The State of the PBM Industry in 2025: New Drugs, Tariffs & Market Shifts

As we wrap up 2025, the pharmacy benefit management (PBM) landscape is advancing rapidly. For brokers, employers, and third party administrators (TPAs), the key to staying ahead is recognizing not just traditional cost drivers but emerging disruptors:

• High-cost specialty and gene/cell therapies

• Global supply chain/tariff dynamics

• New regulatory pressure

Rescription is built for the future of pharmacy benefits and this state-of-the-industry report outlines what matters now, and how you can partner with a PBM alternative that is proactive and transparent.

Market Overview: Elevated Costs & Increasing Complexity

Rising Drug Costs and Specialty Therapies

We’ve seen pharmaceutical costs climb significantly, especially with the rise of specialty and orphan drugs. For Rescription, these aren’t hypothetical; they’re real exposures for self-insured employers and their benefit advisors. Rescription’s model is designed to mitigate these risks through its patent-pending platform Rexi™ and published pricing strategy.

Employers and TPAs should ask: Does your PBM still rely on opaque rebate models or does it guarantee published prices and drive savings at the point of sale? Rescription clearly chooses the latter.

Tariffs, Supply Chain, and Inflation Pressures

Beyond drug innovation, macro-factors are playing a larger role. Materials, manufacturing, and global sourcing are under strain; tariffs and supply chain disruptions are influencing the cost of pharmaceuticals, which cascades down into plan costs. In this environment, a PBM alternative that focuses upfront on lowest possible net price versus chasing rebates is more relevant than ever. Rescription’s approach of direct partnerships with health systems and guaranteed published pricing positions it well.

Fragmentation of Traditional PBM Models

Traditional PBMs face increasing scrutiny—both from plan sponsors and regulatory bodies—for their complex rebate flows, formulary restrictions, and opaque margins. Rescription labels itself as an anti-PBM™ and frames the disruption as necessary.

For brokers and TPAs, this means the conversation is shifting from “which PBM do we pick?” to “which PBM alternative will give our clients radical clarity, alignment, and long-term cost stability?”

Strategic Implications for Brokers, Employers, and TPAs

For Brokers and TPAs

• Emphasize transparency: Recommend evaluation criteria that go beyond rebates. Look at net cost, published pricing, and freedom of drug access.

• Equip clients: Help employers understand that the PBM relationship is evolving. Cost containment now means more strategic plan design, benefit integrations, and partner selection.

• Leverage tools: Rescription’s myRescription™ app and Rexi™ platform give real-time drug lookup, notifications, and analytics.

For Employers

• Ask the hard questions: Are you still paying more when your members spend more? Traditional PBMs are often structured that way; Rescription’s model flips that incentive.

• Review plan design: Specialty drugs and gene therapies may not be fully accounted for in legacy models. Ensure your PBM partner is prepared for these cost drivers and offers clean access, not additional hurdles.

• Consider member experience: Lower costs mean less friction for employees; $0 copays on high-cost drugs, clarity in pricing, and ease of use matter. Rescription offers a model with clear benefits.

For TPAs

• Data and insights matter: With emerging therapies and cost pressures, TPAs must collaborate with PBM partners who provide full visibility, analytics, and member-experience tools.

• Partnering mindset: Firmly aligned PBM relationships (like Rescription’s) allow TPAs to integrate benefit administration, member support, and cost containment seamlessly.

• Value communication: TPAs can help employers articulate the shift from “stop the cost increase” to “optimize investment” in pharmacy benefits where transparency is the differentiator.

What to Watch in 2026 and Beyond

• Escalating specialty drug spend will remain a dominant concern. Employers and sponsors must model for new high-cost therapies and ensure their PBM alternative is equipped.

• Supply chain and sourcing dynamics: Tariffs, global manufacturing shifts, and regulatory reform (drug importation, pricing mandates) could materially impact net costs.

• PBM reform momentum: Legislative and regulatory efforts are increasing oversight of PBMs’ rebate practices and transparency requirements. Rescription publishes commentary on this topic.

• Member-centric technology: The future is real-time pricing, consumer apps, notifications, and transparency, not just formularies and rebate flows. Rescription’s Rexi™ and myRescription™ are positioned for this.

• Shift in relationships: Employers, brokers, and TPAs will increasingly view PBMs not as commoditized vendors but as strategic partners aligned with plan sponsor goals (not vendor profit).

Why Rescription is Built for the Future

At Rescription, we believe the traditional PBM model is broken, and we built our solution from the ground up to replace it. With our anti-PBM™ philosophy, guaranteed published pricing, subscription-based fee (no hidden spread or incentive to drive spend), and technology-driven platform, we deliver radical clarity, alignment, and real savings from day one.

For brokers, employers, and TPAs seeking a modern pharmacy benefit strategy—one that is future-focused, member-centric and cost-efficient—Rescription is the partner of choice.