Rising Pharmacy Costs: Challenges and Drivers
Christina Barrington presented an overview of the market drivers of increases in pharmacy costs. She commented that in 2024, U.S. drug spending reached $806 billion, with specialty medications, especially GLP-1s for diabetes and obesity, driving a 10.2% increase, the highest in a decade1. She also reported that specialty drugs now account for just 1% of prescriptions but 50% of total spend2, a trend expected to continue. Barrington highlighted the impact of new therapies in oncology, immunology, and metabolic disorders, noting that while cell and gene therapies are growing, their actual spend hasn’t yet matched expectations.
UPMC’s Value-Based Pharmacy Initiatives (VBPI)
Bernie Good described the evolution of UPMC’s Center for Value-Based Pharmacy Initiatives (VBPI), which supports pharmacy operations, research, and innovative contracting. VBPI works with Express Scripts, Inc. and other collaborators to analyze real-world evidence, develop value-based contracts, and mentor trainees. Good emphasized that value-based contracts, linking reimbursement to drug performance, are not a cure-all for rising costs but are a critical tool for aligning incentives and improving patient outcomes.
Pharmacy Care Management: High-Touch, Data-Driven
Vanessa Campbell showcased UPMC’s member-centric pharmacy care management programs and how they are working to respond to challenges and drivers and incorporate learnings from the VBPI team. She also discussed how her team uses analytics to identify at-risk members, coordinates care through direct EMR access, and screens for social determinants of health. She shared the example of the CHF (congestive heart failure) stratification program, which has generated over 27,000 pharmacist recommendations for nearly 16,000 members since 2023. These interventions have led to increased use of guideline-directed therapies and reduced hospital readmissions and can serve as a model for future programming to help members manage other similar chronic conditions.
Collaborative Research and Real-World Impact
Samuel Peasah highlighted collaborative research with collaborators like University of Pittsburgh School of Pharmacy and Express Scripts, Inc. as well as teams internal to UPMC. Recent projects he described include trend analyses of GLP-1 use, studies on weight loss and healthcare costs, and investigations into medication patterns for chronic diseases. These collaborations not only inform UPMC’s strategies but also contribute to national conversations on pharmacy value and innovation.
Key Takeaways and Looking Ahead
Specialty drugs are the main driver of pharmacy cost growth; innovative contracting and analytics are essential for managing spend and improving outcomes. Value-based contracts are effective but not a standalone solution; a holistic approach is needed. High-touch pharmacy care management, powered by data and direct provider collaboration, delivers measurable improvements in patient care. UPMC’s learning community model fosters cross-sector collaboration, research, and shared learning to deliver value-based pharmacy services in an ever-changing healthcare environment and other complex healthcare challenges.
1ASHP. (2025, April 24). U.S. drug spending up 10.2% in 2024, with weight loss drugs remaining top driver [Press release]. Retrieved October 14, 2025, from https://news.ashp.org/News/ashp-news/2025/04/24/us-drug-spending-up-10-in-2024-with-weight-loss-drugs-remaining-top-driver
2Pharmaceutical Strategies Group. (n.d.). 2024 state of specialty spend and trend report. Retrieved September 10, 2025, from https://www.psgconsults.com/industry-report/2024-state-of-specialty-spend-and-trend-report/