Dorothy highlights five trends to watch in 2025. She then describes how GoodRx's Cash Point-of-Sale Solution can help brands improve gross-to-net (GTN) while also making medications more affordable for patients.
Click here to download the latest GoodRx data on copay, cash, and patient services programs.
Read on for Dorothy’s insights.
2025 Brand Drug Challenges: A GoodRx Perspective
By Dorothy Gemmell, Chief Commercial Officer and President, Manufacturer Solutions, GoodRx
From unfilled prescriptions to compressed margins to inaccessible brand-name drugs, the prescription drug system is under intense pressure to evolve. Couple this with patients paying more out of pocket and it’s clear that cash pay plays a significant role.
Here are five key 2025 trends that we are tracking:
1) Patients will continue to suffer through an affordability crisis.
It’s a bleak picture. In 2023, IQVIA reported that nearly 900 million prescriptions (adjusted, or normalized to a 30-day fill) go unfilled annually, marking a 56% increase in estimated unfilled adjusted medications since 2018. This trend not only impacts health outcomes but also translates into $90 billion in lost revenue for the healthcare system. And according to Drug Channels Institute’s (DCI) December 13, 2024, webinar, Drug Channels Outlook 2025, the patient-paid market will continue to expand through the use of discount cards (both in- and outside of benefits), cash-pay pharmacies, and the gradual reduction of Usual and Customary (U&C) pricing by pharmacies.
2) It’s time for new models to address gross-to-net (GTN) pressure on brand-name drugs.
Pharmaceutical companies increasingly grapple with negative gross-to-net (GTN). According to DCI, the total value of GTN reductions for brand-name drugs reached $334 billion in 2023, a 10% YoY increase. Over half of these reductions stem from rebates and fees paid to pharmacy benefit managers (PBMs) and other third-party payers.
3) Retail pharmacies will absorb growing financial losses on brand drugs, causing headwinds for pharma.
According to research from Blue Fin Group, pharmacies are also feeling the strain. For large national chains, the typical loss on brand-name medications ranges from $9.51 to $16.22 per prescription, but can go as high as $50 or more, before accounting for additional costs to serve. (Source: Blue Fin Group, proprietary data) The higher the wholesale acquisition cost (WAC) of a drug, the greater the losses for pharmacies.
Brand-name prescription drugs make up a small percentage of unit fills vs. generics. Retail pharmacies are less inclined to dispense brand drugs, because they lose money on each fill and may have to deal with prior authorizations and other administrative costs. As a result, pharmacies are shifting their focus away from brands, further complicating patient access and challenging the traditional pharma launch model.
4) PBMs’ formulary exclusions continue to grow, limiting patients’ access.
PBMs have implemented stringent utilization management practices, making it harder for patients to access brand-name medications. According to IQVIA, Formulary exclusions have tripled over the past five years, and eight out of 10 patients with National Drug Code (NDC) blocks are unable to overcome them to access prescribed therapies. In addition, Deloitte reports that market access challenges are the top reason drug launches fail to meet expectations.
5) The cash market for brand drugs will steadily grow.
The cash market for prescription medications has surged. According to a 2023 study by the Boston Consulting Group, the cash market for prescription medications more than doubled from 4% in 2018 to 9% in 2021. Consumer-driven categories like GLP-1s for diabetes and weight loss have further accelerated this trend. We have seen more than 3X growth in brand drugs offering a cash price via GoodRx for their medications and see the trend continuing as it spreads from LOE brands to launch brands rethinking their approach to market.
THE OPPORTUNITY: PHARMA SHOULD ADDRESS THE CASH MARKET FOR BRAND DRUGS
To address the steadily growing cash market, GoodRx’s point-of-sale (POS) cash discount solution helps over 70 pharmaceutical brands improve their GTN margins while making medications more affordable for patients. Additionally, it supports retail pharmacies by providing an economic model that prevents losses when dispensing brand medications. We see this as the win-win of the future as it also helps patients get the medications their HCP prescribed.
The current prescription drug model is failing patients, HCPs, pharmacies, and pharma brands. Rising costs, reduced access, and financial losses across the board underscore the pressing need for innovative thinking. GoodRx is the number one healthcare platform for medication affordability and access, delivering proven solutions to integrate copay, patient services, and a unique cash pay option to help pharma brands drive first fills and refills, as well as enroll more eligible patients into their patient services programs.
GoodRx solutions address these industry challenges head on, driving better health outcomes and economic viability for all stakeholders. We look forward to continuing to scale and innovate in 2025 to help brands overcome these urgent challenges.
Click here to download the latest GoodRx data and results showing how we support the era of Patient-as-Payer via copay, cash, and patient services programs.
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