The Silent Surge Driving Pharmacy Costs — and How to Stop It 

At LucyRx, we’re not wired to accept “that’s just how it is” in pharmacy benefits. 
If something’s broken, we fix it. 
If it’s the norm today, we challenge it. 
If it’s inefficient, we make it better. 

  • 3 Min read

  • August 27, 2025

Susan Thomas

Susan Thomas

Chief Commercial Officer, LucyRx
Best Practices
The Silent Surge Driving Pharmacy Costs — and How to Stop It- LucyRx Blog

Right now, there’s a storm brewing in specialty drug trend—and most plan sponsors don’t even see it coming. If you’re focused only on high-profile drugs like Humira® or the latest blockbuster approvals, you might miss the bigger problem. 

The real driver? Unmanaged biologic utilization, amplified by direct-to-consumer drug advertising and weak biosimilar adoption strategies. 

Specialty Drug Trend: What the Data Shows 

Pharmaceutical Strategies Group’s 2025 State of Specialty Spend & Trend report reflects what we’re seeing in the field every day: 

  • Specialty drug costs are projected to rise 46% net in just three years—driven by utilization, not price 
  • Inflammatory disorders now account for 37% of specialty spend, led by Skyrizi®, Dupixent®, and Rinvoq® 
  • Removing one high-cost drug doesn’t fix it—spend just shifts to another 

In one client case, anti-inflammatory PMPM costs rose from $17 to over $22 in two years—even after Humira was removed from formulary. Utilization of Rinvoq and Skyrizi doubled. Biosimilar uptake stalled below 40%. 

How Drug Advertising Skews the System 

Direct-to-consumer (DTC) advertising has made these biologics household names. Patients request them by name. Prescribers—especially under time pressure—often say yes. 

Here’s the problem: rebates don’t go away when this happens—they follow the utilization. But the average wholesale price (AWP) of the “next” drug is often even higher. 

It’s like getting a discount on a luxury car when you could’ve bought a reliable hybrid for half the price. 

When “Flat” Costs Are Mistaken for Success 

Traditional PBMs often recognize when specialty drug spend has leveled off, but instead of pursuing deeper savings, they may declare victory too soon. With utilization shifting to higher-AWP products, stable costs are sometimes viewed as a win—when in reality, plans are losing out on the savings that vigilance could have secured. Without real-time oversight and strategic intervention, this “success” is simply a missed opportunity for greater value. 

The LucyRx Model: Precision-Driven, People-Supported 

At LucyRx, we take a different approach—one that aligns cost control with clinical support and member experience. 

Here’s how we do it: 

  • Care Guides who work with members and prescribers during therapy transitions 
  • Real-time surveillance via LucyIQ™ to prevent backdoor switches to high-cost brands 
  • Aggressive biosimilar adoption—up to 80%+ of a drug class, when appropriate 
  • Net savings guarantees—in one client analysis, $11 PMPM savings and a 4:1 ROI 

We also apply this same model to inflationary categories like oncology and skin immunosuppressants—using site-of-care optimization, duration-of-therapy reviews, and specialty pharmacy partnerships through our Connected Specialty Care Network. 

You Don’t Have to Wait Until Renewal

If your costs are trending up, or even appear flat, even after excluding Humira, take a closer look. This pattern could signal a shift toward next-generation brand drugs rather than true savings. 

If your PBM assures you that “rebates will make up for it,” ask to see your trend line. 

And if you’re uncertain about what’s driving your numbers, we’ll help you uncover the real story. 

You don’t have to settle for a black-box PBM.
You don’t have to wait for renewal.
You just have to stop the silent surge before it gets louder. 

See How LucyRx Can Help 

Uncover hidden drivers in your pharmacy spend and explore solutions tailored for employers.

Schedule a Discovery Call

Tags

biosimilar adoption direct-to-consumer drug advertising pharmacy benefits management transparency specialty drug cost containment specialty drug trend

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