How the Complexities, Trends in Drug Benefit Design Are Evolving in Real Time

Amid increased utilization for weight-loss drugs like never before, pharmacy benefit manager (PBM) unbundling, and so many more ongoing developments, trends in drug benefit design are constantly changing. As pharmaceutical companies and plan sponsors attempt to keep up with these trends, the complexities in prescription drug benefit design will almost certainly be realized by the pharmacists dispensing medications and the patients receiving them.

“We see a couple different pricing models currently out here in the market. First one is really cost-plus pricing,” said Scott Halperin, PharmD, senior pharmacy benefit clinical consultant of employer groups at the Pharmaceutical Strategies Group (PSG). “We're also seeing pass-through pricing, where there is no spread being charged to the plan from the PBM. In addition, we're seeing things called a [per member per month] pricing guarantee. These are for plans that are looking for more clarity.”

As a contributor to the report, Halperin joined Drug Topics, with his colleague Morgan Lee, PhD, MPH, CPH, PSG’s senior director of research and strategy, to discuss PSG’s 2025 Trends in Drug Benefit Design Report.

From unprecedented changes in the way weight-loss drugs are covered to a collective move away from PBM practices in benefit negotiations, the prescription benefits industry is on the verge of a turning point, where health plans and beneficiaries are looking at cheaper, more transparent pricing models. Listen to the full conversation with Lee and Halperin to learn more about how drug benefit design has evolved in recent history, and where it is going in 2025 and beyond.

Stay tuned for weekly podcast episodes on Over the Counter every Thursday afternoon. Check out our previous episode with Amina Abubakar, PharmD, AAHIVP, who joined us to discuss her career journey in pharmacy and how she is actively advancing the profession.

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Reference

2025 trends in drug benefit design report. Pharmaceutical Strategies Group. June 10, 2025. Accessed June 23, 2025. https://www.psgconsults.com/industry-report/2025-trends-in-drug-benefit-design-report/