Pharmacy Benefit Trends Shaping 2026: GLP-1 Expansion, Biosimilar Savings, and Shifting Anti-Inflammatory Prescribing
Key Insights
Through the first half of 2026, the FDA approved 23 new drugs and two gene/cell therapies, with early utilization of Lifyorli (search), Icotyde (search), Foundayo (search), Yuviwel (search), and Baxfendy (search) already detected in PharmaLogic data.
FDA approval of CagriSema, a weekly injectable combining semaglutide and cagrilintide for obesity (search) and diabetes (search), is anticipated by year-end 2026, while Retatrutide remains in late-stage trials with FDA submission expected in 2027.
Biosimilar adoption for Humira, Remicade, and Stelara has driven negative cost trends in some plans, with the Specialty Biosimilar Substitution Rate increasing dramatically over three years.
The FDA has approved 23 new drugs and two gene or cell therapies through the first half of 2026, according to Brown & Brown (search)'s PharmaLogic Spotlight analysis of evolving pharmacy dynamics. Early utilization of several newly approved agents — including Lifyorli (search), Icotyde (search), Foundayo (search), Yuwiwel, and Baxfendy (search) — has already been identified in PharmaLogic data, signaling rapid clinical adoption.
The pipeline remains robust, with drugs pending FDA review spanning GLP-1 (search) receptor agonists, weekly insulin, gene therapies, cancer therapies, hemophilia therapy, multiple sclerosis therapy, narcolepsy treatments, a non-stimulant drug for ADHD, an oral PCSK9 drug for lipid lowering, a Parkinson's disease treatment, a new smoking cessation therapy, a drug for stroke prevention, and a myasthenia gravis treatment.
CagriSema and the Next Wave of GLP-1 (search) Therapies
FDA approval of CagriSema is anticipated by the end of 2026 for the treatment of obesity (search) and diabetes (search). The investigational agent combines semaglutide, a GLP-1 (search) receptor agonist, with cagrilintide, an amylin (search) agonist, in a once-weekly injection. Meanwhile, Retatrutide, an investigational injectable therapy whose brand name remains pending, continues in late-stage clinical trials and is expected to be submitted to the FDA for review in 2027.
The GLP-1 (search) category continues to expand with new oral options. Foundayo (search) and oral Wegovy have entered the weight loss market, contributing to continued utilization growth. According to PharmaLogic, some patients who previously avoided injectable GLP-1s have now initiated therapy, adding to both utilization and costs. New patients have also started injectable Wegovy and Zepbound therapies.
This sustained growth creates challenges for benefit managers. Some plans have made the decision to exclude coverage entirely, advising members to consider manufacturer direct-to-consumer options. Most benefits still covering these drugs require prior authorization, enrollment in a behavioral nutrition program, or increased patient copays. Medicare and Medicaid will provide access to GLP-1s through their BALANCE model pilots and programs.
Unit pricing for GLP-1s is gradually improving as competition grows and manufacturers strive to maintain and grow market share. One major PBM that previously excluded Zepbound from its formulary plans to restore coverage later this year following negotiations intended to reduce net costs.
Biosimilars Driving Cost Moderation in Anti-Inflammatory Drugs
Treatment of inflammatory conditions has shifted from drugs that broadly suppress immune responses to newer biologics that are more targeted and precise, blocking specific inflammatory processes. The widespread adoption of biosimilar options for Humira, Remicade, and Stelara has lowered the cost of anti-inflammatory therapies, even as prescribing shifts to newer branded options such as Skyrizi, Dupixent, and Rinvoq.
The overall cost trend in this class has moderated, with some plans experiencing negative cost trends during the past year. PharmaLogic attributes these lower trends largely to increased use of lower-cost biosimilars offsetting new use of costlier brand products. The Specialty Biosimilar Substitution Rate has increased dramatically during the past three years, and formulary strategies that prefer biosimilars and generics while excluding coverage of original brands that have lost patent protection are key to achieving savings.
Inflammatory conditions affected by these trends span joints and muscles (rheumatoid arthritis (search), ankylosing spondylitis, psoriatic arthritis), the digestive system (Crohn's disease (search), ulcerative colitis (search)), skin and hair (psoriasis (search), eczema or atopic dermatitis, alopecia areata), lungs (asthma (search), COPD (search)), and systemic conditions including systemic lupus erythematosus and Sjogren's syndrome.
Biosimilar savings extend beyond anti-inflammatory categories. Biosimilars in oncology, hematologic and blood conditions, ophthalmic disorders, multiple sclerosis, and osteoporosis are also contributing to lower costs across specialty drug classes.
Oncology Therapies Shift Into Prescription Benefits
Oncology drug therapy continues to migrate into prescription benefits as more oral drugs become available and maintenance therapies are used to sustain remission and reduce the likelihood of cancer recurrence. For year-to-date 2026, oncology drugs represent the fourth largest therapy class by cost and account for 8.1% of gross cost in prescription benefits monitored by PharmaLogic. Nearly 97% of oncology drug costs are related to oral drug products in prescription benefits. Employers are advised to leverage formulary management strategies, manufacturer assistance programs, biosimilars, and specialty pharmacy services to help mitigate these costs.
Perimenopausal Drug Therapy Evolves
The perimenopausal treatment landscape continues to evolve. In 2025, the FDA removed most warnings associated with hormone replacement products that had been in place since 2003. Many hormone replacement therapies remain available as low-cost generic medications, exerting minimal impact on prescription benefit costs compared to new brand-name therapies. New non-hormonal therapies, including Veozah and Lynkuet (search), have expanded treatment options for individuals who prefer to avoid hormone therapy, addressing symptoms such as hot flashes, night sweats, sleep disturbances, and mood changes.