless of what lies ahead.
References
- Novo Nordisk. “FDA Approves Ozempic® (Semaglutide) as the Only GLP-1 Ra to Reduce the Risk of Worsening Kidney Disease and Cardiovascular Death in Adults with Type 2 Diabetes and Chronic Kidney Disease,” PR Newswire, 2025.
- Food and Drug Administration Release. “FDA Approves Treatment for Serious Liver Disease Known as ‘MASH,’” FDA, 2025.
- Eli Lilly News Release. “Lilly’s Zepbound® (tirzepatide) Superior to Wegovy® (semaglutide) in Head-to-Head Trial Showing an Average Weight Loss of 20.2% vs 13.7%,” Lilly, 2024.
- Federal Trade Commission Release. “Second Interim Staff Report on Prescription Drug Middlemen,” FTC, 2025.
- Ayesha Rascoe. "New Bills in Congress Aim to Curb Prescription Drug Prices," NPR, 2024.
- Rita Numerof. "The PBM Bill Failed: Americans Dodged a Bullet," Forbes, 2024.
- Skylar Jeremias. “How Pharmacy Deserts, Biosimilars, and Market Trends are Shaping Managed Care,” AJMC, 2024.
- Maia Anderson. “How the Arkansas PBM Ban May Affect Pharmacy Access in the State,” Healthcare Brew, 2025.
- CVS Caremark. “GLP-1 Formulary Information,” CVS Caremark, 2025.
- Zepbound on Track to Transform 2025's Healthcare Landscape
- PBM Reform: A System Under Pressure
- Affordable Care Act Updates for 2025
- GLP-1 Market Update – RX Pulse
- Pharmacy Deserts: Why They Matter for Your Clients and What You Can Do About It
- Policy Spotlight: How Trade Policy Impacts Pharmacy and the Tug-of-War of Drug Pricing
- GLP-1s in Transition: From Compounding Bans to Click-to-Clinic Access
