AVALERE is spotlighting the top trends in 2025.
Healthcare words in 2025 may be very uncertain.
“The new market and policy dynamics of 2025 creates a challenging healthcare environment, but brings new possibilities to stakeholders.” Dr. Sarah AlwardPresident of Healthcare Consultancy Abarel。
The company has released a 2025 healthcare industry outlook. This includes the following three important trends:
・ Trend 1 -Successed in financial pressure: Recognizes the actions of new stakeholders. Find a part D Medicare Drug Plan and significantly shift the cost to the registrant.
・ Trend 2 -Find the benefits of ambiguity: Navigate technical advances and changes in policy. Under the technical part, AI gains the trust of the people and provides results. In the policy part, a compensation solution to satisfy the demand of GLP-1.
・ Trend 3 -Prosperity of complexity: Construction of integrated business strategy. The plan is facing the pressure of working more efficiently.
This health leader features important insights on each trend, focusing on the paid issues and opportunities.
Trend 1 -Success in financial pressure: Recognize the behavior of new stakeholders
Remember them WTW survey results A few weeks ago: Will the employer deal with more medical expenses that are not reduced but with better profit design? The same is true for Medicare Part D drug planning.
“Depending on the financial pressure and the uncertainty of the market … The part D plan has shifted more from the cost of the cost to joint insurance,” said AVALERE, saying, “This is” ” It could lead to an unexpected inconvenient expenditure. ” “”
Self -pay is more predictable for consumers and is generally defined by dollar amount (for example, $ 10 for general generic drags). Conversely, co -insurance is defined as percentage (for example, 10 % of priority drugs) and is more expensive.
The new cost shift to consumers from part D planning is amazing. From 2023 to 2025, the ratio of coinsurance and Copays has increased.
・ 39 % of ophthalmic drugs
・ 34 % of anticoagulants
・ 32 % of some respiratory and diabetic drugs
For example, in 2023, 26 % of anti -pistolkers and bronchodilators were covered by co -insurance. In 2025, it increased to 58 %.
Cost control of Medicare prescription drugs can be felt like a zero sam game. An attempt to support consumers on one side (for example, price negotiations, upper limit of self-paying expenditure), cost shift, and drugs such as GLP-1. But you know what they say: when you squeeze a healthcare cost balloon in a certain place, it is expanding elsewhere.
AVALERE's first 2025 tendency of 2025 -succeeded in financial pressure, but has added cost control efforts for the government and provider.
Trend 2 -Find the benefits of ambiguity: Navigate technical progress and changes in policy
All healthcare sentences inevitably include AI.
Artificial intelligence is the first focus of AVALERE's 2025 high -tech polish trends, and the company states:
In order to obtain the acceptance of the people, the information on AI and its advantages must be consistent and reliable. This is neither truth nor timely, given the latest headline of health care.
・ AI development may be much lower than we said. Chinese AI Startup Deepseek announcement The development of the AI model is only $ 5.6 million, 20-40 times cheaper than Openai. It is not medical -specific, but the industry is great.
・ Consumers trust AI more than health plans. See Recent health leader functions Consumers are required for personalization.
・ The health plan holds a tremendous power for data and coverage. And the stakeholders are not satisfied with it -“active in the dark” employer, etc. Around PBGH President and CEO Elizabeth Mitchell.
AVALERE's prospects for 2025 are added to this, straightening the health plan to the AI -drive -type cost reduction and the optimization of care. “
“For decades, the health plan has accumulated a wide range of medical data. Today, the progress of AI will help convert these data into practical information.”
The area that requires this action is GLP-1。
“Because the interest of patients and policy creators is increasing … Pressure is increasing in public and private paiders to cover the product,” AVALERE said.
The GLP-1 coverage for weight loss varies, which is either expanding, reduced, or both according to the payers. According to the AVALERE outlook, the Biden administration proposes a range of compensation by part D and medicade plan, and the pharmacists and pharmaceutical companies need to be carefully monitored whether the Trump administration has enacted this policy and how to enact. There is. ”
Considering the demand and price of GLP-1, cost shift and use management may be accompanied by the expansion of coverage. This is another example of how health care cost balloons are compressed.
Other insights related to AVALERE's second trend in 2025 -Finding the advantages of ambiguity include the necessity of prescription drug costs that can be predicted by the supply chain and stakeholders as a whole, and is a vaccine policy. Included a change that could compensate for the new administration.
Trend 3 -Prosperity of complexity: Construction of integrated business strategies
Despite their power, even a health plan must adapt their strategies and operations and respond to the increased pressure. AVALERE identifies them as follows:
・ Section of more policies and regulations
・ Higher healthcare service cost
・ Improvement of technology use
In addition to costs, access, and quality, AVALERE has noted that the Federal and State institutions will continue to consider the role of PBM.
Glp-1's tremendous demand and cost, the 2025 Outlook report was added as follows:
“In addition, emerging technologies such as AI may improve efficiency, but it is necessary to be evaluated and need to be implemented,” said AVALERE, calling for the risks and opportunities related to AI and used for prior approval. Call a specific call to do.
Other insights related to the last 2025 trend of AVALERE -Prosperity of complexity: Construction of integration
Business strategy -Contains a diagnosis of prescription drugs, economics, and results related to the results, devices, and monitoring strategies for technology and topics.
In the final advice to the payers, AVALERE states: “The plan is to evaluate care and use management programs to improve product design, provider network performance, and to improve operational efficiency.
Laura Beerman is a health leader free lanced writer.
