Yasser Almuaala, Healthcare Innovator and Chief Executive Officer of SwyftScripts.
As the healthcare landscape accelerates into 2025, many self-funded employers find themselves at a crossroads. Pharmacy benefits, once a manageable line item, now represent a seismic force in the battle to control costs while ensuring employees receive the care they need.
The stakes are high: Prescription drug spending continues its relentless climb, projected to grow at an average rate of 5% from 2021 to 2030. For businesses with self-insured plans, where every dollar saved is a dollar reinvested, it’s especially important to stay ahead of emerging trends.
So, what’s on the horizon for pharmacy benefits this year, and how might these shifts reshape the way employers think about cost containment? Let’s explore three trends I’ve noted in the industry that deserve attention.
1. The Growth Of Biosimilars
Biosimilars are growing from a whisper to a roar. These lower-cost alternatives to high-priced biologic drugs have been trickling into the market for years, but 2025 marks a tipping point. With blockbuster biologics like Humira facing an onslaught of biosimilar competition, self-funded employers have a rare opportunity to rethink their formularies. The promise is tantalizing, with biosimilars costing 15% to 35% less than their brand-name reference biologics.
Yet the catch lies in adoption. Will prescribers embrace these alternatives? Will employees trust them? The data suggests momentum—biosimilar uptake grew significantly in 2024 alone. However, I believe it’s important for employers to ask themselves, “Are we positioned to capitalize, or are we leaving money on the table through inertia?” I believe the answer will hinge on education, incentives and a willingness to challenge the status quo.
2. PBM Transparency
The drumbeat of pharmacy benefit manager (PBM) transparency is growing louder, as well. For years, PBMs have operated in the shadows, their pricing models and rebate arrangements obscured from the employers footing the bill. But regulatory pressure is mounting. Recent federal proposals aim to peel back the curtain, mandating clearer disclosure of fees, rebates and spread pricing. States, too, are flexing their muscles—most have enacted PBM oversight laws since 2020.
For self-funded employers, this shift could be a double-edged sword. Greater visibility might expose inflated costs or misaligned incentives, offering a chance to negotiate smarter. Yet this also raises a question: If the veil lifts and the savings don’t materialize, what then? I believe employers should be ready to use this moment not just to demand transparency but also to redefine their relationships with PBMs entirely—perhaps even exploring direct contracting with pharmacies or manufacturers.
3. The Rise Of Personalized Medicine
Finally, let’s talk about something less tangible but no less critical: the rise of personalized medicine and its pharmacy implications. Advances in genomics and targeted therapies are ushering in an era where treatments are tailored to an individual’s DNA. These therapies, often priced in the six-figure range per patient, are transforming treatment for diseases like cancer and rare genetic disorders. It’s a marvel of science—and a budgetary nightmare.
For self-funded employers, the question isn’t just “Can we afford this?” but “How do we balance equity and economics?” Covering a $300,000 treatment for one employee could strain a plan’s reserves, yet denying it risks morale, retention and even legal scrutiny under the Employee Retirement Income Security Act (ERISA)’s fiduciary duty. The trend may force a reckoning: Will employers lean on stop-loss insurance, carve out high-cost drugs or pioneer new risk-sharing models with providers? The answers aren’t clear, but I believe the conversation is unavoidable.
Conclusion
These trends—biosimilars, PBM transparency and personalized medicine—aren’t isolated ripples. They’re converging waves, each amplifying the others’ impact. Biosimilars could ease the sting of personalized therapies, but only if PBMs play ball. Transparency might unlock savings, but not if employers fail to act on the insights. And as treatments grow more bespoke, the old playbook of cost containment—step therapy, prior authorization, etc.—feels increasingly blunt.
For self-funded employers, I believe 2025 isn’t a year to react; it’s a year to anticipate. The question isn’t just “What’s coming?” but “What are we building toward?” Those who wrestle with these challenges now—probing the data, questioning the incentives and imagining the possibilities—could not only survive the turbulence but help shape what comes next.
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