Philip Sclafani: Will PBM Reform Actually Lower Net Drug Costs?

PwC's Behind the Numbers 2027 report finds that more than 85% of surveyed health plan actuaries expect pharmacy costs to outpace overall medical cost trend in 2027, and identifies oncology and GLP-1 utilization as the categories most responsible for that gap.¹ IQVIA projects that total net spending on medicines will increase by $200 billion in 2030 compared with 2025, as volume growth and adoption of innovation are only partly offset by lower-price drivers such as patent expiries and policy effects.² Pharmaceutical Commerce returned to Philip Sclafani, a partner at PwC and an advisor to the report, for the second half of a conversation that moves from broad market trends into the specific coverage decisions payers and self-funded employers are weighing now.

The discussion opens with a question PC put to Sclafani about whether recent approvals of oral GLP-1 formulations mark a potential inflection point for prescription volume. Removing the injection requirement could ease some of the access and adherence barriers tied to existing GLP-1 therapies, potentially extending eligibility beyond the population already managed under prior authorization.¹

From there, the conversation shifts to oncology, which the report identifies as a structural backbone of pharmacy spend growth. IQVIA reported that US cancer medicine spending reached $143 billion in 2025, and that oncology spending is expected to increase by nearly 60% by 2030, driven largely by antibody-drug conjugates, bispecific antibodies, and other premium-priced therapies.² PwC's report notes that these drugs are typically administered and billed under the medical benefit rather than the pharmacy benefit, placing them outside many of the formulary tools payers use to manage traditional drug spend.¹

The interview closes with Sclafani's assessment of PBM reform. The report stops short of concluding that current transparency and delinking efforts will reduce what plans and employers ultimately spend, and Sclafani expands on that distinction directly.

In this second installment of his conversation with PC, Sclafani discusses whether the oral GLP-1 approval changes payer cost exposure heading into 2027, what levers plans realistically have to manage medical-benefit oncology spend, and why he believes PBM reform may shift the drug pricing model, but not necesarily lower net costs.

References

1. PricewaterhouseCoopers (PwC). Behind the Numbers: Medical Cost Trend. PwC Health Research Institute. Accessed June 19, 2026. https://www.pwc.com/us/en/industries/health-industries/library/behind-the-numbers.html
2. IQVIA Institute. U.S. Medicine Use Trends 2026. IQVIA Institute for Human Data Science. Published April 28, 2026. Accessed June 19, 2026. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/us-medicine-use-trends-2026