Pharmacy is now the fastest-growing line in most benefits budgets, driven by specialty therapies, gene and cell treatments, and GLP-1 demand. Employers are working both sides of the problem: tightening PBM contracts, formularies, and utilization management while deciding which high-demand drugs, GLP-1s first among them, earn coverage and on what terms. The line worth drawing is where pharmacy strategy bends the trend and where plan design merely shifts cost onto employees.
This Session Will Examine:
- Sizing pharmacy exposure before renewal: trend by category (specialty, biologics, GLP-1s), duration of therapy, and the discontinuation rates that change the math.
- PBM contracting and transparency: rebate guarantees, pass-through pricing, and the leverage employers have at renewal, alone or through coalitions.
- GLP-1 coverage as the visible test: eligibility criteria, care-program requirements, emerging buying channels, and rules that hold up clinically, financially, and with employees.
- Biosimilars, site-of-care shifts, and formulary discipline as levers that lower cost without taking benefits away.
- Measuring what the spend buys: adherence, health outcomes, disability and absence, productivity, and retention effects beyond the pharmacy line.
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