On The Radar
By
By 2030, only 4% of global drug sales will remain under patent protection, down from 12% in 2022. This looming “patent cliff” is expected to open the floodgates to generics and biosimilars—pressuring branded drug pricing and creating a $230B projected market loss in the U.S.
➡ Why it matters: Cost-effective alternatives will become more widely available. Employers need smart pharmacy strategies to capitalize on these shifts.
With drug companies spending $10.8 billion on advertising in 2024, lawmakers are pushing back. A proposed bill to ban direct-to-consumer (DTC) drug ads is gaining traction—but legal hurdles and lobbying resistance remain strong.
➡ Why it matters: A ban could reshape drug demand, reduce costs, and lessen pressure on plan sponsors to cover the latest (not always necessary) brand-name therapies.
The U.S. continues to subsidize global pharmaceutical profits. Efforts like the “Most Favored Nation” pricing model aim to fix this—but may have unintended consequences, including global inflation, drug withdrawals in smaller markets, and reduced R&D.
➡ Why it matters: The push for transparency and price control could impact access and innovation. Navigating the trade-offs will be key for self-funded plans.
Industry leaders testified about PBM dominance, opaque pricing, and patent abuse (“evergreening”) that blocks cheaper generics. Experts called out “pay-for-delay” deals and fee-based data access as employer cost drivers.
➡ Why it matters: Employers and brokers alike need partners who cut through the distortion and deliver true net-cost strategies.
The Supreme Court’s refusal to review an Oklahoma PBM law leaves state oversight in limbo. However, Illinois is pressing forward with bold reforms banning spread pricing and steering, and launching a $25M grant for independent pharmacies.
➡ Why it matters: The PBM landscape is fragmented. State laws and court rulings will impact what solutions brokers can recommend.
GoodRx reports that 68% of Americans consider drug costs a burden—more than food, housing, or transportation. Nearly half report financial or health impacts, including medication rationing and skipped refills.
➡ Why it matters: Member affordability is not just a feel-good issue—it’s a retention and compliance risk. Brokers need actionable solutions to address it.
The top 10 ad-spending drugs hit $3.3B in 2024. Two brand name drugs alone spent over $1.2B to maintain market share. This illustrates how marketing costs drive utilization—and employer expenses.
➡ Why it matters: The “demand creation” cycle often starts with advertising. Cost containment starts with transparency, not just discounts.
In a tight labor market, employers are shifting from pure cost-cutting to holistic benefit strategies—including value-based plan designs and pharmacy carve-outs. Specialized coverage and well-being programs are rising in importance.
➡ Why it matters: Brokers should align cost-reduction strategies with employee support goals. SHARx Plus is built to do both.
Final Thoughts
From biosimilar expansion to PBM litigation and evolving benefit models, this edition underscores a simple truth: yesterday’s healthcare playbook doesn’t work in today’s environment. At SHARx, we’re committed to helping brokers and employers deliver sustainable, member-first solutions.
We’ll be back in two weeks with more news you need to know. If you’d like a custom analysis or want to explore SHARx program options for your clients, contact us!
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