In this interview, Josh Canavan, PharmD, head of pharmacy at RazorMetrics, discusses rising specialty drug costs, payer challenges in biosimilar adoption, the importance of seamless prescriber engagement, data-driven approaches to formulary optimization, and emerging trends such as polypharmacy and member cost burden identified in the 2025 State of Drug Access report.

Josh Canavan, PharmD: Hi, I'm Josh Canavan. I'm the head of pharmacy at RazorMetrics. I've been here since about 2018. I've been a pharmacist for over 20 years now. I've worked in retail and hospital. I worked electronic health record (EHR) on implementation and support. I've done work with pharmacy benefit managers (PBMs) to help manage formularies, and now my main role is working with our clinical team—which is our group of pharmacists and physicians—to create all of our clinical products.

What specific challenges are health plans and employers facing in controlling specialty drug costs in 2025, and how do these challenges differ from previous years?

Canavan: The main thing we're seeing is that specialty drug costs are growing by around 40% annually, which is huge, and they're expected to comprise more than half of total drug spend for health plans and employers. The main challenge in 2025 is navigating all the new therapies and making necessary changes to plan design quickly and effectively.

It's a little bit different in 2025 due to the increasing number of biosimilars that we're seeing on the market, along with the growing number of specialty medications that are coming down the pipeline. If a plan wants to control costs, they have to drive towards lower total net cost alternatives, which sometimes is a biosimilar, which doesn't have a rebate, while also adding these new therapies that are coming down the line.

The difficulty is driving towards the biosimilars for some products while also adding in these new biologics that may be costly but may treat a condition more effectively. To do this, the health plan has to employ the right people to collect and analyze all of the data. We see a lot of data analytics and new artificial intelligence (AI) strategies to improve the process, but all of that is meaningless if the right people aren't looking at the data and then implementing the correct changes to the health plan and the formulary in a timely fashion so that the members aren't affected, they can get the lowest cost medication, get the best therapy, and the prescribers are aware of all of this on time, so that everything happens very quickly.

How can payers effectively engage prescribers to consider more cost-effective alternatives without compromising clinical outcomes?

Canavan: We found that the most important factor when engaging a prescriber is to not go outside of their usual workflow.

We won't be successful if we ask prescribers to download a new app, learn a new process, or take on something additional to what they're doing. They're already extremely busy. They already have multiple EHRs that they're working in. They're seeing a ton of patients. We set out to specifically address the problem of staying in their workflow, while also being able to make recommendations and make changes to lower cost alternative medications. That's why we're starting to see a lot of positive results. The most important factor when making a recommendation is to make it easy for the prescriber to accept. You put it in their workflow, but you also have to have the right recommendation.

The alternative has to match the indication. It has to be an appropriate dose, available at the pharmacy so that they're not getting a call back from the pharmacy to switch back to the medication they were already on, and it has to be a lower cost. The process has to be straightforward and easy for the prescriber and the member. The overall goal is to make the recommendation easy for the prescriber to accept without them having to do additional work, download something new, or go outside of their workflow. It needs to fit in seamlessly with what they're already doing.

How can health plans leverage prescriber behavior data to identify patterns that drive higher costs and target opportunities for intervention?

Canavan: One of the biggest problems we hear from prescribers is their inaccessibility to knowing the cost of the medication for each patient. Each patient has a different formulary, each patient has a different co-pay or co-insurance, and prescribers aren't always given this information. Real-time benefit tools tried to solve this problem, but they were unsuccessful for various reasons, and so the adoption rate is very low.

The recent improvements in AI allow us to now take the large amount of prescriber behavior data that exists and obtain results from it. Previously, we couldn't [do this] due to the complexity of all of that data. For example, now we can identify and visualize any differences from one area of the country to the next or across different patient populations or even prescriber specialties, and then we can utilize this data to enhance the approach and recommendations we make to those specific groups. We take all of the results and the feedback we get from the prescribers and can continuously improve the process.

In the 2025 State of Drug Access report, what emerging trends did RazorMetrics identify in pharmacy benefit design and cost containment?

Canavan: Almost half of the patients that we interviewed or talked to have been prescribed a medication they can't afford. That's a large portion. Those patients were also overwhelmingly open to accepting a less costly alternative if it was approved by their prescriber and if their physician is the one quarterbacking that process.

We're going to see medication costs increase. We've seen it before. It will continue in 2025. Benefit design has to focus even more on cost containment, especially for the medications that are unaffordable for many of the members. If you have almost 50% of your patients unable to afford a medication they've been prescribed, then we know that the members are going to be very cost conscious, and they're going to be asking their physicians or asking their pharmacists for alternatives for these.

We can get ahead of that problem; we can get to the prescriber before that happens. We can have the lower cost alternative. It can be sent to the pharmacy, filled, and be ready for the member to pick up so that we're going around the issue of the member getting to the pharmacy, not being able to pick up their medication, and having the problem of going back to the physician at that point and trying to fix it all.

We've also found that biosimilars are still a huge missed opportunity. There are now many biosimilars on the market, with more coming this year, but we found that members don't actually know what a biosimilar is. We found that prescribers are reluctant to write for them due to multiple barriers around not knowing insurance coverage, which we talked about before; availability on the market—just because the biosimilar says it's available, doesn't mean it's at the pharmacy, doesn't mean that it can be ordered, doesn't mean that the member can get it quickly; and then also, again, member cost, plan costs, everything else that goes into that.

What we need for successful adoption is to notify the prescriber of the right biosimilar to write for that member, for that plan, for that pharmacy. We know all of these things. They write for the biosimilar, it costs the member less, the pharmacy has it, and everyone's happy at the end of the day with that change.

We also need to ensure that members know what a biosimilar is, so when they go to pick up their Humira and it has a different name, it doesn't match Humira at all, they need to understand what it is, that it goes through a US Food and Drug Administration (FDA) approval process, that it's similar to Humira, and that it's almost identical to Humira. It covers their condition, and there should be no barrier there from the member accepting the biosimilar at that point.

The last thing we see is polypharmacy. We've really focused on polypharmacy in this last year. It's a growing area of concern. It's members on 5 or more medications that have increased risk for drug-to-drug interactions, drug-disease interactions, and it increases the overall complexity of their prescription regimen. If we can reduce these issues through deprescription, the patient population will be healthier. They'll have less of these interactions. Our patient population is getting older, and polypharmacy is increasing, so we need to head this off right now. We need to attack this problem so that it doesn't keep growing.

A great way to do that is by notifying the prescriber about the medications that the patient is on—not only the ones that they prescribe, but all of the medications—to give the prescriber a full view of what polypharmacy looks like for their patient. They then can make the decisions that they need to with all of the information in front of them.

Is there anything else you'd like to highlight to our audience to take away from this interview?

Canavan: I just want to reiterate that medication costs are rising. We possess the technology now to curtail a lot of that excessive spending and reduce member costs at the pharmacy.

That's probably the most important thing—we want members to pay less so they can afford medications, so that they stay on their therapy, they stay adherent, which leads to a reduction in overall medical spend because they're treating the indications that they're there for. If we can reduce medication spend and increase adherence overall, total medical spend will go down.