National trends in prescription drug expenditures and projections for 2026
Level 4 - case-series / case-control
Level by design analogy for economic database analysis and forecasting model
OpenAlex W7158811377 · doi:10.1093/ajhp/zxag115
What was done
Researchers analyzed historical pharmaceutical purchase data from manufacturers using the IQVIA National Sales Perspectives database. They evaluated spending drivers including new drug approvals, patent expirations, and regulatory/policy factors across categories such as biosimilars, oncology, endocrine therapies, generics, specialty drugs, and vaccines. Growth estimates for 2026 in nonfederal hospitals, clinics, and all sectors overall were modeled using combined quantitative trend analysis and expert opinion.
What was found
In 2025, total US pharmaceutical spending reached $915.2 billion, representing a 12.7% increase over 2024. Growth was driven primarily by increased utilization (+9.3%), with smaller contributions from price increases (+1.2%) and new drug entries (+0.9%). Tirzepatide was the top drug by expenditure, followed by semaglutide and apixaban. Clinic expenditures grew 19.0% to $190.5 billion (volume +13.6%, price +2.7%, new drugs +2.7%), while nonfederal hospital spending grew 9.6% to $42.9 billion (volume +4.6%, new products +3.7%, price +1.5%). For 2026, projected spending growth is 10.0% to 12.0% overall, 14.0% to 16.0% for clinics, and 4.0% to 6.0% for nonfederal hospitals.
Why it matters
This annual benchmark details national pharmaceutical cost drivers, showing that rising utilization of newer metabolic agents like tirzepatide and semaglutide dominates growth, helping health-system pharmacy leaders forecast annual drug budgets.
Limits
Projections for 2026 rely partially on subjective expert opinion alongside quantitative modeling. National aggregate estimates reflect manufacturer purchase data and do not capture local health-system contract pricing, rebates, or individual formulary variations. The exact sample size of purchasing facilities is not reported in the abstract.
Cited by
- supports Annual revenue from semaglutide and tirzepatide alone is projected to exceed $55 billion this year.