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Article

Specialty Drugs are a Major Driver Behind Pharmacy Cost Spikes

The most expensive drugs are “specialty drugs,” but no one has defined exactly what they are. They are generally the drugs that fit into one or more of the following categories: 1. the manufacturer put a high price tag on the drug; 2. the drug treats a complex, chronic, or rare condition; and /or 3. The drug requires special handling, storage, or administration. There is no doubt these types of drugs are in high demand because they deliver life-saving and life-enhancing treatments for many people.

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Article

Medicare Out-of-Pocket Spending Trends for 2025

As we approach 2025, the predictions for Medicare spending are causing panic-level responses. The Inflation Reduction Act (IRA) offered welcome relief to Medicare beneficiaries with the $2000 out-of-pocket cap for covered Part D drugs, but the price of medications did not drop, so Medicare payers are looking for ways to plug the fiscal gaps. Additionally, the IRA isn’t a panacea for high drug costs, and seniors with chronic conditions like asthma, COPD, and diabetes are seeing their costs inflate beyond fixed incomes.

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Article

Pharmacy Deserts Are Growing

Walgreens just announced they are closing 1,200 stores, coming on the heels of similar announcements by other national retain chains. As national pharmacy chains shutter hundreds of stores, a troubling trend is emerging: the creation of pharmacy deserts. These closures, combined with the decline of independent pharmacies, are leaving many communities—especially rural and low-income areas—without access to essential medications and healthcare services. The closures are blamed on declining profits, competitive pressures from online retailers, and regulatory challenges.

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Article

The High Cost of Polypharmacy

Prescription drugs are a crucial part of healthcare, but sometimes, the prescriptions cascade out of balance. About 60% of adults in the U.S. are on at least one maintenance drug, and over 20%  are polypharmacy – taking five or more prescriptions per month.

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Article

Employer Benefit Costs Going Up in 2025

Analysts predict another difficult year for employers as health benefit costs are slated to rise by 5.8% Mercer’s recent “National Survey of Employer Sponsored Health Plans” predicts the surge in 2025 will mimic the increases seen in 2023 and 2024. The substantial annual increase is a shift from previous decades, where annual increases hovered around 3%. Without implementing cost-cutting measures, employees could see a jump in their premiums and copays.

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Article

A New Way to Manage the GLP-1 Explosion

GLP-1 receptor agonists are all the rage these days for the promise of easy weight loss. GLP1s are FDA-approved for managing Type 2 diabetes but physicians are prescribing the medication for off-label use to help their patients lose weight. Between 2020 and 2023, the use of GLP-1 medications such as Ozempic and Wegovy, increased sharply due to off-label prescriptions. While these medications are very effective, they are also very expensive, which is challenging insurers, employers, and patients alike. As the demand for GLP-1 drugs continues to grow, particularly for weight loss, understanding the complexities of coverage and finding cost-saving strategies has become a top priority.

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Article

The Promise of Precision Medicine

In the U.S., medical treatment is based on the diagnosis, not the person. It’s a one-size-fits-all approach in which physicians prescribe medications that have been approved to treat the disease state. The approach has improved lives for many but not all. Recently, a new approach to pharmacology is developing, precision medicine, which tailors a treatment to an individual’s biology.

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