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Medical Pharmacy Trend Report

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PART 2

Drug Overview 2026 SIXTEENTH EDITION

Contributors Laura Walters, RPh

Lisa Polakowski, PharmD, MBA

Specialty Clinical Solutions Director

Director, Medical Pharmacy Trend Report

Ben Messerli, ASA, MAAA

Mel Moktan

Manager, Actuarial Services

Actuarial Analyst

Shelae Cheng

Kristen Reimers, RPh

Principal, Brand Marketing Strategy

Sr. Vice President, Specialty Clinical Solutions

Questions? Contact us at MPTrends@PrimeTherapeutics.com Prime Therapeutics’ 2026 Medical Pharmacy Trend Report is published in partnership with D Custom. All rights reserved. All brand names are the property of their respective owners. The content — including text, graphics, images and information obtained from third parties, licensors and other material (“content”) — is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Figures may be reprinted with the following citation: Prime Therapeutics Medical Pharmacy Trend Report, Sixteenth Edition © 2026. Used with permission. © 2026 Prime Therapeutics LLC

Contents

Methodology The 2026 edition of the Prime Therapeutics Medical Pharmacy

02. . . . . . . . . . . . . . . . . . . . . . . Introduction

Trend Report was developed utilizing medical pharmacy industry standard methodologies, calculations, guidance from medical drug management experts and feedback from previous trend reports. Results were based on a noncontinuous population over the five

04. . . . . . . . . . . . . . Commercial overview

years analyzed (2021-2025).

Health plan claims data Medical benefit drug utilization and trend data were collected

08. . . . . . . . . . . . . . . . . Medicare overview

through secondary analyses of commercial, managed Medicaid and Medicare Advantage health plan medical paid-claims data for the last five calendar years. Claims data was analyzed for medical pharmacy utilization across 1,433 Healthcare Common Procedure Coding System (HCPCS) codes and several outpatient sites of

12. . . . . . . . . . . . . . . . . . Medicaid overview

service.* Analyses compared medical claims data from 2025 to data from 2024. In some cases, the past five years were analyzed to show a

16. . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary

longer period of year-over-year (YOY) spend and trend. All data includes allowed-amount costs directly from health plans for medical drugs only. *Items excluded were diagnostic radiopharmaceuticals and drugs administered in the inpatient hospital setting.

2026 MEDICAL PHARMACY TREND REPORT

E D I T I O N

5 -Y E A R P M P M T R E N D

Introduction Prime Therapeutics is pleased to present the

Commercial

47.2%

$38.66

2021

$44.67

2022

2023

2024

$97.23

Medicare

71.0%

$48.20

$51.67

$56.90

2025

$106.37

$82.07 $62.21

$67.64

2026 Medical Pharmacy Trend Report: Part 2. The drug overview presents a topline analysis

2021

2022

2023

2024

2025

of medical benefit drug claims, highlighting key trend drivers and benchmarking insights for the commercial, Medicare Advantage and managed Medicaid lines of business. Deep dive analyses will be published later this year in the comprehensive Medical Pharmacy Trend Report.

Medicaid

44.0%

$19.50 $15.32

$15.31

$16.64

2021

2022

2023

2024

$22.06

2025

TO P D R U G A N D C AT EG O R Y P M P M

Commercial Keytruda

Medicare

Medicaid

Oncology

Keytruda

Oncology

Keytruda

Oncology

52.2%

101.9%

92.9%

83.8%

55.7%

2021. . . . . . . . . $2.40

2021. . . . . . . . $14.97

2021. . . . . . . . . $8.07

2021. . . . . . . . $33.05

2021. . . . . . . . . . . $1.11

2021. . . . . . . . . $5.06

2025. . . . . . . . $5.28

2025. . . . . . . $22.78

2025. . . . . . . $16.29

2025. . . . . . . $63.75

2025. . . . . . . . $2.04

2025. . . . . . . . $7.88

120.0%

20 2 5 K E Y T R E N D S

20 2 5 T R E N D S* U T I L I Z AT I O N

+10.1% Commercial

Medicare

Medicaid

Enzyme replacement therapies enter top 10

Ophthalmic landscape sees PMPM changes

Gene therapies drive PMPM trend

Increase: Pavblu, Avastin

Increase: Elevidys, Zolgensma

>$1M cost per utilizer for Kanuma and Brineura

Decrease: Eylea, Vabysmo

CO ST

+13.1% +9.4% 3.5%

7.9% 9.8%

9.3% 2.1%

-0.4% Commercial

Medicare

Medicaid

*Due to rounding, totals may not add up accurately.

2026 MEDICAL PHARMACY TREND REPORT

Commercial In 2025, commercial medical pharmacy trend increased by 10.1%, driven primarily by a 7.9%

10.1%

rise in cost and a 2.1% increase in utilization, with double-digit growth in utilizers receiving drugs with annual costs above $10K. Oncology continued to be the primary driver of spend, with stable utilization but a 9% increase in costs, driven largely by Keytruda, Darzalex Faspro, Enhertu and Imfinzi. Enzyme replacement therapies entered the top 10 categories by spend with a 23.9% increase, driven by high-cost drugs such as Kanuma and Brineura. Other notable trends include the continued decline in the oncology support category with colonystimulating factors, while immune globulin, vaccine and rare disease trended upward.

2025 trend

20 2 5 TO P 5 T H E R A P Y C AT EG O R I ES BY P M P M S P E N D % of spend

$56.90 2025 spend

35% 40%

20 24 – 20 2 5 TO P D R U G T H E R A P Y C AT EG O R I ES BY P M P M S P E N D 20 24

20 2 5

$2 2.7 8

$2 0. 93

8.8%

O N CO LO GY B DA I D : C R O H N ’ S D I S E AS E / U LC E R AT I V E CO L I T I S M U LT I P L E S C L E R O S I S

Rare disease

Vaccine

-17.2%

$1 .3 3 $1 .10

0.9%

6.2%

24.7%

Enzyme replacement therapy

$1 .12

R A R E D I S E AS E A L L OT H E R

BDAID: Oncology Ophthalmic rheumatoid support: injections arthritis colony-stimulating factors

$1 .11

$1 .3 0

14%

$1 .14

$1 .4 2 $1 .6 1

$3 .0 3 $3 .5 4 Immune globulin

13.4%

$0 .8 1 $1 .0 1

Multiple sclerosis

I M M U N E G LO BU L I N

16.8%

$0 .9 7 $1 .0 3

Oncology BDAID: Crohn’s disease/ ulcerative colitis

2.2%

$3 .9 3 $4 .0 2

$4 .5 3 $4 .8 1

6.2%

20 24 – 20 2 5 TO P D R U G S BY P M P M S P E N D W I T H CO M P O N E N TS O F C H A N G E* UTILIZERS

CLAIMS PER UTILIZER

I N F L AT I O N

R E I M BU R S E M E N T

MIX

+$0.48 $0.03

$0.25

+$0.23 +$0.21

$0.10

$0.05 +$0.11

+$0.12 $0.20

+$0.06 $0.04

-$0.07

$0.05

$0.19

$0.08

$0.04

$0.08

$0.05

-$0.03

-$0.04

$0.03

+$0.17

$0.05

$0.04

+$0.20

$0.20 $0.10

$0.23

-$0.04 $0.05

-$0.03

-$0.04

-$0.05 -$0.03

-$0.07

Keytruda

Ocrevus

Entyvio

Opdivo

Darzalex Faspro

Gammagard Liquid

Botox

Perjeta

Enhertu

Prevnar 20

*Values under $0.03 not labeled on graph.

Top 3 drugs driving trend Keytruda was a leading driver of trend, reflecting expanded indications, longer treatment and continued price inflation. Limited competitive pressure and site-ofcare optimization opportunities also contributed to this growth. Darzalex Faspro grew primarily due to expanded indications within multiple myeloma. Enhertu’s increasing use reflected indication expansion, earlier-line adoption and a broader shift toward high-cost targeted oncology therapies. 2026 MEDICAL PHARMACY TREND REPORT

20 2 5 P E R- U N I QU E- U T I L I Z E R CO ST L E A D E R S : TO P 1 0 D R U G S

20 24 – 20 2 5 TO P 5 D R U G S I N C R E AS I N G TOTA L YOY P M P M S P E N D

$3.5M

$0.48

$3.2M

$3.1M

$0.31

$2.8M $0.25

$0.23

$0.21

$1.8M $1.6M Keytruda

Skyrizi

Elevidys

Darzalex Faspro

Enhertu

$1.4M

$1.3M

20 24 – 20 2 5 TO P 5 D R U G S D EC R E AS I N G TOTA L YOY P M P M S P E N D Neulasta

Tepezza

-$0.18

-$0.44

Tysabri

-$0.18

Adcetris

-$0.16

Stelara SQ

-$0.14

Hemgenix

Kanuma

Kalbitor

Elevidys

$0.05

$0.14

$0.04

$0.37

Zolgensma Xenpozyme

$0.05 PMPM

$0.04

Brineura

Lamzede

Amondys 45

Gamifant

$0.03

$0.02

$0.07

$0.05

20 21 – 20 2 5 P M P M CO ST D I ST R I BU T I O N BY P L AC E O F S E R V I C E

2021

2021–22 % change

2022

2022–23 % change

2023

2023–24 % change

2024

2024–25 % change

2025

Hospital outpatient (OP)

$19.07

16.5%

$22.22

4.8%

$23.29

7.0%

$24.92

8.9%

$27.13

Physician

$15.21

11.4%

$16.95

10.0%

$18.66

7.6%

$20.07

11.5%

$22.38

Home infusion/ specialty pharmacy (HI/SPP)

$4.37

25.9%

$5.50

13.6%

$6.25

6.9%

$6.68

10.6%

$7.39

Total

$38.66

15.5%

$44.67

7.9%

$48.20

7.2%

$51.67

10.1%

$56.90

20 2 5 U T I L I Z AT I O N T R E N D BY A N N UA L CO ST

+11.0%

$0–99 $100–999

+9.4%

20 2 5 U T I L I Z AT I O N T R E N D CO M P O N E N TS*

+10.4%

UTILIZERS CLAIMS PER UTILIZER

$ 1 ,0 0 0 – 9, 9 9 9 $ 1 0,0 0 0 – 4 9, 9 9 9 $ 5 0,0 0 0 +

18%

3% 14%

+3.4%

-3%

-1%

+1.2%

$0–$99

$100–$999

-7%

$1,000–$9,999

$10,000–$49,999

$50,000+

*Due to rounding, totals may not accurately match previous graph (utilization trend by annual cost).

2026 MEDICAL PHARMACY TREND REPORT

Medicare Medicare medical pharmacy trend increased by 9.4% in 2025, driven almost entirely by

9.4%

a 9.8% rise in cost. Utilization declined slightly by 0.4% and provided minimal offset. The largest spend increases occurred in oncology, osteoporosis and rare disease. Cost was the

2025 trend

primary driver in oncology; and double-digit utilizer growth contributed to trend increases for osteoporosis and rare disease. Ophthalmic injections retained its position as the second-highest category by spend despite an overall 28.8% PMPM decline. This decline in PMPM spend is due to competition from the introduction of biosimilar Pavblu and increased use of compounded Avastin as lower-cost alternatives. Rare disease spend rose 43.6%, largely due to increased Amvuttra utilization following its expanded ATTR-CM indication.

C AT EG O R I ES BY P M P M S P E N D % of spend

$106.37

22%

2025 spend

3% 4%

20 24 – 20 2 5 TO P D R U G T H E R A P Y C AT EG O R I ES BY P M P M S P E N D 20 24

20 2 5 TO P 5 T H E R A P Y

20 2 5

$5 6.1 3

$6 3.7 5

13.6%

60%

O N CO LO GY O P H T H A L M I C I N J EC T I O N S B O N E R ES O R P T I O N I N H I B I TO R S ( O ST EO P O R O S I S )

36.4%

22.8%

-0.6%

-17.2%

$1 .6 5 $2 .2 5

$1 .4 5 $1 .78

$1 .79 $1 .78

$1 .6 9 $1 .6 8

$1 .74 $1 .4 4

Bone resorption inhibitors (osteoporosis)

43.5%

$2 .5 3 $3 .6 3

Ophthalmic injections

I M M U N E G LO BU L I N

16.4%

$3 .5 3 $4 .11

Oncology

33.1%

$3 .3 2 $4 .4 2

$7 .4 8

$1 0. 50

-28.8%

Immune globulin

Rare disease Hematology: myasthenia gravis

Multiple sclerosis

BDAID: Crohn’s BDAID: disease/ rheumatoid ulcerative arthritis colitis

Vaccine

R A R E D I S E AS E A L L OT H E R

20 24 – 20 2 5 TO P D R U G S BY P M P M S P E N D W I T H CO M P O N E N TS O F C H A N G E* UTILIZERS

CLAIMS PER UTILIZER

I N F L AT I O N

R E I M BU R S E M E N T

MIX

+$1.28

+$0.93

$0.60 +$0.68 +$0.65

$0.44 +$0.35

$0.71 $0.29 -$0.18

$0.59

+$0.53 $1.10 $0.24

$0.27

$0.23

-$2.47 $0.45

+$0.51 -$0.80 $0.22

-$0.36

-$0.30

$0.27 $0.46

+$0.11

-$0.36 -$0.47 -$1.67

-$0.89

-$0.37

Keytruda

Darzalex Faspro

Opdivo

Imfinzi

Xgeva/Prolia

Eylea

Padcev

Vabysmo

Reblozyl

Tecentriq

*Values under $0.11 not labeled on graph.

Top 3 drugs driving trend Eylea utilization declined significantly as biosimilar adoption increased and alternative therapies captured additional share within the category. Imfinzi utilization increased following label expansion and earlier-line use in treatment. Keytruda’s inflation increase likely reflects a combination of Inflation Reduction Act of 2022 (IRA)-related dynamics, delayed price negotiation and a high inflation baseline. 9

20 24 – 20 2 5 TO P 5 D R U G S

20 2 5 P E R- U N I QU E- U T I L I Z E R CO ST L E A D E R S : TO P 1 0 D R U G S

I N C R E AS I N G TOTA L YOY P M P M S P E N D

$1.6M $1.28

$0.93 $0.73

$0.68

$0.65

$0.9M Imfinzi

Keytruda

Amvuttra

Darzalex Faspro

Reblozyl

$0.8M

$0.6M

20 24 – 20 2 5 TO P 5 D R U G S

$0.5M

D EC R E AS I N G TOTA L YOY P M P M S P E N D Eylea

Vabysmo

Cimerli

-$0.31

Tepezza

-$0.23

$0.5M

Trodelvy

-$0.15

-$0.80

-$2.47

Xyntha

Nexviazyme

ACApatch

Carvykti

Givlaari

Soliris

Ilaris

completeFT

Tecartus

Hemlibra

$0.19

$0.11

$0.09

$0.33

$0.06

$0.24

$0.06

$0.05

PMPM 10

20 21 – 20 2 5 P M P M CO ST D I ST R I BU T I O N BY P L AC E O F S E R V I C E

2021

2021–22 % change

2022

2022–23 % change

2023

2023–24 % change

2024

2024–25 % change

2025

Hospital OP

$29.37

16.3%

$34.16

22.4%

$41.83

32.7%

$55.53

14.7%

$63.70

Physician

$29.95

2.0%

$30.55

22.1%

$37.30

3.7%

$38.69

2.7%

$39.72

HI/SPP

$2.89

1.0%

$2.92

0.7%

$2.94

2.7%

$3.02

-2.3%

$2.95

Total

$62.21

8.7%

$67.64

21.3%

$82.07

18.5%

$97.23

9.4%

$106.37

20 2 5 U T I L I Z AT I O N T R E N D BY A N N UA L CO ST $0–99

20 2 5 U T I L I Z AT I O N T R E N D CO M P O N E N TS*

+24.6%

$100–999

UTILIZERS CLAIMS PER UTILIZER

$ 1 ,0 0 0 – 9, 9 9 9 $ 1 0,0 0 0 – 4 9, 9 9 9

+12.8% 47%

$ 5 0,0 0 0 +

+2.3% -8.2%

-0.4%

14% 5%

3% -4%

-2%

-13%

$0–$99

$100–$999

-15%

$1,000–$9,999

$10,000–$49,999

$50,000+

*Due to rounding, totals may not accurately match previous graph (utilization trend by annual cost).

2026 MEDICAL PHARMACY TREND REPORT

Medicaid 13.1%

In 2025, Medicaid spend increased by 13.1%, driven primarily by a 9.3% rise in cost and a 3.5% increase in utilization. Total PMPM spend rose by $2.56, with rare disease (non-

2025 trend

CNS), enzyme replacement therapy and rare disease (CNS) categories contributing $0.51, or 20%, of the increase. Gene therapies (Zolgensma, Elevidys) along with enzyme replacement therapies (Crysvita, Elaprase) were key drivers of additional spend. Oncology — led by Keytruda, Darzalex Faspro, Blincyto and Enhertu — remained the top spend category, with increasing cost and utilization.

C AT EG O R I ES BY P M P M S P E N D % of spend

$22.06 2025 spend

20 24 – 20 2 5 TO P D R U G T H E R A P Y C AT EG O R I ES BY P M P M S P E N D 20 24

20 2 5 TO P 5 T H E R A P Y

36%

44%

20 2 5

$7 .8 8

$7 .4 7

5.5% 4%

O N CO LO GY M U LT I P L E S C L E R O S I S R A R E D I S E AS E E N Z Y M E R E P L AC E M E N T

Immune globulin

$0 .5 8 $0 .6 9

17.9%

10.4%

18.6%

56.8%

$0 .3 7 $0 .5 8

Enzyme BDAID: Crohn’s replacement disease/ therapy ulcerative colitis

9.1%

$0 .73 $0 .8 0

$0 .8 1 $0 .9 3

$0 .78 $1 .0 3

$1 .2 0

Rare disease

14.5%

$0 .5 6 $0 .6 6

Multiple sclerosis

31.4%

$0 .6 1 $0 .6 7

Oncology

THERAPY

4.3%

$1 .15

$1 .17 $1 .2 5

6.1%

Contraceptives Antihemophilics

Ophthalmic injections

CNS: rare diseases

B DA I D : C R O H N ’ S D I S E AS E / U LC E R AT I V E CO L I T I S A L L OT H E R

20 24 – 20 2 5 TO P D R U G S BY P M P M S P E N D W I T H CO M P O N E N TS O F C H A N G E* UTILIZERS

CLAIMS PER UTILIZER

I N F L AT I O N

R E I M BU R S E M E N T

MIX

+$0.22 +$0.14 $0.04

+$0.17

$0.09

+$0.16

$0.04 +$0.09

+$0.09

+$0.08 $0.19

$0.02

+$0.07 $0.03

$0.07

$0.02

$0.10

$0.09

+$0.09

$0.02

$0.05

$0.14 +$0.02

$0.08 $0.06

$0.05

$0.03

$0.04

$0.03 -$0.03

-$0.04 -$0.02

Keytruda

Ocrevus

Opdivo

Darzalex Faspro

Elevidys

Botox

Entyvio

Imfinzi

Zolgensma

Hemlibra

*Values under $0.02 not labeled on graph.

Top 3 drugs driving trend Keytruda and Darzalex Faspro utilization increased, likely driven by expanded indications. Zolgensma utilization rose as diagnoses increased and clinical practice shifted toward treatment immediately following diagnosis. 2026 MEDICAL PHARMACY TREND REPORT 13

20 24 – 20 2 5 TO P 5 D R U G S

20 2 5 P E R- U N I QU E- U T I L I Z E R CO ST L E A D E R S : TO P 1 0 D R U G S

I N C R E AS I N G TOTA L YOY P M P M S P E N D

$3.0M $0.22 $0.19 $0.17

Keytruda

Spravato

Darzalex Faspro

$0.16

Zolgensma

Pavblu

$2.5M

$1.4M

$1M

20 24 – 20 2 5 TO P 5 D R U G S D EC R E AS I N G TOTA L YOY P M P M S P E N D Rylaze

Tysabri

-$0.08

Adcetris

-$0.08

Yescarta

-$0.08

$0.9M $0.8M

Tecartus

$0.56

Zolgensma Vyondys 53

$0.6M

$0.31

$0.18

Kymriah

Danyelza

Vyjuvek

Alprolix

Elaprase

Altuviiio

Vimizim

$0.07

$0.05

$0.14

$0.04

$0.22

$0.20

$0.22

PMPM 14

$0.7M

-$0.07

Elevidys

-$0.20

$0.7M

20 21 – 20 2 5 P M P M CO ST D I ST R I BU T I O N BY P L AC E O F S E R V I C E

2021

2021–22 % change

2022

2022–23 % change

2023

2023–24 % change

2024

2024–25 % change

2025

Hospital OP

$9.39

-2.2%

$9.18

7.6%

$9.88

25.0%

$12.35

7.3%

$13.25

Physician

$3.91

4.7%

$4.10

16.7%

$4.78

3.7%

$4.96

25.5%

$6.22

HI/SPP

$2.02

0.8%

$2.03

-2.3%

$1.99

10.7%

$2.20

18.0%

$2.59

Total

$15.32

-0.1%

$15.31

8.7%

$16.64

17.2%

$19.50

13.1%

$22.06

20 2 5 U T I L I Z AT I O N T R E N D CO M P O N E N TS*

20 2 5 U T I L I Z AT I O N T R E N D BY A N N UA L CO ST $0–99

UTILIZERS

+18.7%

$100–999

CLAIMS PER UTILIZER

+15.8%

$ 1 ,0 0 0 – 9, 9 9 9 $ 1 0,0 0 0 – 4 9, 9 9 9 $ 5 0,0 0 0 +

+8.5% 13%

13% 11%

+3.3%

4% 1%

+0.4% -1%

-1%

$0–$99

$100–$999

-2% $1,000–$9,999

$10,000–$49,999

$50,000+

*Due to rounding, totals may not accurately match previous graph (utilization trend by annual cost).

2026 MEDICAL PHARMACY TREND REPORT 15

Glossary ASP ��average sales price ATTR-CM ��transthyretin amyloid cardiomyopathy AWP ��average wholesale price BDAID �� biologic drug for autoimmune disorders CNS �� central nervous system HCPCS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Healthcare Common Procedure Coding System HI/SPP ��home infusion/specialty pharmacy Hospital OP ��hospital outpatient Inflation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ASP/AWP price changes on a per-unit basis IRA ��Inflation Reduction Act of 2022 Mix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . interaction between components of change and other components not otherwise captured PMPM �� per member per month Reimbursement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . changes in the level of provider reimbursement, provider mix and site-of-service mix (relative to ASP) SQ �� subcutaneous Utilizers ��number of unique members YOY ��year-over-year

2026 Medical Pharmacy Trend Report editions Part 1 - Payer survey This report explores real-world payer survey insights on hot topics and emerging strategies, revealing where plans are investing, where barriers persist and what’s shaping decision-making.

Part 2 - Drug overview This report provides a high‑level analysis of key drug trends, highlighting utilization patterns and the clinical and financial factors shaping medical pharmacy spend across commercial,

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Medicare and Medicaid populations.

Comprehensive report: Available this fall This complete Medical Pharmacy Trend Report will include the above content, plus expert insights on PMPM trends and spend, in-depth analyses of top spend disease categories, and integrated benefit trends for select therapy categories.

PrimeTherapeutics.com/MP-Trends