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Every year, pharmacy benefit trend reports reveal both challenges and successes. For 2025, National CooperativeRx’s trend was shaped by the challenges of GLP-1s and specialty medications, and the continued success of our in-house clinical oversight.
Trend in 2025
Since the Cooperative’s inception over two decades ago, we’ve achieved an average annual Rx cost increase of 2%, reflecting our sustainable and effective approaches to managing pharmacy spend.
In 2025, overall trend after rebates across the Cooperative was 9%, compared to industry reports in the low double digits. Following a lower trend of about 6% in 2024, we anticipated higher trend in 2025 given the rapidly expanding GLP-1 and specialty drug environment.
A Note on Our Trend Data
We do not exclude any member group, drug classes, products, or distribution channels from our data. Our data is unmanipulated and calculated after rebates, which are 100% passed through to our members. We believe members and partners deserve real, transparent analysis.
What’s Driving Trend
Anti-Obesity and Antidiabetics
GLP-1s were the largest contributors to non-specialty trend in 2025. Utilization grew significantly from 2024, fueled by expanded FDA-approved indications, new formulations, increased demand for weight-loss therapies, and a growing population deemed eligible for these therapies. Despite this growth, the Cooperative maintained our cost advantage over the PBM benchmark. In 2025, National CooperativeRx’s gross costs PMPY for GLP-1s averaged 27% less than the PBM Employer benchmark comparison.
Dermatologicals and Gastrointestinal Agents
Newer-to-market specialty dermatological brands continued to gain market share, particularly as they received additional FDA-approved indications for autoimmune conditions. These therapies, often ranging between $5,000 to more than $11,000 in gross costs per prescription, represent a small fraction of total claims but are a significant driver of trend. Biosimilar launches within this class provided significant relief, offsetting costs that would otherwise have driven trend considerably higher.
Migraine Products
Demand for newer migraine therapies remained strong, with growth in utilization and significant rises in gross costs in 2025. While this category represents 1% of total prescriptions filled at the Cooperative, its cost impact is notable. Even so, National CooperativeRx continued to outperform the PBM Employer benchmark comparison, with gross costs PMPY approximately 13% lower for migraine products.
The Cooperative’s Strategies for Managing Trend
In-House Clinical Programs
National CooperativeRx’s in-house clinical programs, offered at no additional cost, delivered $114 million in estimated cost avoidance in 2025.
A significant portion—$94 million—came from our specialty prior authorization program, paired with specialty high-dollar reviews and enhanced clinical criteria. Launched in 2023, the specialty prior authorization program continues to demonstrate that effective cost management and positive patient experiences can go hand in hand.
Unlike automated prior authorization systems, our program is clinician-led, hands-on, and personalized, resulting in:
- Meaningful cost mitigation
- A 62% approval rate
- Positive feedback from patients, members, and providers
When specialty prior authorization questions arise, our team answers the phone with no prompts and provides direct access to non-clinical staff for administrative support and to clinicians as needed.
All member groups are automatically enrolled in our specialty prior authorization and pharmacy network oversight programs. Additionally, several other in-house clinical programs, such as our non-specialty and specialty high-cost claim reviews and supplemental formulary management, have been adopted by over 90% of member groups, reflecting an engaged membership committed to high-value care.
Our clinical oversight also extended to prominent therapy classes like GLP-1s and psoriasis. In August 2025, we launched a home-based light therapy program for psoriasis that was integrated within our specialty prior authorization reviews. This opt-in program was designed to ensure cost-effective, guideline-based therapies are used before more expensive psoriasis biologics.
For GLP-1 management, our team worked with CVS Caremark to implement utilization management strategies, ensure adherence to FDA-approved indications, and align approaches with specific plan goals. Education on utilization management strategies, cost share strategies, and wellness programs continue to help members make informed decisions about this therapy class.
High Biosimilar Adoption within the Cooperative
Biosimilar adoption was another impactful mitigator of trend in 2025. Leveraging CVS Caremark’s proprietary ChangeRx process, National CooperativeRx patients quickly transitioned from Humira (adalimumab) to their biosimilars, maximizing savings for our member groups. Heading into 2025, 97% of adalimumab claims had been converted to biosimilars, generating more than $5,000 in list price savings per claim.
In July 2025, Stelara (ustekinumab) biosimilars were added to the CVS Caremark formulary, offering nearly 90% list price savings. As of early 2026, 58% of National CooperativeRx’s ustekinumab utilization is in biosimilars.
This level of adoption reflects more than just market availability; it demonstrates the engagement of our membership and their trust in the Cooperative’s in-house clinical team. Our clinicians work closely alongside CVS Caremark to educate, guide, and coordinate care with patients and providers, ensuring smooth transitions to more cost-effective therapies.
Looking Forward
Expectations of trend for the coming years is expected to moderate slightly. A range of 5% to 8% is expected. Trend results by plan will vary significantly based on drug mix, plan design, and management approach. Certain specialty classes, GLP-1s, and state and federal reforms are expected to drive pharmacy trend higher and fuel market volatility. At National CooperativeRx, we continue to brainstorm and identify approaches to help our members provide higher value and more cost-effective care.
Our Commitment to Navigating the Complex Industry
Successfully managing trend and navigating the dynamic pharmacy benefit landscape requires proactive strategies and guidance from a trusted pharmacy benefit partner.
National CooperativeRx has long guided our members through the complexities of the industry, effectively controlling costs while providing patient-focused care. We remain committed to vigilant oversight, proactively identifying optimization opportunities, and providing strategic guidance to our membership.
Partner with National CooperativeRx for the guidance, oversight, and strategies you need to control pharmacy costs.
