Specialty drug trend remains high, although it decreased from 11.2% to 10.8% on a gross cost basis in Pharmacy Strategies Group’s 2026 State of Specialty Spend and Trend Report. Claim utilization is now the dominant driver of specialty drug trend as the percentage of members using specialty drugs rose to 5.5%.
“For a decade, this report has helped payers navigate the specialty drug landscape and prepare for what’s next,” said Mike Lonergan, president of the independent pharmacy benefits consulting firm. “By leveraging real-world pharmacy and medical claims data, we provide actionable insights that help organizations stay ahead of fast-moving developments across the specialty drug market.”
See also: Specialty drugs now consume over half of total drug spend
Specialty drug trend was 10.8% on a gross basis and 12.5% net of rebates in 2025, continuing a multiyear run of low double-digit growth. Gross specialty drug costs increased to $1,548 per month per year, while net costs reached $1,251. Per-month-per-year specialty costs are projected to jump by another 32% by 2028.
Additionally, post-rebate trend exceeded pre-rebate trend in 2025. This reflects the shrinking role of rebates as an offset to growing utilization, expanded indications and high-cost trend for some specialty medications.
“Continued growth in specialty drug spend is an ongoing burden for payers,” said Morgan Lee, vice president of research and marketing for Pharmacy Strategies Group. “As spend continues to climb, understanding the relative roles of utilization and specialty drug costs in driving specialty drug trend is critical to developing effective management strategies and making informed decisions.”
Biosimilar adoption has likely played a major role in reducing the impact of cost per claim on specialty drug trends. In contrast, new drug approvals and expanded indications for existing drugs have fueled increased specialty drug utilization. Overall biosimilar market share increased from 22.6% in 2023 to 56.3% in 2025, with Humira biosimilars playing a major role. Humira biosimilars climbed from 0.3% market share in 2023 to 82.4% market share in 2025, while Stelara biosimilars reached 18% market share in their first year on the market.
Inflammatory disorder remained the top specialty drug category by spend. Drugs in this category accounted for 8 of the top 10 drugs by spend in 2025, even as Humira fell from number one to outside of the top 10 and Stelara experienced a 29% decline in utilization.
“As innovation accelerates and chronic conditions continue to drive the majority of healthcare spend, organizations must evolve their strategies to meet the increasing complexity of specialty care,” said Bethanie Stein, Pharm.D., president of pharmacy at Humana.
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