PSG announces the results of its extensive research on the latest trends in drug benefit design.
Plan sponsors face complex decisions and challenges as they build and implement their drug benefit. PSG’s 2025 Trends in Drug Benefit Design Report provides a view into how plans work to achieve access and affordability for members while controlling their pharmacy spend.
The report contains valuable insights from benefits leaders representing plans nationwide.
Key Findings
- PBM Unbundling Gains Traction: Most payers believe unbundled PBM arrangements could deliver substantial value, with especially high awareness among health plans.
- Payers Divided on Coverage of GLP-1s for Obesity: While almost all payers cover GLP-1s for diabetes, just 2 in 5 cover GLP-1s for obesity, and nearly half who don’t currently cover these drugs for obesity wouldn’t do so at any price.
- Alternative PBM Pricing Models in Spotlight: As established PBMs and newcomers offer additional options, 1 in 3 payers are using or evaluating PMPM guarantees, while 1 in 4 are using or evaluating cost-plus models.
- Cost Sharing Likely to Increase: The most common pharmacy benefit cost sharing changes under consideration involve increasing member copays/coinsurance or raising deductibles.
- Employers Increasing Benefits Investment: Despite cost pressures, half of employers anticipate increasing their benefits investment in the next 1-2 years.
Want report insights directly from our pharmacy benefit experts? Watch the recording of our report findings webinar here!
