Strength in Numbers: Why Pharmacy Coalitions Continue to Gain Momentum

July 20, 2026

By Simon Leung, PharmD, RPh

Prescription drug costs remain one of the fastest-growing and least-predictable expenses for employers and plan sponsors. Pharmacy continues to outpace most other areas of healthcare spending, driven largely by specialty medications, gene therapies, biologics and rapidly expanding utilization of GLP-1 medications for obesity and diabetes.

Today’s pharmacy marketplace has become increasingly complex and opaque. Traditional pharmacy benefit models are under growing scrutiny from regulators, employers and the public due to concerns about pricing transparency, rebate structures, spread pricing and misaligned financial incentives throughout the supply chain. Therefore, beyond rising costs, employers are increasingly focused on fiduciary oversight, pharmacy benefit transparency and ensuring that pharmacy procurement arrangements are aligned with plan sponsor interests.

Organizations are seeking solutions that can improve purchasing leverage, strengthen oversight and enhance overall pharmacy strategy with minimal disruption for members. One strategy continuing to gain traction is participation in pharmacy purchasing coalitions.

5 Pharmacy Benefits Trends Driving Financial Pressure

Pharmacy costs continue to represent an increasing portion of the total healthcare spend for self-funded employers and plan sponsors, fueled by several trends, including:

1. Specialty medications continue to account for more than 55% of total pharmacy spending despite representing only a small percentage of utilizers.
2. Increasing demand for GLP-1 medications for weight management and diabetes has created substantial cost pressures, challenging employers and plan sponsors to make difficult coverage strategy decisions to balance affordability, member expectations and long-term plan sustainability.
3. New high-cost therapies, including gene and cell therapies, are entering the market at unprecedented price points.
4. Manufacturer pricing strategies, rebate dynamics and pharmacy supply chain economics continue to evolve rapidly.
5. Increased utilization, not just unit cost inflation, is now a major contributor to the overall pharmacy financial landscape.

Reluctant to make major formulary or benefit design changes that could negatively affect member experience or access to care, employers are seeking new ways to improve financial performance while minimizing disruption.

Benefiting From Economies of Scale

Pharmacy coalitions bring together employers, plan sponsors and other purchasers of pharmacy benefits to create larger aggregated purchasing power. By leveraging millions of covered lives collectively, coalitions can often negotiate:

• More competitive pharmacy pricing guarantees
• Improved rebate arrangements
• Better specialty pharmacy economics
• Enhanced contract terms
• Greater audit and transparency provisions
• More favorable clinical program offerings

By leveraging greater scale, pharmacy coalitions can strengthen negotiating power with pharmacy benefit managers (PBM), specialty pharmacies, manufacturers and other vendors while supporting more transparent contracting, stronger audit rights, better visibility into manufacturer revenue streams, stronger pharmacy governance and clearer financial reconciliation. And many arrangements can improve plan economics with minimal employee disruption by maintaining the existing PBM platform, pharmacy network and member experience.

The Evolving Pharmacy Coalition Landscape

The coalition landscape itself has evolved significantly over the last several years. Historically, many pharmacy coalitions focused primarily on negotiating incremental discount and rebate improvements. Today, leading coalitions are also addressing broader strategic issues such as:

• Pharmacy benefit transparency
• Rebate pass-through structures
• Fiduciary considerations
• Specialty drug management
• Biosimilar adoption strategies
• GLP-1 management approaches
• Copay assistance program dynamics
• Clinical appropriateness programs
• Alternative funding models
• Site of care optimization
• Pharmacy data analytics and auditing

As pharmacy coalitions evolve beyond pricing aggregation into broader strategy and purchasing platforms, employers should carefully evaluate each coalition’s financial model, governance structure, incentive alignment, transparency standards and contracting flexibility before participating.

4 Key Areas to Consider When Evaluating a Coalition

Not all pharmacy coalitions operate the same way. Employers and plan sponsors should carefully evaluate several important factors before participating.

1. Transparency and Alignment

Organizations should understand:

• How the coalition is compensated
• Whether the coalition has ownership ties to PBMs or vendors
• What the pass-through framework is for manufacturer revenue streams
• How rebates and administrative fees are handled
• Whether pricing guarantees reconcile at the plan level or aggregate coalition level

2. Contract Flexibility

Some coalition arrangements may improve pricing while limiting flexibility, so it’s important to be aware of any limitations on:

• PBM selection
• Formulary strategy
• Clinical program customization
• Specialty pharmacy arrangements
• Future procurement options

3. Audit Rights and Data Access

Before participating, organizations should confirm the coalition offers several key fundamentals, including:

• Robust audit rights
• Transparent reporting
• Detailed claims analytics
• Visibility into rebate arrangements
• Access to actionable pharmacy utilization data

4. Clinical Strategy

Leading coalitions increasingly provide added services. Employers and plan sponsors may want to seek coalitions that provide:

• Clinical pharmacist support
• Custom formulary management
• Specialty drug oversight
• Biosimilar transition strategies
• High-cost claimant monitoring
• Utilization management optimization

Successful coalition implementation also requires careful evaluation of operational disruption risks, formulary alignment, specialty pharmacy strategy and member communication planning.

Minimal Member Disruption is a Key Advantage

One of the primary reasons coalitions continue to gain popularity is that many arrangements can improve financial performance with limited member disruption. In many cases:

• Members maintain access to the same pharmacy networks
• Existing medications remain covered
• The PBM platform remains unchanged
• ID cards and member experience remain largely intact

Looking Ahead

Pharmacy benefits will remain under pressure from specialty drugs, gene and cell therapies, GLP-1 utilization, PBM scrutiny, fiduciary expectations and transparency demands. Coalitions can help employers meet those challenges by improving leverage, oversight and pharmacy strategy. Additionally, pharmacy coalitions can support sustainable cost management, broader governance, clinical oversight, robust analytics, disciplined procurement and careful contract management.

The most successful employers and plan sponsors will have strong consulting support to bring all of these elements together.

The Conner Strong & Buckelew Advantage

Conner Strong & Buckelew’s experienced in-house team of consultants, analysts and clinical pharmacists has a proven track record of helping organizations navigate today’s complex pharmacy benefits landscape and develop integrated pharmacy solutions that balance member satisfaction with fiscal responsibility.

Reach out to us to learn how a thoughtful pharmacy coalition strategy can help strengthen your employee benefits plan and lower your pharmacy benefit costs with minimal member disruption.