Pharmacy Optimization
An Ethica Pharmacy Advisors feature on managing one of the fastest-growing components of health plan spend.
Pharmacy trend continues to be one of the fastest-growing components of health plan spend — and in 2026, the pressure is coming from multiple directions at once.
different drugs witnessed price hikes in January of 2025.
of adults taking prescription drugs report difficulty affording their medications.
average annual cost of a specialty medication.
Key Areas of Focus
Plan oversight and audits
Validate pricing, discounts, and rebate performance.
PBM transparency
Strengthen contract terms and improve disclosure of revenue arrangements.
Clinical formulary management
Ensure the right drugs are covered at the right cost.
Specialty drug oversight
Expand access beyond PBM-preferred channels when clinically appropriate.
What Employers Should Watch Next
GLP-1 Medications
GLP-1s continue to gain popularity for diabetes and weight-loss indications, raising complex questions about long-term coverage strategy.
Gene Therapies
These therapies offer curative potential for rare conditions, but their price tags require financial modeling, stop-loss evaluation, and risk-sharing planning.
Biosimilars
Biosimilars represent a major cost-saving opportunity, but savings require education, formulary alignment, and active provider engagement.
Ready to optimize your pharmacy strategy?
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