^{Lisa Polakowski, PharmD, is the Medical Pharmacy Trend Report director for Prime Therapeutics.} 

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When we began developing the 2025 Medical Pharmacy Trend Report, one of our top priorities was to expand the lens through which we view specialty drug trends. For years, medical and pharmacy benefit data have lived in separate silos, making it difficult for payers to see the full picture of drug utilization, cost and patient access. This year, we changed that. 

For the first time, our report includes integrated medical and pharmacy claims data for commercial and Medicare lines of business, for select top categories, offering a unified view of how therapies are used and reimbursed across benefit types. This is more than a technical enhancement; it’s a strategic shift that helps payers make smarter decisions. 

We focused our integrated analysis on three high-impact categories: 

• Multiple sclerosis (MS) We saw a clear shift toward newer, high-efficacy therapies on the pharmacy benefit, such as Kesimpta and Vumerity. Meanwhile, Briumvi — administered under the medical benefit — experienced a 219% increase in utilization. Ocrevus remained the top spend driver, with medical benefit costs nearly double those of any other MS drug. 
• Immune globulin. In the commercial population, 92.8% of immune globulin spend occurred on the medical benefit. Products like Hyqvia and Hizentra showed more balanced distribution across benefits, while Asceniv stood out for its exceptionally high cost per claim. With the majority of the spend on the medical benefit, drug costs in the hospital outpatient setting remain significantly higher. These insights help payers evaluate site-of-care strategies and manage cost variability. 
• Oncology. Integrated data revealed that 59.5% of commercial oncology spend and 53.9% of Medicare spend occurred on the medical benefit. Keytruda and Opdivo dominated medical spend, while oral agents like Verzenio and Revlimid led on the pharmacy side. This dual perspective is essential for understanding regimen-based costs and impacts to members who receive treatments that span both benefit types. 

Why does this matter? Because payers need clarity. They need to know where spend is happening, how utilization is shifting and which therapies are driving trend. Integrated data helps answer those questions — and it’s a foundation for better forecasting, understanding impacts and most importantly better patient care. We’re proud to help bring this level of insight to the industry. We believe integrated data isn’t just a feature — it’s the future of specialty pharmacy solutions. 

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Register now: Medical Pharmacy Trend Report webcast

Join our Medical Pharmacy Trend Report live webcast on Monday, Oct. 13, 2025 from 12–1 p.m. CT. You'll get key updates on medical pharmacy spend and trends by lines of business, in-depth analysis of top-spend disease categories, insights from our payer survey and more! 

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