2026 PBMI Annual National Conference

The 2026 Pharmacy Benefit Management Institute Annual National Conference was held Sept. 10-11 in Orlando, Florida. Here is a sample of our coverage. Click here to see the full flight of our articles and videos.

Growth of GLP-1 therapies has reshaped the market

Nearly half of the growth in prescription drug sales now can be attributed to glucagon-like peptide 1 (GLP-1) therapies. On the diabetes side, GLP-1s, including Mounjaro and Ozempic, make up a $98 billion market, with a 16.5% year-over-year growth. GLP-1 therapies for weight loss, including Zepbound and Wegovy, saw 75% year-over-year growth and generated $55 billion in sales in the past 12 months, which is up from $2 billion in 2022, said Scott Biggs, director of supplier services at IQVIA, in the keynote address at the PBMI meeting.

The economics of which segments are filling these prescriptions has changed, Biggs said. Retailers, including independent pharmacies, are making very conscious decisions about whether to fill these prescriptions. For example, a year ago, approximately 48.5% of independent pharmacies were not filling prescriptions for GLP-1 for weight loss; now, 35% of independent pharmacies won’t fill weight loss GLP-1 prescriptions and 8% won’t fill prescriptions for diabetes GLP-1s. “Independents are starting to embrace the weight loss GLP-1s,” he said.

Approximately 80% of the GLP-1 market is being sold through retail pharmacies, but Biggs said mail delivery is increasing as direct-to-consumer options, although small, become more popular. Mail delivery now accounts for 12.9% of GLP-1 prescriptions.

The growth of the GLP-1 category has also reshaped the diabetes market. Sales of insulin products have slowed for 2026. Insulin made up just 9.8% of the diabetes market in June 2026, down from 38.4% in 2021. In terms of the number of prescriptions, insulin products account for
16% of prescriptions filled, down from 21% in 2021.

Biggs said he is beginning to see sizeable demand for GLP-1 therapies for weight loss through Medicare Part D’s Bridge program, a CMS demonstration program that began July 1, 2026, that provides some beneficiaries with access to Wegovy (semaglutide), Zepbound (tirzepatide) and Foundayo (orforglipron) for $50 per month.

“In the first three days, we showed 9,000 claims paid. By my estimates, that would be almost $2 million paid for by CMS,” he said.

Biggs expects both sales and the number of prescriptions of GLP-1 products to increase as new therapies become available and are approved for other indications. The pipeline for GLP-1 products has expanded beyond obesity and diabetes, with approximately 200 molecules in development, Biggs said.

"There are also some emerging frontiers going on in this area,” he said during his presentation. “One that we’ve been talking about is mental health. There are some trials that suggest there are some possibilities for GLP-1s to improve some depressive symptoms. I’ve heard a lot about substance use disorders. There are links found between the GLP-1s to reduce alcohol consumption, opioid overdose risk and tobacco use.”

In the short term, the GLP-1 pipeline is evaluating therapies that could minimize side effects to improve tolerability, maintain muscle mass and achieve greater weight loss, either alone or in combination.

Longer term, Biggs said, researchers are also exploring GLP-1 therapies for decreasing the risk of prostate cancer progression, endometrial cancer and some obesity-related cancers; addressing women's health for fertility and ovulation and polycystic ovary syndrome; and addressing systemic inflammation for respiratory disease and neurodegenerative diseases, such as dementia and Alzheimer’s disease.

“This will be an interesting category to watch to see how the market goes,” he said. “Obesity can be linked to many other things in a person's system. Researchers are talking about immune pathway overlap, plasticity and whether it alters the immune disease phenotype; some weight-dependent pharmacology; microbiome dysbiosis; and biomechanical stress.”

Other points from IQVIA’s 2026 Use of Medicines Trend report include the following:

• Total prescription medicine use increased 1.5%, reaching 210 billion days of therapy in 2025 compared with 2024.
• The U.S. market at net prices grew 10.6% in 2025 and an average of 9.3% annually over the past five years.
• Patient out-of-pocket costs reached a record $110 billion in 2025, increasing by $6 billion from 2024.
• Pricing pressures and patent expirations will slow growth through 2030, offset by the continued uptake of innovative therapies.
• U.S. medicine spending at net prices is forecast to grow 4.5% to 7.5% by 2030 and 6% to 9% at list prices.

Transparency is out. Actionable data is in.

The economics of pharmacy benefits are shifting, creating a time of disruption for payers and patients. Regulatory shifts such as the Inflation Reduction Act, rising cost pressures and technology such as artificial intelligence (AI) are creating an environment of disruption.

Data transparency is needed, but it’s not enough to successfully prepare for the future of pharmacy care, speakers said at the opening session of the PBMI annual meeting. What’s needed is actionable data and real-time technology to better manage rising costs and provide patients access to needed medications, they said.

Overall, retail prescription drugs accounted for 8.8% of healthcare spending in 2025, according to the Peterson-KFF Health System Tracker. But panelists said costs are rising sharply, and they expect specialty and medical-benefit drug spending to add another 10% to 15% of medical costs to pharmacy spending.

Regulatory and legislative pressures for transparency are affecting not only government health programs but also the commercial sector. But Dana McCormick, RPh, vice president of Practice Innovation and Business Strategy, Academy of Managed Care Pharmacy, cautioned that transparency does not equal value.

“I don’t want us to confuse increased transparency with increased value because that is not the case,” McCormick said. “You can have transparency all day long, but that does not necessarily increase the value of what you’re purchasing.”

She pointed out that policy decisions driving increased transparency, requiring pass-through rebates and delinking fees could end up increasing costs for employers.

Panelist Krista Siano, vice president of Business Transformation and Advisory Services at Pharmaceutical Strategies Group, said that employers and their pharmacy benefit managers (PBMs) need to have conversations about the strategy they want to employ and the data they will need to support it. “Transparency means being able to see every dollar the pharmacy benefit touches, from manufacturer to PBM to pharmacy to patient, because once you can see where that dollar is going, you can make decisions that can really impact the total net cost.”

Siano pointed out that there used to be a willingness to deprioritize transparency for the guarantee of lower costs. “Now the economics are shifting, and those guarantees aren’t materializing,” she said. “Transparency is an ingredient now for trust and values.”

But employers have to own their pharmacy benefits strategy before looking for a new PBM, and they need a real understanding of their employee population and what those employees are looking for, said Patty Starr, president and CEO of Health Action Council. “We're looking for employers to create a new level of accountability that goes across the ecosystem,” she said. “Employers have to bring pressure for more accountability to each of their partners.”

In the past, McCormick said, employers have expressed concern about rising pharmacy costs, which have sometimes led to bad decisions. “There are opportunities for disruption and applying point solutions, but point solutions are not all equal. Employers need to be thoughtful about not giving up quality and value in exchange for lowering costs.”

Speakers said that over the next five years, employers will continue the unbundling of pharmacy services and apply technology, especially AI.

Technology can increase transparency, McCormick said. She provides the example of utilization management policies, which are set at the population level. “There's not a ton of capacity to really build policies and include the dynamics of the patient and the patient experience and the specific patient demographics. Technology could change the way a policy needs to be applied for patients to get access.”

Technology could also help to create policies that are more personalized to the patient’s needs, Starr said. “We really expect a personalized and simple experience for the member. But the experience also has to guide people to the right care,” she said. “As we get that patient to the right place, we know that the overall care journey is going to have better outcomes and therefore impact, actually, the whole healthcare system.”

States push for new PBM reporting rules

Legislative and regulatory changes at the federal level are bringing new reporting requirements to the forefront. The Consolidated Appropriations Act, 2026, the first new federal legislation in 20 years to address pharmacy benefits, requires the reporting of drug pricing, rebates, pharmacy reimbursement and benefit design structure. The Department of Labor has proposed similar rules for Employee Retirement Income Security
Act plans.

But that hasn’t stopped the states from putting forth their own laws and regulations related to pharmacy benefit managers (PBMs), pharmacies and drug coverage. State proposals are targeting prior authorization, mandated coverage, formularies, biosimilar substitution, point-of-sale rebates, pharmacy reimbursement and pharmacist scope of practice. These efforts aim to provide oversight and transparency, as well as increased access for patients.

These state laws, however, bring compliance, administrative and technology challenges to PBMs to ensure they meet all of the state reporting requirements, said speakers at a session at the PBMI meeting.

“We’re going to see a lot of regulations on how to report," said Robyn Crosson, J.D., vice president of government relations at Navitus Health Solutions. “PBMs have to know where their data is and how to pull it because your rebate data are not in the same place as your claims data.”

One thing that the states, Crosson said, are asking for is reporting on prior authorization statistics, including how many prior authorizations were appealed and how many were lost and won on the appeal. There are many efforts to reform prior authorization underway, said Crosson, and she expects to see additional regulations in the future.

“Prior authorization is a hot target,” she said. “We’re seeing bills that are saying mental health medications should not have any prior authorization. And a bill in Pennsylvania just was dropped [on] the 18th of August that says PBMs have to pay for all FDA-approved Alzheimer's medications or treatments, with no step therapy. Cancer is another area where states are considering exempting medications from prior authorization.”

In fact, 45 states have rules or laws that address prior authorization, and 39 states have restrictions on utilization reviews, Navitus officials said.

Crosson said she expects more state efforts to freeze formularies, under which PBMs would not be able to make formulary changes during the plan year. “This could be really costly,” she said, pointing to Navitus’ effort to move people from Stelara to a biosimilar, which saved clients $120 million.

Panelist Grant Wallace, who manages benefits for Arkansas, said one-size-fits-all solutions don’t work for members and sponsors. “You lose the ability for nuance and doing the appropriate thing for the member,” he said. “Every instance is very unique. Every drug interaction is very unique. Every patient is very unique, and I think that gets missed when you try to engage in public policy.” Wallace is director of the Employee Benefits Division and the Office of Property Risk for Arkansas.

Panelists at the meeting also spoke about a federal effort to bring price transparency to consumers through the Patients Deserve Price Tags Act, a proposed law by Congress. Crosson said there are two versions, but the goal is to allow consumers to access drug prices at various facilities. One version of the bill includes a hold harmless provision, which could present some challenges because drug pricing is fluid, Crosson said.

“The hold harmless would say that if patients were shown a price of $15 at Walmart, but when they get to Walmart, now it’s $18, the patient would pay $15, and the employer would pay $3,” she said. “But we could be dealing with a GLP-1 [glucagon-like peptide-1] drug or a drug that has a $50 difference. That will add it up. That’s the biggest and scariest issue.”

Crosson said the bill is an effort to have price checks that drive responsible behavior and force people to show where the money is being spent. “But that part of the act is dangerous. For plan sponsors and for PBMs, this might change the way people are contracting.”

The Patients Deserve Price Tags Act also changes the narrative for pharmacies, Sharon Faust, Pharm.D., senior vice president, chief pharmacy officer at Navitus Health Solutions, said during the session. “Pharmacies are more of a consumer-driven dynamic where lower prices attract consumers, and regulation may prevent them from doing that.”

For PBMs, Faust pointed out that if they aren’t able to simultaneously remove a brand product when adding a biosimilar, for example, sponsors will ultimately pay more. “It's really an unintended consequence. It really comes down to our ability to use utilization management and how that utilization management drives outcomes and creates a
sustainable trend.”