U.S. drug spending reached $487 billion in 2024 — an 11.4% increase from the year prior, according to IQVIA. Biologics make up more than half of that total.  

These upward trends are prompting employers and health plans to address drug costs and reevaluate formulary management approaches, particularly for medical-benefit drugs, according to Simone Ndujiuba, PharmD, BCOP, senior principal clinical oncology pharmacist at Prime Therapeutics, who spoke at the recent Academy of Managed Care Pharmacy (AMCP) Southwest Annual Day of Education in Dallas, Texas.  

Ndujiuba, who led the session “Inside the huddle: Hot topics in specialty drug management,” shared more about the rapid growth of U.S. drug spending, the expanding complexity of specialty care, and the need for cohesive management strategies across pharmacy and medical benefits.  

Drugs on the pharmacy benefit may include medications a member picks up at the pharmacy. Other medications, usually infused by a physician, may be covered on the medical benefit.  

“The one topic that especially resonated at the session was change,” Ndujiuba shared. “Changes in policy, and its unpredictable nature, continue to drive the need for cross‑benefit approaches and innovative strategies to manage spend and address rising drug launch prices.” 

Ndujiuba’s session focused on how payers, providers and specialty pharmacies can work together to improve specialty drug management through stronger communication and aligned clinical governance. The discussion also highlighted the operational and patient impact challenges that arise when shifting drugs across benefits and evolving strategies such as site-of-care optimization. 

Some key points from her session included:  

• Drug prices are on the rise across all lines of business, driven by new approvals and historically high launch prices. From 2009 to 2024, commercial drug spend increased 191% per member per month (PMPM), while Medicare drug spend increased 83% PMPM, according to Prime’s 2025 Medical Pharmacy Trend Report, further emphasizing the need to address drug spend. 

• Priority strategies include site-of-care optimization, benefit alignment, expanded use of value-based contracts, improved data integration, and new financing models for advanced therapies.

• Site-of-care changes — especially movement toward home infusion — represent a major pressure point shaping future specialty strategy, offering up to 50% savings and aligning with patient preferences.

• Specialty drug distribution is shifting away from traditional buy-and-bill models toward more flexible, market-driven distribution approaches.

• Effective payer–provider collaboration remains essential, especially as organizations navigate 340B program requirements and technology limitations that make cross-benefit data integration challenging.

• Strong communication between health plans and pharmacies is critical to improving outcomes and reducing costs.  

“The Southwest Annual Day of Education has always provided impactful education, but I’m especially impressed by the depth and variety of information that was provided at this year’s event,” Ndujiuba said of the event. “There’s something for everyone — whether you’re in clinical practice, pharmacy benefit management, data analysis or policy. Each presentation was thoughtful, addressed current concerns and provided meaningful answers that can help improve current practices or create opportunities to advance care.”  

Read the latest Oncology Insights column by Ndujiuba