On The Radar – 28th Edition
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Rising premiums and out-of-pocket costs are forcing more Americans to delay or forego care. With enhanced ACA premium tax credits expiring, individual market premiums are projected to rise another 15% in 2027 after a sharp increase in 2026, potentially pushing millions out of coverage.
➡ Why it matters: Rising healthcare costs are no longer just a budget problem. When affordability declines, access declines with it, creating longer-term health and financial consequences.
Nearly 190 drugs are expected to lose patent protection between 2026 and 2030, putting hundreds of billions in pharmaceutical revenue at risk. In response, major manufacturers are expected to lean heavily on acquisitions and outside innovation to replenish their pipelines.
➡ Why it matters: The patent cliff could accelerate pharmaceutical M&A while increasing competition for promising therapies, reshaping which drugs and manufacturers dominate the next decade.
Prescription drug pricing involves more than manufacturers and insurers. Contract Research Organizations influence how quickly therapies reach market, while PBMs can directly shape pricing and access through formulary decisions, contracting, and reimbursement models.
➡ Why it matters: Employers need visibility into the entire pharmaceutical ecosystem to understand what is actually driving pharmacy costs and where greater oversight may be needed.
New polling highlights the real-world consequences of healthcare affordability challenges. Many Americans report delaying care, skipping prescriptions, cutting pills, or substituting over-the-counter options because of cost.
➡Why it matters: Medication affordability directly affects adherence. When patients cannot afford prescribed therapies, the downstream consequences can include worsening health and higher healthcare utilization.
Growing utilization of GLP-1 medications is adding significant pressure to employer healthcare budgets. Employers are responding with prior authorization, clinical eligibility requirements, wellness programs, and tighter coverage criteria.
➡Why it matters: GLP-1s are forcing employers to make increasingly difficult decisions about balancing access to effective therapies with the long-term sustainability of their health plans.
Employers face growing accountability for how health plan dollars are managed. Heightened fiduciary expectations are putting greater pressure on plan sponsors to scrutinize vendor compensation, PBM contracts, fees, and healthcare spending.
➡Why it matters: Passive oversight is becoming increasingly difficult to defend. Employers need documented processes for evaluating vendors, contracts, and plan costs.
Debate surrounding the 340B Drug Pricing Program continues as pharmaceutical manufacturers and participating healthcare organizations clash over how the program should operate. Advocates argue that manufacturer restrictions could threaten resources used by safety-net providers to serve vulnerable populations.
➡ Why it matters: Changes to 340B could have significant implications for medication access, safety-net providers, and the broader economics surrounding high-cost prescription drugs.
A bipartisan opinion piece argues that U.S. patients continue to shoulder a disproportionate share of global pharmaceutical profits, paying substantially more for many medications than patients in other developed countries. The authors advocate for legislation tying U.S. prices more closely to international pricing.
➡ Why it matters: International drug-price disparities remain a central part of the affordability debate and could continue driving federal efforts to change how prescription prices are established.
Federal reforms are forcing PBMs to disclose more information and rethink traditional rebate structures. Some major PBMs are already moving toward fee- and cost-based models, but questions remain about whether lost rebate revenue could simply reappear elsewhere as higher administrative fees.
➡ Why it matters: Transparency alone does not guarantee lower costs. Employers will need to evaluate total compensation and net plan impact rather than focusing on a single revenue stream.
More employers are reportedly leaving the country’s largest PBMs in favor of smaller competitors offering greater pricing transparency. Rising prescription costs and growing fiduciary scrutiny are helping accelerate the shift.
➡ Why it matters: Employer expectations are changing. Transparent pricing, measurable financial impact, and greater control over pharmacy spending are becoming increasingly important factors in PBM selection.
Prescription drug prices fell 3.1% over the previous 12 months, according to August CPI data, marking the steepest annual decline since 1963. However, forecasts for 2027 suggest pharmaceutical prices could begin climbing again.
➡ Why it matters: A short-term decline in prescription prices is encouraging, but employers should be cautious about interpreting it as a lasting reversal of broader pharmacy cost trends.
Final Thoughts
Affordability is emerging as the common thread across nearly every corner of healthcare. Patients are delaying care, employers are tightening oversight, GLP-1 utilization continues to pressure budgets, and PBM relationships are being reconsidered as transparency expectations rise.
At the same time, pharmaceutical patent expirations, 340B policy battles, and changing federal pricing strategies are reshaping the drug market itself.
For employers, the message is increasingly clear: understanding where healthcare dollars go, how pharmacy partners are compensated, and whether plan strategies are actually improving access and affordability is becoming essential to managing the next wave of healthcare cost pressure.
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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