Pharmacy Benefits Research: Illuminating the Path Forward

Advancing Industry Understanding with Research

For over three decades, PSG has been the expert voice in all aspects of managing pharmacy benefits. Our comprehensive research series doesn’t just observe the healthcare landscape—it actively shapes understanding, empowers decision-makers, and reveals critical market dynamics. Learn more about how our research is developed, what important trends emerged from 2024, and what key themes we anticipate in 2025.

Independent Pharmacy Benefits Research

PSG’s annual research series is an authoritative source of market information, thoroughly crafted to provide healthcare payers with deep insights using research methodology that goes far beyond traditional market research. Each of our four annual reports is the result of detailed independent analysis, capturing nuanced perspectives from hundreds of industry leaders and stakeholders.

Our four-part research series systematically breaks down different dimensions of pharmacy benefits management, offering a holistic view of the complex ecosystem. We conduct comprehensive surveys to hear directly from healthcare payers, and we leverage advanced analysis to uncover trends. By maintaining our independence, we ensure unbiased, credible findings that cut through industry noise and provide actionable intelligence.

2024 Research Highlights

Last year’s research showed pivotal trends across traditional and specialty drug benefits. We tracked remarkable growth in specialty drug spending—with a 14.0% year over trend—while also deeply evaluating drivers of change in non-specialty drug spending and strategy. The GLP-1 medication landscape emerged as a particularly fascinating area of investigation. Our research exposed the intricate debate surrounding coverage options for GLP-1s for obesity, revealing that only 36% of payers currently cover these medications for obesity, compared to 92% for type 2 diabetes. We also discovered critical insights on health equity, finding that merely 1 in 5 employers had established processes for tracking health disparities among plan members, but over 80% emphasized the importance of point-of-care benefit transparency. Meanwhile, health plans were beginning to explore unbundled PBM services approaches, with 1 in 4 reporting they were moderately or very likely to pursue an unbundled arrangement.

Looking Ahead to 2025 Research Trends

As the pharmacy benefits landscape continues to evolve, our research becomes an increasingly important tool for payers navigating complex market dynamics. Our comprehensive analysis provides strategic intelligence on emerging treatment and benefit design landscapes, offering deep insights into critical areas of industry transformation:

• GLP-1 Medication Strategies: GLP-1 medications represent a critical frontier in pharmacy benefits management. Our 2024 research found that just 1 in 3 payers covered GLP-1s for obesity. Have expanded indications for these medications, shifting perceptions of obesity, and more data on the outcomes and costs of coverage shifted coverage decisions? We will continue to explore the clinical, economic, and strategic implications of these transformative medications in 2025.
• Pharmacy Benefit Manager (PBM) Accountability: Transparency has continued to be a pivotal concern for healthcare payers, and our 2024 research indicated payers see their PBMs as lacking in transparency with respect to rebates and sources of revenue. Will congressional and FTC scrutiny of PBM business practices intensify transparency concerns and momentum for change in the industry? Our research will further delve into the evolving PBM landscape, examining alternative pricing models, emerging market players, and strategies for creating more transparent benefit management approaches.
• Specialty Drug Innovations: The cell and gene therapy (CGT) market presents unprecedented opportunities and significant challenges, with projections indicating a 3.5x increase in spending over the next five years. Our 2024 research uncovered a crucial paradox: While most respondents anticipated affordability challenges, fewer than half were confident in their understanding of the financial impact of CGTs, signaling a substantial gap in market preparedness. Will payers’ knowledge and strategic preparedness grow in 2025? Similarly, the biosimilar market remains a focal point of strategic interest, with Humira serving as a critical case study. Despite the introduction of biosimilars, Humira maintained market dominance for over a year, highlighting the complex dynamics of brand versus generic competition. The anticipated introduction of Stelara biosimilars in 2025 represents another potential market disruption, and we will be tracking how payers approach the decision between guaranteed rebate revenue from brand products and potentially lower gross costs from biosimilars.

Moving the Industry Forward with Research

As we enter another year of research, our analyses continue to illuminate the evolving landscape of pharmacy benefits. Our complimentary, in-depth reports have established themselves as essential market intelligence resources, connecting with thousands of stakeholders and gathering insights from healthcare benefits leaders across the industry.

The strength of our research stems from genuine collaboration—through both the diverse perspectives shared by industry experts and the visionary organizations supporting our work. When you join us by participating in our annual research initiatives or sponsoring our reports, you become part of a movement that deepens collective understanding of pharmacy benefits strategies and trends.

Help us chart the course of pharmacy benefit evolution in 2025. Your engagement—whether sharing expertise or enabling research through sponsorship—powers the insights that drive industry transformation.