^{Simone Ndujiuba, PharmD, BCOP, is a board-certified oncology pharmacist and clinical oncology pharmacist senior principal at Prime Therapeutics.} 

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Over the past 15 years, Prime Therapeutics (Prime) has tracked oncology drug trends with increasing precision. In its 2025 Medical Pharmacy Trend Report, Prime presents a first-of-its-kind integrated analysis of select medical and pharmacy claims data, offering a holistic view of oncology spend across commercial and Medicare lines of business. This deep dive reveals not only the top drugs driving costs but also the clinical and market dynamics shaping utilization, reimbursement and future forecasting. For pharmacy and medical benefit managers, understanding these trends is essential to managing rising costs while maintaining quality cancer care. 

Oncology spend trends across benefits 

For the commercial line of business (LOB), overall spend for integrated oncology increased 11.6% from $31.51 per member per month (PMPM) in 2023 to $35.19 PMPM in 2024.¹ Medical benefit accounted for 59.5% of overall spend, with the top ten drugs consisting of six medical and four pharmacy benefit drugs. For medical benefit drugs, the top three drugs by spend were Keytruda ($4.80 PMPM) followed by Opdivo ($1.55 PMPM) and Darzalex Faspro ($1.30 PMPM). Additional drugs included Perjeta ($0.79 PMPM), Mvasi ($0.73 PMPM) — the only biosimilar in the top ten — and Enhertu ($0.70 PMPM).  

For pharmacy benefit drugs, the contribution to overall spend was minimal compared to medical benefit drugs. The top spend drugs were Verzenio ($1.32 PMPM), followed by Revlimid ($0.83 PMPM), Spyrcel (0.69 PMPM) —  slightly down from ($0.73 PMPM in 2023) — and Ibrance ($0.64 PMPM), down from $0.82 PMPM in 2023.¹ The loss of exclusivity (LOE) for Ibrance in 2027 is expected to make way for lower priced generics to enter the market.² Therefore, additional shifts in spend will likely occur over time.  

For Medicare, based on integrated oncology data, medical benefit accounted for 53.9% of oncology overall spend.¹ All the top 10 drugs saw increased utilization, resulting in a positive spend trend.  PMPM increased from $80.11 in 2023 to $104.00 in 2024, a 29.8% increase with the top ten drugs consisting of three medical and seven pharmacy benefit drugs. In 2024, the top spend medical benefit drugs were Keytruda ($14.81 PMPM), Darzalex Faspro ($6.31 PMPM) and Opdivo ($4.53 PMPM). For pharmacy benefit drugs, the top three drugs by spend were Revlimid ($7.00 PMPM), Xtandi ($3.83 PMPM) — slated for the inflation reduction act (IRA) initial price applicability year (IPAY) 2027 with LOE Q3 2027 —  and lenolidomide ($2.73 PMPM), a Revlimid generic.^3,5 Additional top spend oral drugs include Jakafi ($2.58 PMPM), Pomalyst ($2.56 PMPM) — included in IPAY 2027 with LOE Q3 2026, Brukinsa ($2.56 PMPM) and Imbruvica ($2.44 PMPM) — scheduled for IPAY 2026 with LOE Q1 2032.^2-4  

For both commercial and Medicare, the top three medical benefit drugs were PD-1 drugs Keytruda and Opdivo, followed by Darzalex Faspro.¹ All three medications gained expanded indications in 2023 or 2024.5 They also gained expanded indications in earlier cancer stages that typically include maintenance therapy. Keytruda topped the spend list for both commercial and Medicare LOB.¹ Opdivo was the second highest spend for commercial but fourth highest spend for Medicare.  

Therapeutic area highlights 

Multiple myeloma 

Multiple myeloma (MM) is a type of hematologic cancer that affects blood cells and is typically diagnosed in older adults eligible for Medicare, median age of 69 years.⁶ 

However, diagnosis may occur in younger age groups. For Medicare, four of the top 10 drugs are indicated to treat MM.⁵ New MM cases increased slightly in 2019 but decreased in 2022.⁶ Unfortunately, due to cancer cell changes that lead to treatment resistance, relapses are common.⁷ Consequently, MM is considered incurable.  The introduction of novel drug therapies has led to continued downward trend in the death rate.  

For MM, Darzalex Faspro and Revlimid drove spend in both commercial and Medicare LOBs.¹ Darzalex Faspro is the third highest spend for Medicare and the fourth highest spend for the commercial LOB. Darzalex Faspro administration ease and decreased adverse events has led to continued Darzalex intravenous market erosion. Therapy for MM also includes oral medications. Revlimid is the second highest overall spend for Medicare, but fifth highest spend for commercial. Sixth ranked lenolidomide, a Revlimid generic, found on the Medicare top 10 list only, saw increased utilization in 2024.^1,5 Pomalyst ranked seventh, appearing on the Medicare top 10 spend list only, and rounds out the drugs used to treat MM. 

Breast cancer 

The most recently published data shows that the rates of new breast cancer cases rose slightly in 2021 but declined in 2022.⁶ Due to earlier detection from screenings and drug therapy advancements, death rate continued a steady decline.⁶ Female breast cancer is typically diagnosed at a median age of 63 years, prior to Medicare initiation, but may be diagnosed in younger years. The commercial LOB included five breast cancer treatment drugs ranked in the top 10 list, while Medicare included only Keytruda.^1,5 Keytruda is indicated for triple negative breast cancer which typically occurs in women less than 50 years old but occurs in 15% to 18% of women greater than 60 years of age.⁸  Two of the top spend drugs, Ibrance and Enhertu, gained an indication expansion in 2024.⁵   

Oral breast cancer drugs classified as CDK 4/6 inhibitors, ranked as top commercial spend drivers.^1,5 Verzenio, the third highest overall spend, has indications in both early and advanced breast cancer.⁵ Ibrance, indicated for recurrent and advanced disease, rounds out the top 10 list. With the overall survival benefit demonstrated, the Q4 2024 expanded indication of Ibrance combined with Itovebi and fulvestrant may shift 2025 utilization.⁹  Additional breast cancer top spend drugs included Enhertu and Perjeta.¹ Enhertu gained an expanded indication in Q2 2024 with an accelerated approval for adult patients with HER2-positive (IHC3+) solid tumors, a tumor-agnostic indication based on the cancer’s biomarkers and not the tumor type.^5,10  Tumor agnostic approvals are expected to continue, further emphasizing the importance of tumor biomarker testing to drive cancer therapy selection.¹¹  

Prostate cancer 

Prostate cancer is typically diagnosed at a median age of 68 years, within Medicare eligible age, but may occur in younger groups.⁶ Based on the most recent published data, rates of new cases increased in 2021 but declined in 2022.  Due to treatment advancements and early detection, death rate continued a downward trend.¹² Xtandi is the only drug indicated for prostate cancer that appears on the top spend list. It is ranked fifth in overall spend and is included only in the Medicare list.¹ The Q4 2023 expanded indication to early-stage disease likely contributed to its continued spend impact.⁵ A study that evaluates Xtandi use during prostate cancer active surveillance to decrease potential for transformation into prostate has shown positive results. A new drug approval application filing is anticipated and approval in this space will further drive increased utilization and spend.¹³ 

Leukemia and lymphoma 

Leukemia and lymphoma are two types of hematologic cancers commonly diagnosed at a median 68 years of age, within Medicare eligible age, but may be diagnosed throughout pediatric and adult years.⁶  Overall new cases and the death rate have continued to decline due to medication therapy advancements. Oral drugs used to treat this cancer were in the top 10 list for Medicare and commercial LOBs.¹ For Medicare, Brukinsa, indicated for both leukemia and lymphoma, gained an expanded indication in Q1 2024 with an accelerated approval for follicular lymphoma.  Imbruvica, also indicated for both cancers, rounded out the list. For the commercial LOB, Sprycel, indicated for pediatric and adult leukemia, occupied the ninth spot for overall spend.¹ 

Polycythemia vera (PV) 

Polycythemia vera (PV) is a hematologic cancer.^14-16 The median age at diagnosis is within the Medicare eligible age at 65 years and the rate of new cases has remained stable. Jakafi is the market leader as the only oral JAK2 inhibitor indicated for PV management.⁵ Besremi is an injectable drug indicated for PV.  However, it carries black label warnings for psychiatric, autoimmune, cardiac and infectious disorders that limit its use and market growth.¹⁸ Jakafi, which appears in the top 10 spend list for Medicare only, is expected to face market competition if the pipeline drug rusfertide receives U.S. Food and Drug Administration (FDA) approval for PV.¹⁸  FDA filing for rusfertide is expected end of 2025. 

Biosimilar spotlight 

Mvasi is notable, representing the only biosimilar in the top 10 PMPM spend that continues to gain market share over its reference product Avastin.¹ Mvasi has indications to treat multiple cancers and is ranked seventh in overall commercial spend but does not appear on the Medicare list.  

Drivers of increased spend 

Routine annual price increases that typically range from 3%–4%, expanded indications that may lead to utilization growth, and earlier-stage treatment approvals contribute to rising costs. 

As oncology spend continues to climb, integrated benefit management is no longer optional; it’s essential. The data from Prime’s trend report underscores the need for coordinated strategies across medical and pharmacy benefits to ensure value-driven care. By aligning clinical insights with utilization trends, payers and providers can better manage costs while supporting optimal outcomes for cancer patients. 

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All brand names are property of their respective owners.   

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References 

1. 2025 Prime Medical Pharmacy Trend Report, Fifteenth Edition. Retrieved on September 1, 2025 from https://issuu.com/primetherapeutics/docs/2025_medical_pharmacy_trend_report?fr=sODQ4ZTgzNDUwNjE   
2. IPD Analytics. Oncology: Breast. Retrieved on September 16, 2025. 
3. Centers for Medicare and Medicaid Services. Press Release. HHS Announces 15 Additional Drugs Selected for Medicare Drug Price Negotiations in Continued Effort to Lower Prescription Drug Costs for Seniors. Retrieved on September 24, 2025 from https://www.cms.gov/newsroom/press-releases/hhs-announces-15-additional-drugs-selected-medicare-drug-price-negotiations-continued-effort-lower   
4. Centers for Medicare and Medicaid Services. Fact Sheet. Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026. Retrieved on September 24, 2025 from https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026   
5. U.S. Food and Drug Administration. Oncology (Cancer) / Hematologic Malignancies Approval Notification. Retrieved on September 1, 2025 from https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancerhematologic-malignancies-approval-notifications   
6. SEER Cancer Stat Facts: National Cancer Institute. Bethesda, MD. Retrieved on September 2, 2025 from https://seer.cancer.gov/statfacts/   
7. McCurdy A, Seow H, Pond GP, et al. Cancer-specific mortality in multiple myeloma: a population-based retrospective cohort study. Haematologica 2023;108(12):3384-3391. 
8. J, Knapp G, Quan ML, Bouchard-Fortier A. Cancer-Specific Outcomes in the Elderly with Triple-Negative Breast Cancer: A Systematic Review. Curr Oncol. 2021 Jun 24;28(4):2337-2345. doi: 10.3390/curroncol28040215.  
9. Turner, NC et al. INAVO120: Phase III trial final overall survival (OS) analysis of first-line inavolisib (INAVO)/placebo (PBO) + palbociclib (PALBO) + fulvestrant (FULV) in patients (pts) with PIK3CA-mutated, hormone receptor-positive (HR+), HER2-negative (HER2–), endocrine-resistant advanced breast cancer (aBC). J Clin Oncol 43, 1003-1003(2025). DOI:10.1200/JCO.2025.43.16_suppl.1003  
10. National Cancer Institute Dictionary. Retrieved on September 2, 2025 from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tumor-agnostic-therapy   
11. Subbiah V. Tissue-agnostic cancer therapies: promise, reality, and the path forward. Nat Commun. 2025 May 29;16(1):4972. doi: 10.1038/s41467-025-60369-1. PMID: 40436909; PMCID: PMC12120101. 
12. American Cancer Society. Key Statistics for Prostate Cancer. Retrieved on October 2, 2025 from  https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html#:~:text=The%20prostate%20cancer%20death%20rate,extensive%20experience%20in%20medical%20writing   
13. Shore ND, Renzulli J, Fleshner NE, et al. Enzalutamide Monotherapy vs Active Surveillance in Patients with Low-risk or Intermediate-risk Localized Prostate Cancer: The ENACT Randomized Clinical Trial. JAMA Oncol. 2022 Aug 1;8(8):1128-1136. doi: 10.1001/jamaoncol.2022. 
14. Tefferi A, Vannucchi AM, Barbui T. Polycythemia vera: historical oversights, diagnostic details, and therapeutic views. Leukemia. 2021 Dec;35(12):3339-3351. doi: 10.1038/s41375-021-01401-3. Epub 2021 Sep 3. PMID: 34480106; PMCID: PMC8632660.  
15. Liu X, Wang B, Liu Y, et al. JAK2 inhibitors for the treatment of Philadelphia-negative myeloproliferative neoplasms: current status and future directions. Mol Divers. 2024 Oct;28(5):3445-3456. doi: 10.1007/s11030-023-10742-3.  
16. Szuber N, Mudireddy M, Nicolosi M, et al. 3023 Mayo Clinic Patients with Myeloproliferative Neoplasms: Risk-Stratified Comparison of Survival and Outcomes Data Among Disease Subgroups. Mayo Clin Proc. 2019 Apr;94(4):599-610. doi: 10.1016/j.mayocp.2018.08.022. 
17. Besremi [package insert]. Nangang District, Taipei; PharmaEssentia Corp; April 2024. 
18. Valletti, D and McGovern, G. Rusfertide Gains Breakthrough Therapy Designation for Polycythemia Vera. Pharmacy Times News Articles. August 25, 2025. Retrieved October 2, 2025 from https://www.pharmacytimes.com/view/rusfertide-gains-breakthrough-therapy-designation-for-polycythemia-vera#:~:text=Conclusion,burden%20of%20this%20chronic%20disease