PharmaLogic® Spotlight 2026: Edition 2
- | 10 min read
PharmaLogic® Spotlight communications explore evolving pharmacy dynamics and emerging trends that influence drug utilization and cost, supporting informed benefits decision-making.
Inside this PharmaLogic® Spotlight:
New Drug Approvals Influencing Benefits
Eleven new drugs and one gene therapy have already received FDA approval in 2026, following almost 60 new drug approvals in 2025.
2026 approvals include AvlayahTM, a treatment for a rare genetic disease called Hunter syndrome, IcotydeTM for plaque psoriasis, FoundayoTM for weight loss, and BysantiTM for schizophrenia and bipolar disorders.
Key to watch:
- The next oral GLP-1, FoundayoTM was FDA approved on April 1, 2026 adding to the options available to treat obesity.
- HepcludexTM, if approved, will be the first drug to treat hepatitis D. The hepatitis D virus only infects patients who are also infected with the hepatitis B virus.
- IcotydeTM, now approved for plaque psoriasis, is the first drug in a new class of medication used to treat plaque psoriasis. It is a once daily oral medication.
- XocovaTM, will undergo FDA review for approval mid-year. It is an antiviral given to prevent COVID-19 infection after an individual has been exposed to someone infected with the virus.
Review your plan use of drugs FDA approved so far in 2026 on the PharmaLogic® Spotlight report.
GLP-1 Developments
New oral GLP-1s are entering the market, changing usage patterns – especially for weight loss treatment. Drug manufacturer and government actions are impacting pricing and costs. Unit pricing is generally improving as competition grows and manufacturers strive to maintain and grow market share of their products while utilization of GLP-1s continues to increase. Plan sponsors are exploring cost-saving options to ensure they are able to continue to provide affordable, high-value benefits.
Updates:
- The first oral weight loss GLP-1, Wegovy®, became available in Jan 2026.
- FoundayoTM, the next oral option was FDA approved on April 1, 2026. Approval of other new oral and injectable options will follow.
- Explore other drugs in research and development and possible new indications or uses for GLP-1 drugs in the chart below.
- U.S. patents protect semaglutide brands Ozempic® and Wegovy® until ~2030. Patents in other countries begin to expire in 2026. Semaglutide generics may be available in Canada and India in 2026.
- Benefit managers struggle to sustain coverage of weight loss GLP-1 drugs, buckling from increases in use and cost. Some benefits exclude coverage. Most benefits covering the drugs require prior authorization, some require enrollment in a behavioral nutrition program for coverage and others have increased patient copays.
- Drug makers are offering lower cost direct-to-consumer options, allowing benefit design flexibility and announcing price reductions to maintain market share.
- Medicare/ Medicaid will provide access to GLP-1s through their BALANCE model pilots and programs.
Review your plan’s use of GLP-1 drugs for diabetes and weight loss via the Spotlight and GLP-1 Utilization PharmaLogic® reports.
Remedy will assist you in discussions with PBMs and disease management providers to hone your benefit approach to weight loss and other uses for GLP-1 drugs.
Drug Importation / International Sourcing
The FDA and U.S. Customs and Border Protection regulate importation of drugs. While federal governmental pressures are encouraging more domestic drug manufacturing, importation of products and active ingredients under FDA oversight is important to ensure sufficient U.S. drug supplies. Most other types of importation are prohibited, although personal-use exemptions may apply.
Safety concerns, lack of FDA oversight, counterfeit risks, benefit continuity, the patient experience, and inconsistent availability must be considered when relying on personal importation or other alternative sourcing strategies. Please consult your legal counsel for further guidance related to importation.
Generic & Biosimilar Use
Patents are expiring for several key brand specialty and non-specialty drugs, clearing the way for new generic and biosimilar options in 2026. Use of these and other lower cost generics and biosimilars yields savings for benefit plans.
Availability of new generic and biosimilar options for these brand drugs is anticipated during 2026:
Formulary or preferred drug list updates occur as additional generics and biosimilars become available. Pharmacy Benefit Managers (PBMs) typically announce those changes on a quarterly basis. Changes to prefer Humira biosimilars in 2024 and 2025 have resulted in significant shift to biosimilar options. A large PBM recently announced the removal of Stelara® subcutaneous injectable, Tysabri and Soliris from its formularies, preferring biosimilars as of July 1, 2026.
Formulary strategies preferring biosimilars and generics and excluding coverage of original brands that have lost patent protection are key to achieving savings.
Review your plan’s use of these brands via the Spotlight and Specialty Biosimilar Use in Rx Benefit PharmaLogic® reports.
Shifts in Drug Pricing Models
Over time, the economics of brand drug pricing and financial models have been morphing from higher list prices coupled with higher rebates to lower list prices and reduced rebates. The goal is to focus on lowest net cost and less on the size of a rebate check.
Changes in the market are supporting list price reductions, a shift from rebates and to more aggressive price competition. Market changes include:
- While Medicare focused, negotiation of Maximum Fair Prices (MFP) for brand drug lists is impacting overall market prices
- Price adjustments related to federal Most Favored Nations policy
- Direct-to-consumer pricing from manufacturers and via the TrumpRx portal
- State legislation requiring NADAC or rebates at the point-of-sale
- PBMs offering financial model options less focused on rebates
CMS is negotiating a Maximum Fair Price (MFP) for certain brand medications. Ten drugs were on the negotiation list for 2026. Fifteen additional drugs will be added for each of the next 2 years, 2027 and 2028. While Medicare focused, negotiation of MFPs is impacting overall market prices.
Review your plan’s use of drugs on MFP lists via the Spotlight PharmaLogic® report.
Remedy will support your review of new pricing models to guide your plan to the options that best meet your financial goals and service needs for members.
Our team is ready to assist you as you face new prescription benefit challenges and contemplate benefit changes and potential solutions. Together, we can review strategies with PBMs, including optimizing formulary incentives to support biosimilar use and utilization and behavioral management related to new and continuing drug therapies.
Review your plan’s use of new drugs, biosimilars, vaccines, anti-inflammatory drugs and GLP-1s via the Spotlight and other PharmaLogic® reports.
PharmaLogic® reporting monitors COVID-19 vaccination utilization in your pharmacy benefit and showcases specific at-risk groups in your population with underlying conditions that you may need to target with a communication.
Log in to your PharmaLogic® Portal to check your COVID-19 Monitoring report for utilization of vaccinations in your pharmacy benefit and look for specific at-risk groups in your population with underlying conditions that you may need to target with a communication.
