A look back: Top 5 PBM 2024 market trends
It has been a year of rapid growth for pharmacy benefit managers (PBMs). Take a look at our recap of the top 5 PBM trends in 2024, and be on the lookout in January for our 2025 PBM outlook.
5. Increased scrutiny
PBMs in general have been facing increased scrutiny after the Federal Trade Commission released a report about them in July. The report investigated the six largest PBMs in the U.S. and discussed vertical integration, consolidation, and pharmacy practices.
Congress is also currently looking at four bills related to PBMs:
- The Prescription Drug Supply Chain Pricing Transparency Act
- The Amendment to Title XI of the Social Security Act to Enhance PBM Transparency Requirements
- The Preserving Telehealth, Hospital, and Ambulance Act
- The Delinking Revenue from Unfair Gouging (DRUG) Act
With the new administration taking office in January 2025, there could be further changes and legislation regarding PBMs.
4. Drug shortages
There have been drug shortages throughout the year. In the first quarter of 2024, there were shortages of 323 drugs, the highest figure since 2014. The top five classes of drugs in shortage are chemotherapy drugs, central nervous system stimulants, antimicrobials, hormone agents, and intravenous fluids. Some weight loss drugs are also in short supply because of increased demand.
The FDA says many of these shortages are occurring because of manufacturing and quality issues, supply chain gaps, and discontinuations.
3. Drug prices
Drug prices rose in 2024. At the beginning of the year, prices for medications went up on average by about 4.5%. There were 700 brand name drugs with a price increase of about 5.4%, and there were about 40 generic medicines with a price increase of about 39%.
Prescription drug spending in general has been expected to go up by 10% to 12% in 2024.
Related posts
2. Biosimilars
The use of biosimilars increased in 2024. Biosimilars are medications that are highly similar to biologic medications (called reference products) already approved by the FDA and have no clinically meaningful differences from them.
PBMs are increasingly introducing biosimilars to their formularies. For example, this year Humira® has been removed from many formularies and biosimilars are being used instead. As of September 2024, there are 10 approved biosimilars for Humira.
There are 62 biosimilars in all that have been approved by the FDA as of November 2024. This year alone, 17 biosimilars were approved.
The market size of biosimilars has gone up since 2023. That year, global market size for biosimilars was $29.45 billion, and in 2024, it is expected to be $34.66 billion.
Related posts
1. GLP-1s
Glucagon-like peptide-1 (GLP-1) agonists dominated the news. GLP-1s can be used to treat diabetes and obesity. A recent study shows that GLP-1 use for treating diabetes has increased by 15.6% from last year. And for obesity, that percentage is even higher — it has gone up 78% for weight loss. Since the beginning of 2024, prescriptions for Wegovy® and Zepbound® have gone up by three digits— Wegovy prescriptions rose by more than 100% and Zepbound prescriptions by more than 300%. This year, GLP-1s will likely be the number 1 selling drug on the market, taking the spot from PD-1 inhibitors, which are used to treat cancer. GLP-1s are expected to reach approximately $50 billion in annual sales in 2024. Annual sales last year were around $40 billion.
Wegovy®, a GLP-1, was approved by the Food and Drug Administration (FDA) in March 2024 to help prevent cardiovascular disease. Additionally, GLP-1s are being studied to treat a range of other conditions, including sleep apnea, substance use disorder, and Alzheimer’s disease.
Related posts
- One size does not fit all: GLP-1 weight loss coverage options for three companies
- GLP-1: How to Decide What is Best for Your Plan
References
- Khemlani, Anjalee. GLP-1s partly to blame for spike in health insurance costs in 2025. Yahoo! Finance. August 22, 2024.
- Kim Constantino, Annika. Prescription fills for weight loss drugs Zepbound and Wegovy more than doubled in 2024, GoodRx says. CNBC. December 5, 2024.
- Park, Andrea. GLP-1s on track to take drug sales throne from PD-1 inhibitors in 2024: analyst. Fierce Pharma. March 15, 2024.
- The growing market for GLP-1 drugs. Natixis Investment Managers. July 16, 2024.
- Biosimilars Basics for Patients. Food & Drug Administration. August 1, 2024.
- Billingsley, Alyssa. Is There a Biosimilar for Humira? Yes, Here Are 10 Humira Biosimilars to Choose From. GoodRx. May 14, 2024.
- What biosimilars have been approved in the United States? Drugs.com. October 17, 2024.
- Biosimilars Market Size Poised to Hit USD 150.26 Billion by 2033. BioSpace. June 17, 2024.
- Picchi, Aimee. Drugmakers hiking prices for more than 700 medications, including Ozempic and Mounjaro. CBS News. January 18, 2024.
- Tichy, Eric, Hoffman, James M., Tadrous, Mina, Rim, Matthew H., Cuellar, Sandra, Clark, John S., Newell, Mary Kate, and Glen T. Schumock. National Trends in prescription drug expenditures and projections for 2024. July 8, 2024. American Journal of Health-System Pharmacy.
- Robledo, Anthony. Drug shortages at highest since 2014: Chemo drugs, Wegovy, ADHD medications affected. USA Today. April 17, 2024.
- McPhillips, Deidre. Drug shortages reach record high in US. CNN. April 12, 2024.
- Christensen, Jen. Drug shortages may mean difference between life and death for some US patients, experts say. CNN. February 6, 2024.
- Pifer, Rebecca. FTC slams pharmacy benefit managers in first report from ongoing investigation. Healthcare Dive. July 9, 2024.
- Warmuth, Jay A., Bonnstetter, Evan M., and Medeiros, Mason S. Recent Legislative Developments Impacting Pharmacy Benefit Managers, Health Plans & More. Faegre Drinker. September 16, 2024.
Learn more
Curious how Maxor can help you improve plan value and member outcomes? Contact us by filling out the form below.
