The Future of Prescription Drugs: 5 Trends Shaping Benefits

Prescription drugs are a major part of health care today and rising costs continue to affect both members and organizations. At Excellus BlueCross BlueShield (BCBS) our commitment stays rooted in the people we serve. As a nonprofit, we spend 92 cents of every premium dollar on medical and pharmacy care, and we’re focused on helping members access quality care without letting affordability get in the way. Through programs like pharmacy support, preventive care, chronic condition management and personalized guidance from our clinical teams, we’re working to keep members healthier while managing costs.

Looking ahead to 2026, several key trends are shaping how prescription drug benefits are designed. In fact, we’re already putting solutions into practice to support both employers and employees through these changes.

1. Rising Specialty Drug Use

Specialty medications are often used to treat complex conditions such as cancer, multiple sclerosis, or autoimmune disorders. These drugs can alter the course of disease in a positive way for members, but they also carry exceptionally high costs. Recent data shows that specialty drug utilization and spending continue to rise. Specialty use continues to grow; 75% of new drugs in development are specialty¹ and utilization is rising across both the pharmacy and medical benefits². By 2026, specialty drugs are expected to account for more than half of all drug spending³.

Excellus BCBS helps manage this challenge with a comprehensive suite of programs. In addition to our specialty pharmacy network that supports members with education, refill coordination, and clinical guidance, we offer:

• SaveOn programs to reduce member out-of-pocket costs⁴
• Biosimilar optimization to encourage use of equally effective but lower-cost alternatives⁴
• Specialty drug benefit optimization strategies to keep coverage sustainable⁴
• High-cost claimant management, which saved more than $4 million in medication costs and cost avoidance through pharmacy interventions^{4, 5}

Together, these solutions ensure members receive the medications they need while employers can better control costs.

2. Focus on Medication Adherence and Safety

Taking medications correctly is one of the most effective ways to improve health outcomes and reduce avoidable medical costs. Missed doses or drug interactions can lead to hospital visits and complications, making adherence a growing priority.

Employers can play an important role by encouraging preventive care and supporting employees in taking their medications as prescribed. At Excellus BCBS, we provide tools and programs that help members stay on track, including:

• Pharmacy concierge programs like Sempre Health, which uses short message service (SMS) reminders to improve adherence⁶
• Condition management resources for chronic conditions such as diabetes and inflammatory bowel disease(IBD)⁷
• Member education and outreach that reinforces safety, prevention, and whole-person care

These efforts ensure members remain healthier, more productive and more supported in their daily lives.

3. Managing Out-of-Pocket Costs

High prescription costs can be a barrier for both members and employers. As health care costs continue to rise, Excellus BCBS is committed to making care affordable without compromising quality.

Through our condition management program, members living with chronic conditions such as diabetes or IBD receive personalized support, education, and coordinated care to help manage both their health and medication costs. In addition, our pharmacy trend management initiatives analyze high-cost drug categories and implement strategies, such as preferred drug lists, clinical reviews, and affordability solutions, to help keep prescriptions within reach.

By focusing on whole-person health and smart pharmacy management, Excellus BCBS ensures that cost never becomes a barrier to the care members need.

4. Growth of Home Delivery

More members are choosing home delivery for convenience, reliability and potential cost savings. Ordering a 90-day supply of maintenance medications can lower costs while reducing trips to the pharmacy.

Excellus BCBS partners with ESI and Wegmans Home Delivery to offer home delivery options⁸ across many plans. Members benefit from timely access to prescriptions, improved adherence and the peace of mind that comes with dependable service, while employers benefit from healthier, more supported teams.

5. Smarter Use of Drug Management Tools

Employers are seeking balance between access to quality care and affordability. Drug management tools such as prior authorization, step therapy, and quantity limits help ensure that medications are safe, clinically appropriate, and cost-effective.

At Excellus BCBS, these tools are designed with member health in mind. For example, step therapy may require trying a clinically proven generic before moving to a higher-cost brand, ensuring that medications used are both medically necessary and sustainable from a cost perspective.

We also provide employers with insight into our core pharmacy suite savings, which helps save an average of $27.77 PMPM⁹, showing how these programs deliver measurable results without compromising member health.

Looking Ahead

The future of prescription benefits will continue to balance access to quality care, affordability and safety. Specialty drugs, home delivery, federal policy changes and smarter cost management are shaping what comes next.

At Excellus BCBS, we are already putting these solutions into practice. Our pharmacy programs are designed to help employers manage costs and give members the support they need to stay healthy.

Want to learn how Excellus BlueCross BlueShield can help your organization manage prescription drug costs while supporting member wellbeing? Visit ExcellusForBusiness.com to explore pharmacy benefit solutions and connect with our team.

Disclaimers:

1. Excellus BCBS Specialty Drug Trends
2. Excellus BCBS Pharmacy Trend Management Report
3. Mercer (2025): Pharmacy Trends – 2025 and Beyond
4. Excellus BCBS Specialty Pharmacy Network
5. Excellus BCBS High-Cost Claimant Team Outcomes Report
6. Excellus BCBS Pharmacy Concierge Program
7. Excellus BCBS Condition Management Programs: Diabetes & IBD
8. Excellus BCBS Home Delivery Pharmacy Options
9. Excellus BCBS Core Pharmacy Suite Savings