Where did 2025 go? All over the place, at least in the world of pharmacy.
Following a year of significant shifts in the prescription drug landscape, millions of Americans suddenly have more ways to access medication and navigate cost than they did the year before. While several market and industry moves are aimed at patient access, the flip side is more complexity in an already fragmented system.
Take GLP-1s, for example. Maybe a patient’s health plan covers them, maybe not. Coverage could be condition-specific, or for a different GLP-1 than what the patient has been taking with good results. If coverage doesn’t exist or equate to affordability, today that patient can find help outside the pharmacy benefit:
- Enrolling in a patient assistance program, if eligible
- Filling at retail with a discount card or coupon, if available
- Purchasing through a direct-to-consumer or direct-to-manufacturer channel
The good news: Patients can turn to an expanding variety of sources and products for treatment. The challenge: Making sense of it all so that they, their providers, and care teams can determine more cost-effective options.
How the Right Pharmacy Solution Can Help
To fully understand their options, a typical health plan member with a GLP-1 prescription has some work to do:
- Determine whether the drug is covered, along with the copay or deductible-adjusted out-of-pocket cost
- Research available patient assistance programs, eligibility, copay cost, and enrollment parameters
- Check discount card price, direct-to-patient or direct-to-manufacturer options
- Compare available choices and their near-term and long-term costs
- Discuss the best treatment plan with their doctor, repeat the process each new plan year
Members with access to Rx Savings Solutions (RxSS) have a much easier workload. The RxSS member portal now features a GLP-1 guide that points a member to the covered and non-insurance options they have. All the complex pricing, plan design, and clinical data are converted into consumer-friendly choices for clear, simple comparison.
The same kind of transparency informs decisions and drives savings for RxSS members on thousands of other prescription drugs; the new portal feature just packages and presents it for GLP-1s. Additionally, we’re connecting the RxSS member experience to available biopharma-sponsored copay programs to improve access and affordability in various therapeutic areas.
RxSS recognizes the growth in pharmacy consumerism and the deeper transparency needed to navigate this changing landscape. We’re helping plans empower their members and respond to market demand for streamlined solutions that clarify medication affordability and access. And we’re just getting started.