PharmaLogic® Spotlight communications review evolving pharmacy dynamics and trends driving prescription drug use and cost and guide benefits decision-making.
Amidst the many leadership and staffing changes occurring in federal agencies early in 2025, the Food and Drug Administration (FDA) has approved 20 new drugs and 2 new gene/cell therapies. Other new drug applications are pending FDA decision and may push the total number of new approvals to over 30 by the third quarter of this year.
Dr. Martin Makary, the new commissioner of the FDA, has outlined priorities that include faster evaluation of new drug applications using artificial intelligence tools for the first review of application documents.
Recent approvals include:
Approvals pending FDA review:
Federal and state legislators continue to be busy proposing and enacting rules related to prescription benefits and drug prices.
Some legislative actions can limit a plan’s flexibility to administer a benefit and restrict use of plan design features that encourage the use of lower-cost options. As a result, new rules can raise prescription benefit and healthcare costs, limit member choice and require that national and regional plans deal with an array of state-specific benefit administration regulations.
Executive orders and congressional activities that are intended to lower drug prices:
Key themes of state legislation related to prescription benefits and drug prices include:
Your plan’s benefit design and strategies may be impacted by legislation.
NADAC or National Average Drug Acquisition Cost is a pricing index estimating the average drug price paid by pharmacies. The Centers for Medicare and Medicaid Services (CMS) conducts a monthly survey using a random sample of retail pharmacies (mail and specialty not included) to provide data. NADAC prices are not available for all drugs.
Vaccinations are more frequent from September through January each year as patients receive their annual influenza vaccine and, more recently, COVID-19 vaccination updates.
HHS Secretary Kennedy recently appointed new members to the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP), replacing all seventeen members previously holding committee positions. The changes to ACIP membership prompted some strong reactions from infectious disease and vaccine experts in the medical community.
The new ACIP panel announced that it will review immunization schedule recommendations, cumulative effects of vaccines, and the safety of thimerosal, a preservative used in multi-dose vials of influenza vaccines.
During its first meeting on June 25-26, 2025 the new ACIP panel voted to support existing CDC recommendations for annual influenza vaccination for all people over 6 months old and voted to recommend use of influenza vaccines that do not contain the preservative thimerosal. Thimerosal was removed from most vaccines years ago and only remains in some multi-dose vials of influenza vaccine.
PharmaLogic® data for 2025 year-to-date reveals that more than half of specialty drug spend is related to biologic drugs. Biologics are not new, but the introduction and use of new biologics is occurring at a rapid pace.
When patents for brand biologic drugs expire, lower cost biosimilar options become available. While biosimilars have been available for some biologics since 2015, use became more prominent when Humira® biosimilars entered the market in 2024. Stelara® and Prolia® biosimilars became available in 2025 and biosimilars for Xolair® and Soliris® will soon join the mix, presenting additional biosimilar savings opportunities for prescription benefit plans.
Focused and aggressive formulary strategies to prefer biosimilars and exclude coverage of the reference/originator brands are key to achieving the greatest biosimilar savings.
Growth in use and associated high-cost trends with GLP-1 therapies continue to create concern and urgency among benefit managers seeking to manage costs and ensure positive healthcare outcomes.
New GLP-1 options and additional indications, or uses, for these medications are in development and awaiting approval. Additional GLP-1 therapies and uses may expand the patient population using these drugs but will also create more competition in the marketplace, supporting cost management.
Benefit plans are exploring strategies to help balance cost and increasing patient demand for weight loss GLP-1s:
Our team is ready to assist you as you face new prescription benefit challenges and contemplate benefit changes and potential solutions. Together, we can review strategies with PBMs, including optimizing formulary incentives to support biosimilar use and utilization and behavioral management related to new and continuing drug therapies.
PharmaLogic® is Brown & Brown’s proprietary pharmacy data analytics platform that enables millions of dollars of annual financial savings and provides intelligent clinical analytics that positively impact individual medication access and improve overall population health. PharmaLogic® is leveraged for PBM contract modeling, PBM RFPs and/or negotiation, ongoing claims monitoring, advocacy and management, and consulting services to ensure that customers understand plan design, trends, forecasts, and issues that impact spend and population management.