On The Radar – 6th Edition
By
Merck’s Keytruda remains the world’s top-selling drug ($15.2B), but the fastest climbers are GLP-1 therapies, with Ozempic ($9.5B) and Mounjaro ($9.0B) reflecting the explosive growth of weight-loss medications. Meanwhile, biosimilars continue to erode Humira’s market share, and Pfizer’s COVID-19 vaccine exits the top ranks.
➡ Why it matters: The rise of GLP-1s and shifting patent expirations reveal a new “franchise-to-franchise” survival model for pharma and a new cost reality for employers.
The FDA is tightening rules on how drugs are advertised, especially around risk disclosure and online claims. The new standards apply not only to commercials but also to clinical trial recruitment and social media outreach.
➡ Why it matters: Transparency expectations are increasing across the board, from patient marketing to research recruitment.
In response to federal pressure, companies like Pfizer and AstraZeneca are offering steep price reductions (up to 85%) and selling drugs directly through a government-backed website called TrumpRx, bypassing PBMs entirely.
➡ Why it matters: Direct-to-consumer (DTC) models could bypass intermediaries but may also disrupt employer plan pricing and rebate structures.
New entrants like Judi Health (formerly Capital Rx) are reshaping the PBM market with transparency, AI-powered tools, and performance-based fee models.
➡ Why it matters: Employers now have access to PBM models that emphasize clarity, predictability, and true cost alignment.
With medical trend hitting 8.5 percent and pharmacy costs surging, benefits advisors are urged to move beyond reactive claims management toward proactive oversight in oncology, dialysis, behavioral health, and specialty pharmacy spend.
➡ Why it matters: Advanced analytics and aggressive vendor management are now non-negotiable for long-term plan sustainability.
Transparent, pass-through PBMs are rapidly winning share from CVS, OptumRx, and Express Scripts by aligning incentives, eliminating rebate complexity, and prioritizing patient engagement.
➡ Why it matters: Brokers and employers are embracing PBMs that earn only when clients save.
Drugmakers are expanding DTC platforms to sell branded drugs directly to patients—sometimes at steep discounts—but these models face legal scrutiny under Anti-Kickback laws.
➡ Why it matters: DTC platforms offer lower cash prices, but risk regulatory challenges and undermine pharmacy oversight.
PhRMA will debut AmericasMedicines.com, a platform connecting patients directly with manufacturer discounts and purchase options, bypassing PBMs.
➡ Why it matters: The industry’s largest trade group is publicly embracing DTC sales, proof that the middleman model is being rewritten.
Facing bipartisan pressure, PBMs are proposing voluntary reforms like limiting out-of-pocket costs and supporting rural pharmacies to preempt government regulation.
➡ Why it matters: Self-regulation may delay, but not replace, the push for binding federal PBM oversight.
By 2030, more than 190 drugs, including 69 blockbusters, will lose exclusivity, erasing an estimated $236 billion in revenue. Pharma giants are responding through aggressive M&A to refill pipelines.
➡ Why it matters: Employers could see short-term relief as generics and biosimilars enter, but consolidation could slow innovation long term.
WTW projects an 8 percent rise in employer healthcare costs for 2026, driven by GLP-1s, chronic care, and specialty drugs. Employers are focusing on transparency, vendor efficiency, and selective plan design.
➡ Why it matters: Employers cannot cost-shift their way out of this cycle and will need structural changes in benefits strategy.
PBMs are proposing limited voluntary reforms to appease regulators, but independent pharmacies remain skeptical, calling the move a “stall tactic.”
➡ Why it matters: The PBM status quo is under existential threat, and change is no longer optional.
Final Thoughts
From the rise of transparent PBMs to TrumpRx, direct-to-consumer models, and historic patent cliffs, the U.S. drug market is transforming in real time. Brokers and employers must adapt quickly, prioritizing transparency, data-driven decision-making, and vendor accountability to stay ahead.
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!
Stay Connected with SHARx
Subscribe to our newsletter for monthly updates from our CEO, curated industry news, insights from our in-house pharmacist, the latest blog posts, and more. Just fill out the form to stay informed.
Newsletter Sign-up
Be the first to learn what’s new with SHARx.