4 PBM Trends in 2025

The pharmacy benefits management (PBM) landscape is changing as employers, insurers, and policymakers push for more transparency, cost-effectiveness, and better overall outcomes. In 2025, we hope this to continue with several key trends reshaping how PBMs operate, deliver value, and impact healthcare costs. These shifts are driven by different factors including rising costs, changing patient needs, and increasing public scrutiny. For employers, understanding these trends will be essential for navigating the future of pharmacy benefits and ensuring the best outcomes for their employees and members. Let’s dive in!

1. Movement Toward Transparent PBM Models

Legacy PBMs have faced criticism for their lack of transparency in pricing and rebate structures - something that has been especially prominent this past year. This has resulted in hidden costs for employers and employees alike. In 2025, we are already seeing a clear shift toward modern, transparent PBM models. Employers are demanding clarity in pricing and assurance that medications their employees need are being provided at the best possible prices.

Here at SmithRx we are reimagining how PBMs work and serve their clients. We offer a transparent, straightforward approach to pharmacy benefits that eliminates junk fees and other obstacles, so we can focus on passing savings directly to employers and their employees.

Our model provides employers with clear and transparent pricing, detailed reporting, and the ability to directly manage pharmacy costs without relying on opaque practices like spread pricing or hidden rebates. The result is better value for employers and a more seamless experience for employees.

Additionally, our focus on patient outcomes and specialty medication management has helped employers better control the costs of high-cost drugs like MS therapies and GLP-1 medications. By focusing on providing high-quality care and promoting medication adherence, we strive to make an impact in the PBM space and set the standard for modern PBMs in 2025 and beyond.

Why This Matters:

• Cost Transparency: Transparency allows employers to know exactly what they are paying for and ensures that savings are passed on to employees.
• Better Control: Transparent PBM models help employers and brokers be able to make the best decisions when it comes to selecting benefits.
• Improved Care: Patients benefit from clear pricing and outcome-focused care, which can lead to improved health and medication access.

2. Increased Scrutiny and Regulatory Pressure

This year, legacy PBMs will continue to face increasing scrutiny from both policymakers and regulatory bodies. Legislative efforts in recent years have highlighted concerns about legacy PBM practices, particularly the lack of transparency, conflicts of interest, and their impact on drug prices and accessibility to necessary medications.

One important regulatory change expected in 2025 involves efforts to curb legacy PBM practices that involve the ownership of both PBMs  and pharmacies. Legislators are pushing for reforms that would require legacy PBMs to be independent of pharmacy ownership to eliminate potential conflicts of interest. Additionally, proposed regulations are looking to mandate that all rebates and fees collected by PBMs be passed through to plan sponsors, instead of being kept as profit.

These reforms are expected to have significant impact on the industry, forcing legacy PBMs to adopt more transparent and fair practices, which will greatly benefit health plans and employers. 

Why This Matters

• Fairer Pricing: As legislation evolves, PBMs will need to operate with more integrity, which leads to better price control and accessibility to medications.
• Accountability: PBMs will be held accountable for their pricing and rebate practices, benefiting both employers and employees.

3. Focus on Specialty Medication Management

Specialty medications are becoming an increasingly important focus for PBMs, and for good reason. These high-cost treatments for chronic or complex conditions represent a growing portion of overall healthcare spending. PBMs are working to implement targeted strategies for managing their utilization, ensuring adherence, and controlling costs.

One of the most successful areas of innovation of late has been in the management of speciality drugs like MS treatments. Programs designed to help members better manage their medications, including personalized support and adherence monitoring, are becoming more popular. These efforts help ensure that patients receive the right drugs at the right time and are not subject to unnecessary barriers that could prevent them access to necessary medications.

Why This Matters

• Cost Control: Proper management of speciality medications helps reduce overall spending on high-cost drugs.
• Improved Outcomes: Speciality medication management ensures that patients receive the right treatment at the right time, improving overall health.

4. Adoption of Value-Based Contracting

The shift from volume-based to value-based healthcare continues to gain momentum, and PBMs are no exception. In 2025, we expect to see more PBMs entering value-based contracts that reward the delivery of positive patient outcomes rather than simply reducing the cost of medications. These contracts incentivize PBMs to ensure that prescribed medications lead to better health outcomes.

By focusing on patient outcomes, PBMs can help reduce overall healthcare spending by improving patients’ health, preventing costly complications, and fewer hospital visits.

Why This Matters

• Outcome-Driven: Value-based contracting shifts the focus from cost alone to the effectiveness of treatments, driving better health outcomes.
• Cost Savings: By improving health and reducing complications, value-based models can help lower overall health care costs.
• Long-term Impact: This approach leads to better health for members, which can reduce long-term medical expenses for employers.

Looking Forward

As we move into 2025, the PBM landscape is poised for significant change. With a growing focus on transparency, patient outcomes, and specialty medications, the PBM model of the future will be more accountable, cost-effective, and aligned with the needs of employers and their employees. The adoption of value-based contracts and increased regulatory scrutiny will continue to shape the industry, ensuring that PBMs provide value beyond just negotiating drug prices. 

Employers looking to stay ahead of these changes should consider partnering with PBMs that offer transparency and focus on better patient outcomes. For more information about SmithRx and how we are revolutionizing the PBM space, take a look at our blog. If you have any questions or are interested in learning more, feel free to speak with a SmithRx representative, we would love to hear from you.