New research shows organizations are focused on three priorities: improving affordability, making benefits easier to navigate, and demonstrating measurable value from their investments. As employers and health plans prepare for the future, understanding these trends can help strengthen pharmacy benefit strategies and improve the experience for the people they serve.
Key findings from the research
Rising prescription drug costs are increasing affordability pressure
- 75% of consumers are concerned about the affordability of prescription drugs.
- 35% say they have been unable to afford a medication prescribed by their doctor.
Benefit complexity is creating friction for members and organizations
- Nearly 9 in 10 buyers believe members understand their benefits yet 64% of consumers say they struggle to know when to use specific benefits or solutions.
- On average, vendor coordination consumes an average of 13 hours weekly for employers and 19 hours for health plans.
Organizations want proof of value
- Improving clinical outcomes is a growing investment priority.
- More than 8 in 10 buyers are evaluating alternative PBM models with greater transparency.
1. Affordability pressure is intensifying
Affordability remains one of the most pressing concerns for organizations and consumers. Rapid innovation and high-cost therapies are increasing market pressure, prompting plan sponsors and members to look for ways to stay ahead while maintaining sustainable pharmacy benefit strategies.
The rapidly evolving GLP-1 landscape and continued innovation in gene therapies are central to these discussions. Organizations are taking a more deliberate approach to determining where coverage makes sense, establishing appropriate clinical criteria, supporting members throughout treatment, and considering sustainable coverage models.
Organizations are combining proven pharmacy management strategies, including formulary optimization and utilization management, with wellness, prevention and additional approaches to address emerging cost pressures while supporting clinically appropriate access.
2. Benefit navigation helps turn benefits into value
Organizations continue to invest heavily in health benefits, digital tools, and support programs. Yet research suggests many people still struggle to find, understand, and use the resources available to them.
This disconnect creates a significant challenge. Valuable programs may go underutilized not because they lack value, but because members don't know they exist or aren't sure how to access them.
Addressing this navigation gap requires more than adding new solutions. Many organizations are focusing on integrated benefit platforms and pharmacy-specific navigation services that guide people to the right resources at the right time. These approaches can help reduce confusion and improve engagement with existing benefits.
Complexity isn't only affecting members. As benefit ecosystems expand, many organizations are managing an increasing number of vendors, each with its own programs, reporting requirements, and measures of success. As a result, organizations are looking for ways to simplify vendor management while creating a more connected, seamless experience for the people they serve.
3. PBM transparency and accountability are competitive necessities
Cost management remains essential. Organizations increasingly expect it to be paired with demonstrated clinical value and a better member experience, including evidence that investments are improving outcomes, supporting medication adherence, and helping people achieve better health.
This shift comes at a time when drug pricing transparency is receiving heightened attention across the industry. While transparency was once considered a differentiator, many buyers now view it as a baseline expectation.
As a result, organizations are seeking partners that not only provide reporting, but also help translate data into action. They want guidance on improving clinical outcomes, managing pharmacy costs, and making informed decisions about future investments.
Turning insights into action
The future of pharmacy benefits is being shaped by three connected challenges: rising costs, growing complexity, and increasing demands for accountability. Organizations that are succeeding are balancing affordability with access, simplifying the experience for members and administrators, and demonstrating measurable value from their investments.
At Express Scripts Pharmacy Benefit Services, we believe pharmacy benefit strategies should help organizations manage costs, reduce complexity, and deliver better outcomes for the people they serve.
Download the research
Explore the full findings from our latest Buyer Insights research:
And connect with our team to discuss what these insights could mean for your pharmacy benefit strategy.
Express Scripts Pharmacy Benefit Services helps employers and health plans navigate rising prescription drug costs, improve member experiences, and drive better health outcomes. Through a consultative approach, actionable insights, and flexible pharmacy benefit solutions, we help organizations balance affordability, access, and transparency in an increasingly complex pharmacy landscape.
