Pharmacy benefits are becoming more costly for employers. With new regulations, emerging drug therapies, and rising expenses for specialty drugs, balancing these costs without sacrificing access is more complicated than ever.
At the Benecon Health Benefits Summit in Lancaster, Pa., Gary Petruzzelli, Vice President of Pharmacy at Capital Blue Cross, outlined some key trends affecting pharmacy benefits and what employers should do now to prepare.
1. Data Integration Is Unlocking Smarter Care Decisions
Combining medical and pharmacy data by having both lines of coverage through a single insurer is becoming a more effective way to improve both cost management and member outcomes.
One way integrated medical and pharmacy data can reduce costs is by guiding site‑of‑service decisions. By analyzing where high‑cost drug therapies are delivered, employers can identify opportunities to shift to lower-cost options without compromising quality.
For example, Petruzzelli said certain treatments traditionally delivered in hospital settings may be safely and effectively administered in lower-cost outpatient or home environments, depending on the patient.
What this means for employers:
The value isn’t just in having data — it’s in how it’s used. Employers should focus on where data can improve care and reduce unnecessary costs.
2. Specialty Drugs Are Driving the Majority of Costs
Petruzzelli said a small percentage of prescriptions drive a large share of total drug spending, citing this stat:
While specialty medications may only account for 1%–3% of prescriptions filled, they can make up more than 50% of total prescription spend.
These high-cost therapies, including biologics and gene therapy treatments, can be life-changing but present significant financial challenges due to limited competition and complex administration.
What this means for employers:
Proactive planning is essential. As more specialty drugs enter the market, employers should work closely with trusted advisors to anticipate and manage these costs.
3. GLP-1 Medications Are a Long-Term Consideration
Originally developed for diabetes, GLP-1 medications are expanding into weight management and other potential uses, including cardiovascular and behavioral health applications.
Petruzzelli said there is evidence that new oral versions may further increase demand by making these medications more accessible.
What this means for employers:
GLP-1s are not a short-term trend, and they’re most effective when combined with lifestyle changes. Employers should evaluate how these drugs are used and whether they are delivering meaningful health outcomes.
4. Rethink Who Drives Decisions and Who Ultimately Benefits
Changes are pushing the industry toward greater visibility into how prescription drug pricing is structured.
As consolidation continues across healthcare, employers are reexamining how pharmacy benefits are managed – and whose interests those decisions serve. Vertically integrated models – such as when an insurer also owns a hospital – can limit choice and flexibility, prompting many employers to seek approaches that prioritize value, clinical outcomes, and long‑term cost control.
What this means for employers:
Understanding who influences pharmacy decisions is key to designing benefits that truly support both employees and the bottom line.
5. Preparation and Collaboration Are More Important Than Ever
With ongoing regulatory changes, emerging therapies, and rising costs, pharmacy benefits are becoming more complex – and more central to overall healthcare coverage.
“Collaborate with people who understand the industry and can help you navigate the complexity,” Petruzzelli said. “There’s still a lot evolving, and it’s important to understand all aspects of it.
“There aren’t always perfect answers right now,” Petruzzelli noted. “The best thing organizations can do is stay informed and be prepared.”
What this means for employers:
Success will depend on working with trusted advisors who can help employers make better long-term decisions about their pharmacy benefits.
Bottom Line
Pharmacy benefits are becoming a more central part of how employers manage healthcare costs.
Rising specialty drug expenses, new drug therapies, and industry changes are making decisions more complex. Employers that stay proactive, leverage data, and align with the right partners will be best positioned to balance cost, care, and long-term value.