A Message from Mona Chitre
As we step into 2026, we’re proud to reflect on the progress we’ve made together - because caring for Western New Yorkers starts with collaboration. We’re looking forward to the exciting developments this year has in store for pharmacy care.
2025 Pharmacy Updates - A Year In Review
The past year brought rapid innovation and important updates that continue to shape how we deliver value to you and your team.
- Policy News
The Trump administration’s Most Favored Nation (MFN) pricing aims to align U.S. drug costs with the lowest prices in peer nations and curb “global free-riding.” The policy seeks to match U.S. drug prices to the lowest in peer nations.The Trump administration has announced MFN agreements with Eli Lilly and Novo Nordisk with intention to reduce prices for high-demand drugs, including GLP-1 therapies. Under these agreements, Medicare and Medicaid will gain access to GLP-1s for weight management at significantly lower costs, and some products will be offered directly to consumers through the proposed Trump Rx platform, which is not yet fully established. This GLP-1 agreement is currently being positioned as a Medicare demonstration project, signaling early efforts to test cost-control strategies for high-impact therapies.
A new voluntary Medicaid GENEROUS Model (Guaranteed Economic Rebates Offering Net Universal Savings) will provide supplemental rebates to state Medicaid programs based on international benchmarks. This is set to launch in early 2026. Two additional models under review include GUARD (Guarding U.S. Medicare Against Rising Drug Costs) and GLOBE (Global Benchmark for Efficient Drug Pricing), which may extend MFN pricing to Medicare Parts B and D.
With all of these potential changes, we can expect major disruption to pharmacy benefit managers, wholesalers, and 340B pricing. While the details are limited, we are closely monitoring any developments to assess potential downstream impact to your business and team.
- Trend Management
Balancing access with affordability remained a top priority in 2025. For 2026, we updated our prescription drug formulary: three weight-loss GLP-1s (Wegovy®, Saxenda®, Zepbound®) were removed from Univera Healthcare Preferred Value and Small Group/Individual Market closed formularies. This change provides us the flexibility to adjust to marketplace dynamics with the expected introduction of new weight loss drugs in 2026. These medications can still be covered through an exception request as long as the prescriber can verify that the member meets our coverage criteria.
We also revamped our Univera Healthcare formulary drug tiers to reflect market changes. While generics were once a more affordable alternative to brand-name drugs, rising prices mean not all generics remain cost-effective. Select high-cost, low-value generics moved from Tier 1 to Tier 2 or 3 or removed from the formulary. Both the GLP-1 and generic tier formulary changes are effective January 1, 2026 or upon plan renewal.
Additionally, we continue to lean on biosimilars for effective treatment of chronic conditions. Biosimilars are FDA-approved, safe, and up to 90% less expensive than their biologic counterpart, offering significant savings and value. This year we expanded our biosimilar coverage. Ustekinumab products, often recognized by the brand name Stelara, now have two preferred options for new starts: Selarsdi (Teva®) and Yesintek (Biocon®). We will continue to monitor upcoming biosimilar launches in 2026, including Xolair® in the asthma market and Eylea®, which is expected to see six biosimilar entrants in the ophthalmology space.
What’s In Store For 2026
The year ahead promises to continue to deliver exciting product advancements. While these advancements may improve health outcomes, we continue to monitor their impact on affordability.
- Expanding Therapy Indications
Expanded indications for high-impact therapies continue to emerge, from inflammatory conditions to oncology and chronic disease management. Innovation is reshaping treatment options; creating new opportunities for improved outcomes but also introducing significant cost pressures. Our approach as new indications emerge remains focused on balancing access with affordability—giving you confidence that employees receive the medications they need while health care dollars are protected from wasteful spending. To illustrate, consider Dupixent®: between 2020 and 2025, we implemented 34 utilization management policy changes to align with market needs, including expanded indications and criteria adjustments. Without our utilization management measures, expanded indications could have added an estimated $7.7M in costs, but our strategies delivered $23.6M in savings in 2024 alone*. As therapies continue to broaden their reach, we will lead with thoughtful, sustainable solutions that protect both clinical outcomes and financial health.
- New Drug Formulations Emerging
Manufacturers are finding new ways to deliver existing medicines such as pills, injections under the skin, or syrups, to make treatment more convenient and prepare for older patents expiring. For example, Keytruda®, a popular cancer drug, used to only come as an IV infusion. Now there’s an option to get it as a shot under the skin (subcutaneous). It still needs to be given by a health care professional, but it takes less time than an IV, which could ease the strain on hospitals and clinics. The IV patent is expected to expire in 2028, so increased adoption of the subcutaneous formulation is anticipated.
We’re seeing similar changes in other areas. For spinal muscular atrophy (SMA), the FDA approved Itvisma®—the first gene therapy for patients two years and older. Unlike Zolgensma®, which is only for children less than two years of age and given by IV, Itvisma is a one-time injection that can help older kids, teens, and adults. Both drugs have a price tag of $2.5 million. Individuals who received Zolgensma as a child would not receive future treatment with Itvisma. -
Biomarkers Paving The Future Of Precision Medicine
Precision medicine continues to evolve with biomarkers or biological clues like proteins or genetic markers. These biomarkers help doctors identify diseases and choose the right treatment for each patient. In 2026, this trend will expand beyond cancer into areas like Alzheimer’s, heart disease, and rare genetic disorders, bringing breakthrough treatments. These developments signal a shift toward highly targeted, high-cost interventions, creating challenges for balancing innovation with affordability. As supporters of your business, we will continue to monitor this evolving pipeline throughout the year ensuring our policies align with the latest data.
As we look ahead to the coming year, our commitment remains clear: expanding access, managing costs responsibly, and driving innovation that truly matters. We’re deeply grateful for the trust and collaboration as we work together to make pharmacy benefits smarter, more affordable, and more impactful—because caring for Western New Yorkers is at the heart of everything we do.
With appreciation,
Mona Chitre, Chief Pharmacy Officer & President of Pharmacy Solutions
*2024 Health Plan Data
Additional Articles
In case you missed any of our previous Rx Updates content. Here is a recap of some helpful resources.
- Rx Update - The Future Of Prescription Drugs: 5 Trends Impacting Your Business And Employees
- Manage Rising Health Care Costs: 3 Practical Tips
- Rx Update - Watch the Recording: August Pharmacy Webinar Featuring OncoHealth
- 2025 - August - Pharmacy Updates From Mona Chitre
- Rx Update - Smart Ways To Reduce Pharmacy Costs—Without Cutting Benefits
- Manage Rising Health Care Costs: 3 Practical Tips
- Formulary Changes - Employer
