Drugs are in the news – again.
Whether driven by White House cost-reduction executive orders or celebrity-led pharmacy startups, all sectors of the economy have a stake in the struggle to provide greater access to prescription drugs while lowering their price. Americans spend more on prescription drugs per capita than citizens in any other country, causing many people to skip doses, take smaller amounts, or delay refills. Managing pharmacy costs shouldn’t feel like an unsolvable puzzle, yet for most employers, that’s what the balancing act of providing pharmacy benefits and controlling costs has become.
Despite the complexities of the American healthcare system, there are some practical approaches employers can take today to reduce pharmacy spending. What could these solutions look like? With more than three decades in the pharmacy benefits space, I have seen strategies that can work for cutting through the confusion to make sure employers and members get what they need, at a fair price.
Employers need to think “integration” – searching across benefits to control costs for the company’s bottom line and their employee pharmacy costs. It’s important to have a partner that provides a whole-system view of medical channel and PBM channel prescriptions, as well as deep expertise in pricing and negotiation. Let’s look at how this is playing out with two of the most talked about – and costly – categories of drugs employers see in their utilization: high-cost specialty drugs and GLP-1s.
Practical solutions for high-cost drug categories
Specialty drug prices eclipse all other drug costs, and employers are desperate for solutions to help manage this significant expense. While only 2% of consumers receive specialty drugs, those treatments now account for a disproportionate 51% of employers’ total annual pharmacy costs, according to a report from Evernorth Health Services.
Employers who track specialty drug costs are seeing an average increase of more than 11% in drug spend compared to overall health benefit costs per employee rising just 3% – 4% annually. How can we rebalance the need and investment? Location, location, location, for starters.
High-cost infusions (for example, drugs to treat multiple sclerosis, osteoarthritis, Crohn’s disease, and cancer) can be safely given in the home, which reduces the cost associated with hospital or outpatient settings. With the right partner, infused pharmacy products can be purchased and then paired with qualified nursing services. This enables employers to reduce costs while maintaining physician oversight of care. It also allows the patient to receive the medication more conveniently, which will likely improve adherence.
Additionally, the price of specialty drugs that are self-injected or orally ingested vary by pharmacy. At the basic level, employers will want to ensure they are taking advantage of their PBM’s coupon maximization program, an often underutilized benefit. The cost reductions average from $4.50-$6.50 per member per month, and most programs offer the member a $0 or very low-cost cost share to participate.
Other options to consider are Patient Assistance Programs and international sourcing. Both options are impacted by regulations but can provide significant savings. The Trump administration has indicated there will be tariffs on imported drugs, which will increase the costs of those medications. At this time (November 2025), enforcement has not been defined.
What employers can do about GLP-1s
Every period has its blockbuster drug – Valium in the 1970s and 80s, Prozac in the 1980s and 90s, and more recently Humira. Today, GLP-1s are topping employer utilization and cost charts along with the cultural narrative.
GLP-1s are a category that covers both medications approved for the treatment of Type 2 diabetes and different formulations approved for the treatment of weight loss. For people who’ve struggled to lose weight, GLP-1s represent a breakthrough, with 1 in 8 adults in the U.S. taking the medication for weight loss – and other possible uses on the horizon.
But GLP-1s are notoriously expensive.
If used for weight loss, patients’ monthly bills have been running between $936 and $1,349 before insurance, and many employers are saddled with the cost. Up to 85% of weight-loss users do not remain on the medication, which results in wasted costs incurred by both the member and their employer. That’s bad health and bad economics.
The key to patients sticking with GLP-1s for weight loss is for employers to offer a wrap around weight management strategy. Experts who specialize in weight loss can coach members on side effects, access, and how to pair GLP-1s with lifestyle changes for long-lasting health. That last part is essential – and is in compliance with the conditions of the FDA’s approval of GLP-1s for weight loss. Having access to coaches who understand weight loss from a lifelong maintenance perspective can improve members’ overall health and help amortize the total cost for employers.
It’s worth noting, of course, that GLP-1s are not a magic formula — there are complex considerations such as dosages, costs, side effects, and comparisons between specific drugs. It’s why it’s so important for a clinical expert to help guide a member’s weight loss journey.
Pharmacy is not – and should not be – a siloed issue; it is deeply connected to overall medical care. With half of Americans taking at least one prescription medication daily, pharmacy is an essential part of employers’ healthcare benefit. Every year the tension between drug utilization and cost intensifies, leaving employers searching for market solutions. Employers must work with partners who can identify opportunities at every step: from negotiating with PBMs, assessing and providing access to the best site of care, to approaching prescriptions with a long-term view of patient health. Choices around clinical management, cost, and long-term solutions are the building blocks to affordability.
Ready to transform your approach to healthcare spend? Hear from top industry voices as they reveal the real cost drivers, explore the impact of AI and emerging tech, and provide actionable strategies for self-funded employers to elevate care and reduce costs without compromise.
Meet the author
Donna Clifford Klein, SVP Pharmacy Strategy