As healthcare costs climb and new drug therapies hit the market, employers are under pressure to act.

But quick fixes – like carving out pharmacy benefits, aggressive formulary exclusions, or shifting costs to employees – often create more problems than they solve. Gary Petruzzelli, Vice President of Pharmacy Strategy & Services at Capital Blue Cross, said businesses that take a data-driven, long-term approach can balance affordability with access to quality care.

“Pharmacy trends can feel like fads, but Capital takes a clinical, data-driven approach to every recommendation,” Petruzzelli said. “That means looking beyond trending quick fixes and focusing on long-term impact and the lowest net cost.”

Taking a Strategic Approach to Emerging Therapies

Emerging drug therapies often generate buzz, but jumping in without considering the long-term consequences could saddle employers with higher costs or lower employee satisfaction. Consider these examples:

Biosimilars

Biosimilars are generally cheaper than their reference (brand) equivalent, but the price of medication is only one of several factors that impact employer and employee costs in a group health plan, Petruzzelli said.

His advice: Be wary of solutions that do not focus on the overall lowest net cost. Capital Blue Cross has several formulary options that give employers the flexibility to do what’s best for their employees – some include a mix of reference products (brands)/biosimilars, while another formulary (new in 2026) would offer biosimilars only.

Some health plans are pushing employers toward biosimilars‑only formularies to reduce prescription drug costs, but this strategy can easily backfire. Even in these tightly managed designs, about 10% of members continue using the reference (brand) drugs, creating enough “leakage” to wipe out the savings biosimilars are intended to deliver.

A Capital Blue Cross analysis* shows just how slim the margin is: it takes only one member out of 16 sticking with the brand medication to erode all potential savings from a biosimilars‑only policy. In other words, if even a small portion of your workforce doesn’t switch with a biosimilar-only formulary, the financial benefits disappear – leaving employers with disruption but little real savings.

GLP-1 Therapies

Medications like Ozempic, Zepbound, and Wegovy continue to generate significant attention for weight‑loss and treatment of chronic conditions like diabetes. And the landscape is shifting quickly.

In late 2025, the FDA approved the first oral GLP‑1 pills, offering a more convenient option for individuals who prefer pills over injections.

At the same time, nontraditional healthcare companies, including telehealth and direct‑to‑consumer providers such as Ro and Hims/Hers, are increasing access to GLP‑1 prescriptions, and despite these therapies remaining relatively expensive, prices are dropping rapidly.

These developments only reinforce the need for employers to take a measured, data‑driven approach.

Using these medications for lasting weight management typically requires lifestyle changes, behavioral support, and medical oversight. It’s well documented that GLP-1s require long-term use, as most people regain two-thirds of lost weight within a year of stopping.

Employers who rush to cover these drugs without a broader strategy risk high costs and limited health impact. A data-driven, comprehensive approach – like the one Capital Blue Cross offers – helps balance affordability with employee wellness.

Cell and Gene Therapies

The biggest challenge with cell and gene therapies isn’t whether they work, but how employers can manage their extraordinary costs.

Price tags can reach millions of dollars, so businesses need proactive strategies to protect both their budgets and their employees. As these lifesaving therapies evolve, so do affordable solutions for businesses.

Strategies can include buying stop-loss insurance – and Capital’s family of companies now offers cell and gene therapy stop-loss insurance to supplement its Administrative Services Only (ASO) group employers’ existing stop-loss policies. The stop-loss product covers several cell and gene treatments and places these therapies into a separate risk pool from the primary policy, thus removing the risk of premiums rising due to gene or cell therapy claims.

With education, planning, and innovative coverage solutions, businesses can make lifesaving therapies accessible without jeopardizing financial stability.