Navitus: Specialty drugs and GLP-1s continue to drive drug trend

Specialty drugs and GLP-1 medications continue to push drug spending higher, according to Navitus Health Solutions’ 2025 Drug Trend Report. Prescription drug costs rose 8.4% for Navitus clients in 2025, reaching $120.08 per member per month (PMPM), up from 7% the prior year.

“Costs do continue to go up in the industry, but there are meaningful and impactful things that we can do to help manage costs and also make sure that patients get the treatments that they need,” Navitus’ chief pharmacy officer Sharon Faust said in an interview.

For the 10th consecutive year, specialty medications continued to drive increases in drug costs; specialty trend climbed 11.1% in 2025, to $62.25 per member per month. Growth came from increased utilization, particularly in oncology, immunology and dermatology. In oncology trend rose $1.47 per member per month, driven by a 7.3% increase in utilization of therapies such as Novartis’ Kisqali (ribociclib), which is a targeted therapy to treat patients with breast cancer.

Faust said that managing oncology costs is particularly difficult. “There are guidelines for the use of cancer drugs, and you can manage to do some utilization management. But it tends to not be as aggressive as utilization management in other areas,” she said. Navitus has partnered with Civica Rx, a not-for-profit drug manufacturer, to access lower-cost generics in the oncology space, one of the few cost-containment levers available in a category where aggressive utilization management is often inappropriate.

In dermatology, trend increased $1.40 per member per month, largely due to expanded use of Sanofi/Regeneron’s Dupixent (dupilumab), which is used to treat eczema, asthma and other conditions. The autoimmune drug Skyrizi (risankizumab-rzaa) from AbbVie was the single largest individual cost contributor, adding $1.43 per member per month on its own to drug spend.

Adopting generics and biosimilars is a strategy that can be employed to save in high-cost categories. The biosimilar launch of ustekinumab, which references Stelara, drove a $1.92 per member per month reduction in specialty spending for Navitus clients. Combined with biosimilars for Humira, targeted immunomodulators as a whole posted a net $0.46 per member per month decrease, the Navitus Trend Report found.

Navitus achieved a 95% patient conversion rate to biosimilar alternatives within months of adding them to its commercial formulary while removing corresponding high-cost brand products.

Central to Navitus’s biosimilar strategy is its relationship with Lumicera, the company’s specialty pharmacy subsidiary. “What we did with that unique relationship is drive down to the lowest net cost and get rid of all of the margins in the middle so that we can deliver the lowest cost to patients and members,” Faust said. Lumicera has access to the full range of available biosimilars and negotiates drug prices based on volume dispensed.

Looking ahead, Faust said additional biosimilars — including for Prolia (denosumab) in the osteoporosis space—are expected to lead to further savings. “Within the next three to five years, we'll see a number of biosimilars come through that will significantly help the trend,” she said.

GLP-1s: Demand persists, but pace moderates

GLP-1 medications that are used to treat diabetes remained among the most influential cost drivers in 2025, according to the Navitus report. Overall drug trend was 8.4%, but just 7.9% without GLP-1s, a narrower gap than in 2024. Improved contracting and stricter utilization management helped temper cost acceleration.

Eli Lilly’s Mounjaro (tirzepatide), which is used to treat patients with type 2 diabetes, was the single largest cost-growth agent in Navitus's commercial book of business, adding $2.40 per member per month. At the same time, Novo Nordisk’s Ozempic (semaglutie) and Eli Lilly’s Trulicity (dulaglutide), both of which are used to treat patients with type 2 diabetes, have decreased in costs.

“What stands out is how quickly utilization patterns are changing,” Faust said. “Members and prescribers are moving rapidly toward newer and more effective therapies. That shift is happening across nearly every major category.”

Faust noted that most Navitus clients do not currently cover GLP-1s for weight loss. “There are a lot of direct-to-consumer options within the weight loss space now,” she said.

Still, as oral GLP-1 formulations come to market and indications expand into areas such as sleep apnea and metabolic liver disease, coverage pressure is expected to grow. “As prices go down and as there are new indications, there will be more demand for coverage,” Faust said. Navitus's DirectAccess program is designed to offer plan sponsors flexible, out-of-benefit options for managing GLP-1 access and cost.

Looking ahead

Faust said plan sponsors will increasingly rely on utilization management and upfront pricing transparency to navigate this environment. "Not focusing on rebates, but trying to move savings up front — to the front — is going to be really important in the near future," she said.

Despite rising costs, Navitus reported that 32% of its clients paid less in 2025 than in 2024, and 44% saw increases of no more than 5%, a result the company attributes to its pass-through pricing model and evidence-based formulary design.