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There were a lot of healthcare surprises this year, and there are bound to be at least some in 2025 that take us by surprise. But that won’t stop us—or payers—from trying our darndest to plan ahead!
Next year will bring a new presidential administration, new regulations, and new specialty drugs to market. And while no one has a crystal ball, Healthcare Brew asked a few executives at leading insurance and payer consultant companies what they predict might be on the horizon.
These answers have been lightly edited for length and clarity.
Sandhya Rao, chief medical officer, Blue Cross Blue Shield of Massachusetts
Prescription drug spending will continue to increase, especially driven by demand for high-cost brand drugs, like the GLP-1s for diabetes and weight loss. While these treatments are helping many of our members lead healthier lives, they are also increasing pharmaceutical costs. Our spending on these medications has risen by 250% over last year, putting us on track to spend nearly $200 million on these medications in 2024.
Luke Hansen, chief medical officer, Arcadia
In 2025, Medicare Advantage plans will continue to recalibrate in response to forces including V28 [version 28] risk adjustment impacts, persistent increases in utilization, and star ratings cut point stringency. These pressures will likely tighten plan margins and lead to reduced supplemental benefits, potentially influencing both net enrollment and enrollment mix. I hope to see further emergence of narrower, performance-driven networks in response to squeezed margins.
The new [presidential] administration could usher in pivotal changes for payers. For example, individual coverage Health Reimbursement Arrangement adoption and enhanced transparency regulations might gain momentum, creating opportunities for employers and consumers to reimagine health plan design.
David Brailer, EVP and chief health officer, the Cigna Group
The new generation of blockbuster drugs is transformational, with near-curative impacts on many longstanding diseases and conditions. They are coming to market in 2025 and over the next few years in unprecedented numbers.
These are complex drugs and need to be given in careful and exacting ways. Ensuring that patients have access to these complex and costly drugs and managing the highly specialized care needed for them to be effective is what PBMs [pharmacy benefit managers] do every day for millions of people. PBMs will play an increasing role in the future of ensuring that people get access to and can afford these powerful treatments.