DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS 🎓 Expert Commentary / Peer Perspective
US prescription drug spending reached $915.2 billion in 2025, driven overwhelmingly by utilization growth rather than price increases, with clinic-sector expenditures rising nearly twice as fast as hospital spending. Pharmacy leaders should expect continued divergence between practice settings in 2026.
Professional Impact
- Utilization, not price, drove 2025 spending growth, accounting for 9.3 percentage points of the 12.7% overall increase; price contributed only 1.2%, reframing the formulary pressure narrative away from drug pricing toward drug volume.
- Tirzepatide topped 2025 drug spend for the first time, followed by semaglutide and apixaban, establishing endocrine and cardiometabolic agents as the dominant formulary cost category alongside oncology.
- Clinic-sector expenditures grew 19.0% in 2025, more than double the hospital rate, driven by 13.6% volume growth; 2026 projections of 14.0%–16.0% growth in clinics signal sustained formulary pressure for ambulatory care programs.
- Nonfederal hospital spending growth is projected at a comparatively modest 4.0%–6.0% in 2026, with specialty, endocrine, and cancer drugs remaining the dominant cost categories in both settings.
Action Items
- Model 2026 pharmacy budgets against the 14%–16% clinic and 4%–6% hospital growth projections as a baseline, adjusting for local formulary composition and payer mix.
- Review GLP-1 and endocrine drug utilization trends; tirzepatide and semaglutide volume trajectories will likely outpace any single other formulary category in ambulatory settings.
- Evaluate biosimilar conversion opportunities across high-spend specialty categories; the full article includes a focused biosimilar sub-analysis not captured in the abstract.
- Establish internal expenditure tracking cadence aligned to IQVIA benchmarks to identify early divergence from national projections before year-end budget variances accumulate.
