Summary
This white paper examines the evolving landscape of pharmacy benefits and drug pricing trends as they relate to commercial drug costs, specifically looking ahead to 2026. It discusses the impact of recent legislative changes and manufacturer pricing strategies on the pharmacy benefits market, noting a shift towards lower upfront product costs and the declining relevance of manufacturer rebates. The paper projects significant increases in spending on GLP-1 agonist drugs for weight loss, estimating a gross cost increase of 21% to 40% annually among commercial plans from 2024 to 2026. Additionally, it outlines the implications of the Medicare Drug Price Negotiation Program and its potential effects on the commercial market. The methodology section details the analysis based on Milliman’s proprietary claims database, which includes data from over 80 million lives. The report aims to provide a foundation for understanding pharmacy cost trends and assist in future budgeting and planning efforts.
