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Large employers are taking increasingly aggressive steps to manage pharmacy benefits and hold vendors accountable, according to the 2025 Employer and Coalition Trends in Health Management report from Gallagher Benefit Services. The survey of 103 jumbo employers covering 6.8 million lives reveals a significant shift toward customized benefit strategies and closer scrutiny of relationships with pharmacy benefit managers.
The proportion of employers accepting their pharmacy benefit manager's standard prescription drug list without modifications has dropped to 41 percent, down from 54 percent in 2023. This trend reflects growing employer sophistication in benefit design, with 69 percent now leveraging data to hold vendors accountable for outcomes, an 11-point increase from the previous year. Additionally, 65 percent conduct contract reviews and financial checks against current market conditions based on their specific populations.
Specialty drug management has emerged as the top medication-related focus area for 95 percent of employers, followed by weight loss medications at 79 percent and high-cost therapies at 68 percent. In response, 52 percent now mandate specialty pharmacy use for all biologic fills, up dramatically from 36 percent in 2024. 30% participate in prescription drug group purchasing collectives, and 57% of those participants report high satisfaction levels.
Cell and gene therapy coverage continues to gain acceptance, with 87 percent of employers agreeing that these treatments should be covered as benefits. However, only 49% report having figured out payment mechanisms, though this represents a 21-point increase from 2024. The biosimilar outlook has shifted substantially, with 99% expecting a moderate to significant impact on specialty spending by 2030, compared to just 76% projecting significant implications for 2025.
