Prescription drugs touch the lives of most people in the U.S. in some way. About six in ten adults say they are currently taking at least one prescription drug, and a quarter say they currently take four or more prescription medications. The United States spends significantly more on healthcare compared to other developed nations. One of the driving reasons for this is because of high cost of prescription medication in America.
Drug Company Profits Are a Major Contributing Factor to Prescription Drug Costs
Despite seeing their general benefits to society, about eight in ten adults (82%) say the cost of prescription drugs is unreasonable, and the public sees profits made by pharmaceutical companies as the largest factor contributing to these prices. About eight in ten adults or more across partisans say profits made by pharmaceutical companies are a “major factor” in the price of prescription drugs. This is followed by more than half who say the cost of research and development is a “major factor” contributing to the price, and about half saying the same about the cost of marketing and advertising.
What to expect in prescription drug prices for 2026
In 2025, key trends such as the growing demand for specialty medications, pricing regulations, and innovations in biosimilars are expected to shape the market. Employers and employees will need proactive strategies to navigate these changes and control costs without sacrificing access to necessary treatments.
Why drug prices continue to climb
In 2024, prescription drug prices continued their upward trajectory, placing significant financial pressure on both employers and employees.
According to the Kaiser Family Foundation, the average annual drug spend per capita in the U.S. was approximately $1,500.¹ This high expenditure underscores a critical issue: controlling pharmacy benefit costs has become increasingly challenging in the face of rising prices.
Several key factors have driven the current pricing trends:
- Inflation: General inflationary pressures have contributed to increased production and distribution costs, ultimately leading to higher drug prices.
- Supply chain issues: Ongoing supply chain disruptions, from raw material shortages to delays in manufacturing and transportation, have further inflated costs.
- Innovation in specialty drugs: The growing demand for advanced specialty medications, particularly for chronic and rare diseases, has significantly impacted overall drug spending. Specialty drugs, which often come with a high price tag, now account for a larger share of total pharmacy costs.
These trends from 2024 set the stage for 2025, where further shifts in pricing and demand will likely continue. Employers and employees must prepare for these challenges by staying informed and adopting proactive cost-management strategies.
Specialty drugs: The dominant driver of costs
The demand for specialty drugs—those used to treat chronic and rare diseases—is projected to increase further.
These high-cost medications, which already account for a substantial portion of pharmacy spending, could represent 60% of total drug spending by 2025.² This shift highlights the importance of managing specialty drug costs effectively, as they pose a growing challenge for employers offering comprehensive pharmacy benefits.
While the 2025 Employer Health Benefit Survey finds there was a notable increase in the share of the largest firms (5,000+) that cover GLP-1 medications for weight loss, the conversations with employers highlight their concerns about the cost of these medications.
Many employers reported that use was higher than expected and covering them significantly increased prescription drug cost. While recognizing their effectiveness in addressing obesity, many employers indicated they were considering scaling back coverage.
Implications for employers
The rising cost of prescription drugs presents significant challenges for employers, particularly those managing self-funded or level-funded pharmacy benefit plans. Higher pharmacy benefit costs can strain budgets, making it difficult to maintain financial balance while offering robust employee benefits.
Employers face increasing pressure to cover the growing demand for specialty medications, which often carry high price tags. Without effective cost-containment strategies, these rising costs can erode profits and limit resources for other critical business investments.
How ClaimLinx addresses these challenges
ClaimLinx helps small businesses uncover meaningful savings on prescription drug costs by analyzing employee prescription utilization and identifying opportunities for smarter purchasing. By looking at prescription patterns, ClaimLinx can pinpoint trends, flag high-cost prescriptions, and recommend cost-effective alternatives. This proactive approach helps control rising pharmacy costs while making sure employees still get the medications they need.
Through this detailed analysis, ClaimLinx implements multiple savings strategies that benefit both employers and employees. These strategies include identifying available manufacturer coupon and assistance programs, comparing pricing across different pharmacies, and evaluating how medications are covered within the existing health plan. These steps can lower out-of-pocket costs for employees and reduce overall healthcare spending for the business.
Affordable drug prices means happier, healthier employees
ClaimLinx understands that employees need to be able to afford their medications. When people can take their prescriptions as directed, they are more likely to stay healthy and avoid bigger health problems later. Missing doses or skipping medications because of cost can lead to serious health issues and higher medical expenses over time.
Healthy employees are also more productive at work. They have fewer sick days, more energy, and can stay focused on their jobs. This helps create a stronger, more successful workplace for everyone.
That is why ClaimLinx focuses on analyzing prescription usage. By studying how medications are used and where savings can be found, ClaimLinx helps make prescriptions more affordable. This supports employee health while helping businesses manage their healthcare costs.
Custom solutions for complex problems
When it comes to serious health conditions, extensive medical procedures, or long-term care, sometimes even a health insurance plan isn’t enough. That’s where supplemental coverage (or sometimes called ancillary benefits) comes into play. It’s additional assurance you will be able to afford the care you need, and ClaimLinx can tailor supplemental insurance options to your workers’ needs.
Employers face increasing pressure to cover the growing demand for specialty medications, which often carry high price tags. Without effective cost-containment strategies, these rising costs can erode profits and limit resources for other critical business investments.
Supplemental Coverage = Additional Affordable Assurance
For many businesses, providing supplemental coverage as part of employer-paid benefits can seem like a luxury that is just out of reach. But that’s one of the best parts about the ClaimLinx Simple Option Solution. ClaimLinx creates savings and a unique opening in a company’s health insurance plan and budget to reinvest in employees and purchase supplemental coverage.
Employers face increasing pressure to cover the growing demand for specialty medications, which often carry high price tags. Without effective cost-containment strategies, these rising costs can erode profits and limit resources for other critical business investments.
ClaimLinx provides a forward-thinking approach to managing the rising costs of prescription drugs through its innovative Supplemental Coverage. This program is designed to help employers and employees navigate the complexities of drug pricing while ensuring access to high-quality medications remains affordable. Contact us today to get set up.
Tom Quigley
National Benefits Consultant, Owner
Tom Quigley has been helping businesses save money on health insurance for 25 years. He co-founded ClaimLinx to help small businesses. He wants every owner to know how to save 20% or more on their company health plan.
Anthony McMahon
Business Benefits Consultant
Anthony has seen small businesses save thousands on their health insurance with the ClaimLinx Solution. He’d like to show you how to do the same. It’s never too late, or too early, to make a change that saves your company thousands.
Tina Hatfield
Business Benefits Consultant
Tina loves helping small business owners save thousands on their healthcare benefits! Whether you have 3 employees or 100+, Tina can show you a solution that’ll improve benefits and decrease cost. Let’s schedule a conversation!
