Pharmacy benefits: Lessons from 2024 and what lies ahead for 2025

The healthcare industry experienced a rollercoaster of a year in 2024, with pharmacy benefits undergoing significant shifts. Rising drug costs, advancements in medication technology, and changing coverage strategies have forced employers, health plans, and patients to navigate difficult challenges.

More specifically, new solutions for polypharmacy, biosimilars, and GLP-1 (glucagon-like peptide 1 agonists) medications emerged as top new frontiers, set to reshape the pharmacy and pharmacy benefits industries. Understanding these trends offers vital information for avoiding pitfalls on the road ahead in 2025.

Addressing polypharmacy: A growing crisis

Polypharmacy—the use of five or more medications by a single patient—has nearly doubled in the last 20 years and has become a defining challenge in healthcare. Nearly 24% of the working population now takes five or more prescriptions monthly. For older adults managing chronic conditions, this number is even higher. While these medications are often necessary, the consequences of overprescribing can be severe. Adverse drug interactions, poor adherence, and unnecessary medical costs are just the beginning.

On average, the US spends approximately $177.4 billion annually on polypharmacy, with downstream impacts like adverse reaction hospitalisations driving costs even higher. A key barrier to addressing polypharmacy is the fragmented nature of healthcare data. Many electronic health record (EHR) systems lack integration across providers, leaving prescribers with incomplete information about their patients’ medication regimens. This disconnect often leads to redundant prescribing or missed opportunities to deprescribe unnecessary medications.

Despite the complexity of the issue, 2024 saw increased awareness among health plans and employers. Many began exploring solutions that leverage artificial intelligence (AI) to analyse pharmacy claims data, identify patterns of overprescribing, and recommend interventions. However, broader implementation remains a challenge, with limited systems in place to connect prescribers, health plans, and pharmacies effectively.

Looking ahead to 2025, technology is expected to play an increased role in mitigating the risks of polypharmacy. By providing prescribers with comprehensive insights into their patients’ medication histories, AI tools can empower healthcare providers to reduce redundant prescriptions, improve adherence, and lower costs as well as risks. Employers are also likely to invest in education programmes that promote deprescribing and better medication management practices, driving both financial and clinical improvements.

Biosimilars: Unlocking potential, confronting barriers

Biosimilars, the FDA-approved alternatives to biologic drugs, have steadily gained traction as a cost-saving solution. These medications are clinically equivalent to their branded counterparts, but often cost significantly less—approximately 30% less in the case of treatments like Humira. For health plans and employers, adopting biosimilars represents a clear opportunity to contain rising pharmacy budgets while maintaining high standards of care.

In 2024, biosimilar adoption grew, but the pace was uneven. While some health plans integrated biosimilars into their formularies seamlessly, others struggled to overcome provider hesitancy and patient scepticism. Misconceptions about biosimilars’ efficacy and safety remain a significant barrier, echoing the resistance seen with generic drugs in earlier decades.

Despite these challenges, the financial impact of biosimilar adoption was undeniable. Case studies demonstrated millions in savings for plans that successfully transitioned members to biosimilar therapies. These outcomes emphasised the importance of education and trust-building in driving adoption.

As we enter 2025, efforts to normalise biosimilars are expected to intensify. Health plans will likely focus on targeted educational campaigns to inform both providers and patients about the clinical safety of biosimilars. Policymakers may also implement measures to encourage broader adoption, such as pricing transparency initiatives and streamlined formulary integration. These strategies will not only drive cost savings, but also expand patient access to vital treatments.

The GLP-1 revolution: Managing opportunity and risk

Few drug categories captured attention in 2024 like GLP-1 medications. Originally developed to manage type 2 diabetes, these drugs—such as Ozempic and Wegovy—have become widely used for weight loss and, increasingly, for cardiovascular health. Over the past two years, prescriptions for GLP-1s rose by an astonishing 181%, reflecting their growing popularity among both patients and providers.

While the therapeutic benefits of GLP-1s are clear, their adoption has introduced new challenges. The high cost of these medications has strained pharmacy budgets, leading some insurers to shift GLP-1s from drug benefits to medical benefits. This change means these drugs are now subject to deductibles and coinsurance, significantly increasing out-of-pocket costs for patients. For many, the shift creates financial barriers, disrupts adherence to treatment plans, and adds layers of complexity to accessing care.

For employers, covering these drugs for weight loss has become a financial balancing act, with rising costs threatening the sustainability of benefits programmes. While 2024 saw increased use of utilisation management tools, such as prior authorisation, to limit GLP-1 prescribing, these strategies also create administrative burdens for providers and delays in care for patients with diabetes. As GLP-1 applications continue to expand, these tensions are likely to grow.

In 2025, managing the demand for GLP-1s will require innovative solutions. Employers and health plans will need to strike a balance between controlling costs and ensuring accessibility. Tiered benefit structures, combined with data-driven prescribing tools, may offer a way forward. By aligning coverage policies with clinical guidelines, stakeholders can address the financial pressures of GLP-1s without compromising patient care.

Charting a path forward: Strategies for 2025

In 2025, pharmacy cost containment will require a more coordinated and forward-thinking approach. Employers, health plans, and healthcare providers must work together to address rising costs while improving access and outcomes.

For polypharmacy, the emphasis will be on leveraging technology to streamline medication management. AI-driven tools can help identify unnecessary prescriptions, promote deprescribing, and reduce risks associated with medication overload. These interventions will not only lower costs, but also improve safety and adherence for patients.

Biosimilars, meanwhile, represent a strategic lever for cost containment. Educational efforts to build confidence among providers and patients will be key to unlocking their full potential. With policymakers likely to push for broader adoption, 2025 could be a turning point for biosimilars, delivering substantial savings across the healthcare system.

Finally, GLP-1 management will require creative solutions to navigate rising demand. Utilizstion management tools, combined with better patient education and support programmes, can help ensure these medications are used appropriately and affordably. Employers and health plans will also need to collaborate on innovative benefit designs that align financial sustainability with equitable access.

Building a sustainable future

The lessons of 2024 stress the need for innovation and collaboration in pharmacy benefits. Polypharmacy, biosimilars, and GLP-1 medications illustrate the challenges and opportunities facing the industry. By embracing data-driven solutions, fostering trust, and prioritising patient-centred care, stakeholders can create a more sustainable and fair healthcare system.

As 2025 unfolds, the focus must remain on balancing cost containment with value-based outcomes. With the right strategies in place, the healthcare industry can navigate change and deliver better value for all involved. By looking beyond immediate challenges and investing in long-term solutions, the future of pharmacy benefits can increase both effectiveness and accessibility.