^{Kristen Reimers, RPh, is the senior vice president of specialty clinical solutions at Prime Therapeutics.}

Fifteen years ago, Prime Therapeutics (Prime) launched its first Medical Pharmacy Trend Report to help payers navigate the costs of drugs covered under the medical benefit. Back then, the landscape was simpler — only five of the top 16 drugs by sales were considered specialty, and most were medical-benefit drugs. Fast forward to today, and the market has transformed. In 2024 alone, the U.S. Food and Drug Administration (FDA) approved 61 new drugs, 45 of which were specialty products. That’s nearly 75% of all approvals, reflecting a surge in high-cost therapies, rapid innovation and evolving care models.  

It’s this growing complexity that drives the continued evolution of our report. The 2025 edition reflects this transformation — it’s a multidimensional analysis powered by experts across Prime’s organization. Data analysts, clinicians, pharmacists and strategists all contribute to a report that not only assesses current progression but predicts future trends. 

This year’s report integrates commercial and Medicare medical and pharmacy claims data for certain therapeutic categories for the first time, offering a more complete view of total cost of care. It dives deep into therapeutic categories like oncology, immune globulin and multiple sclerosis — areas where spend and complexity are surging.  

The complexity of managing specialty drugs is underscored by the concentration of spend among a small portion of members. While the report notes that 11% of members account for 91% of total drug spend, a deeper look at the data reveals an even more striking concentration: Just 5% of members drive 89% of spend. This level of intensity demands precision strategies and cross-functional expertise to manage effectively. Nowhere is this more evident than in oncology, where six of the top 10 drugs by per member per month (PMPM) spend fall under the medical benefit, and only four under the pharmacy benefit. The top PMPM spend drug on the medical side is nearly four times higher than its pharmacy counterpart, highlighting the financial weight and clinical complexity of therapies administered in medical settings. These insights underline the critical need for Prime’s industry-leading integrated solutions, which bring together a multidisciplinary team of experts to interpret complex trends and deliver diverse, data-driven strategies for managing specialty and medical benefit drugs. 

But the numbers only tell part of the story. The report also includes insights from payer surveys, revealing how health plans are responding to these challenges. Nearly three-quarters of surveyed plans say managing financial risk is their top concern when it comes to gene therapy coverage. That’s a signal that innovation in contracting and benefit design is not just helpful; it’s essential. 

What makes this report so valuable is its ability to connect dots across disciplines. Clinical experts help interpret the implications of new drug approvals. Data scientists identify utilization trends and cost drivers. Strategy teams forecast what’s coming next. Together, they create a resource that helps payers make informed decisions in an increasingly unpredictable environment. 

As the medical and specialty drug market continues to expand and evolve, so too does the Medical Pharmacy Trend Report. By analyzing historical trends and emerging patterns across specialty drugs, the report not only reflects where we've been — it helps guide where we're going, offering critical foresight for navigating the future of drug management. 

Explore the full archive and latest edition at PrimeTherapeutics.com/Read.