Creating An Agenda For Stakeholders To Transform Pharmacy

As an industry, we need to stop thinking of pharmacy services as another line item or cost center. They are reshaping how employers, payers, providers, and consumers interact with the healthcare system.

Rising costs, combined with innovative new drug therapies and evolving consumer expectations, necessitate a new response from industry stakeholders. That message came through loud and clear at the 2025 Oliver Wyman Health Innovation Summit where we led sessions across three converging topics that are forcing industry leaders to rethink the value proposition for pharmacy services: rising drug costs, drug pricing, and the proliferation of GLP-1s.

Below is a discussion of those trends. Follow-up articles will dig deeper into how stakeholders can continue transforming pharmacy services as a critical piece of the broader healthcare system.

Pharmacy costs and their impact on total cost of care

We estimate that US retail prescription drug spending — mail order and non-mail order — is more than $600 billion. Spending on provider administered drugs — inpatient and outpatient — exceeds $370 billion. For many payers, pharmacy spending is eclipsing traditional medical cost. This shift is not being driven by volume; it’s the rising complexity and cost of specialty drugs, which account for over half of total drug spending despite making up a fraction of prescriptions. Four intertwined themes emerged from our discussion around pharmacy costs, all of which demand urgent attention from leaders:

• Delivery fragmentation: Patients get their medications through a number of channels, including traditional pharmacies and direct-to-consumer platforms, complicating care coordination.
• Pharmacists plus AI as care extenders: Pharmacists are increasingly being asked to do more than dispense drugs. Artificial intelligence (AI) and analytics can empower pharmacists to deliver personalized, real-time care interventions, while reducing medication errors.
• Misaligned incentives: Fragmentation between payers, providers, pharmacy benefit managers (PBMs), and manufacturers leads to inefficiencies and missed opportunities for coordinated care and savings.
• Lack of transparency: Lack of clarity around PBM fees, rebate structures, and patient out-of-pocket costs undermine trust and value, leading to calls for greater transparency and direct contracting.

Tension is building as GLP-1 usage climbs

GLP-1 spending in the US is estimated to climb to $100 billion over the next five years, up from $71 billion now. Few drug categories have captured the public imagination and scrutiny like GLP-1s, especially as off-label usage increases and resistance — or at least demands for more judicious prescribing — is growing from employers and payers.

Industry leaders at the Health Innovation Summit discussed approaches to addressing these challenges.  Employers and payers are instituting coverage thresholds like minimum BMI. Manufacturers are expanding capacity and deploying comprehensive support services paired with direct-to-consumer initiatives to simplify access. Leaders stressed the need for durable, real-world outcome data to prove long-term value and return on investment. They also emphasized that GLP-1s must be supported with wraparound services like behavioral coaching, nutrition counseling, and adherence programs.

Looking ahead, the sustainability of GLP-1 coverage hinges on shared accountability, more robust outcome data, and collaborative market-wide solutions. Without alignment, there is risk of growing disparities and strained benefits that could threaten broader healthcare affordability.

Redefining payment models

Healthcare’s broader transition from volume to value should extend to pharmacy. Traditional reimbursement models based on list prices or units dispensed don’t capture the true clinical or economic value of a drug. They also leave payers and employers bearing the risk of high-cost therapies with uncertain long-term benefit.

Emerging models like outcome-based contracting, drug warranties, and risk-sharing arrangements offer opportunities to innovate but adoption remains uneven. Sarah Emond, President of ICER, said the industry must be prepared to make hard choices: not every high-priced therapy will deliver value commensurate with its cost. System-wide sustainability will require aligning payment with demonstrated outcomes, patient quality of life, and broader societal benefits.

Pharmacy as a catalyst for change

Given pharmacy’s outsized role in how care is delivered, how outcomes are measured, and how risk is shared, it is imperative that leaders act now. Six mandates emerged from the Health Innovation Summit:

• Build aligned, integrated models that hold all stakeholders accountable for cost and outcomes.
• Evolve payment models to share risk and reward equitably between manufacturers, payers, providers, and employers.
• Embrace transparency and simplify pharmacy benefits to enhance trust and efficiency.
• Generate real-world evidence and invest in wraparound services to support adherence and clinical effectiveness.
• Leverage AI and digital health to expand pharmacist capacity and precision in patient care.
• Engage policymakers proactively to balance innovation with affordability and access.

Stakeholders who invest now in collaborative, patient-centered, and evidence-driven approaches will shape a future in which pharmacy is a strength, not a liability. Pharmacy’s next act is here. The time to lead it is now.