Dr. Jeni Hayes, Senior Clinical Manager, Strategic Clinical Intelligence, and Dr. Heather Pace, Senior Clinical Manager, Ambulatory Care, join host Carolyn Liptak to discuss the Vizient Winter 2026 Spend Management Outlook, with a focus on pharmacy projections and key changes from prior outlooks. The episode also covers ambulatory care and self-administered drugs, biosimilar therapeutic insights, and dynamic pharmacy market forces.
Guest speaker:
Jeni Hayes, PharmD, BCPS
Senior Clinical Manager, Strategic Clinical Intelligence
Vizient Spend Management Solutions
Heather Pace, PharmD
Senior Clinical Manager, Ambulatory Care
Vizient Center for Pharmacy Practice Excellence
Host:
Carolyn Liptak, MBA, BS Pharm
Pharmacy Executive Director, Regulatory Compliance & Revenue Integrity
Center for Pharmacy Practice Excellence (CPPE)
Vizient
Show Notes:
00:05 — Introduction
- Announcer welcomes listeners to Verified Rx, produced by the Vizient Center for Pharmacy Practice Excellence.
00:14 — Episode Overview
- Host Carolyn Liptak, Pharmacy Executive Director at Vizient, introduces the Winter 2026 Spend Management Outlook (SMO).
- Focus areas:
- Pharmacy inflation projections
- Acute vs ambulatory care trends
- Provider-administered vs self-administered drugs
- Biosimilar therapeutic insights
- Dynamic pharmacy market forces shaping 2026–2030
- Guests:
- Jeni Hayes, Senior Clinical Manager, Strategic Clinical Intelligence
- Heather Pace, Senior Clinical Manager, Ambulatory Care
01:09 — What Is the Spend Management Outlook (SMO)?
- Biannual Vizient publication projecting price trends across healthcare spend categories.
- Pharmacy headline:
- Inflation slightly lower than last edition
- Total spend still rising, driven by utilization growth and new technologies
01:49 — Top-Line Pharmacy Inflation Projection
- 2.84% projected drug inflation for purchases between July 2026 – June 2027.
- Down from 3.35% in the prior edition.
- Based on October 2024 – September 2025 wholesaler data.
- Heavily weighted toward highest-spend drugs.
- Contracted products show lower inflation; non-contract drugs still ~70% of spend.
02:45 — Inflation by Site of Care
Acute Care
- 3.03% projected inflation
- Driven by:
- Sugammadex
- Kcentra
- Clotting factors
Ambulatory Care
- 2.85% overall, but with key divergence:
- Provider-administered drugs: 3.35%
- Self-administered drugs: 2.43%
04:02 — Provider-Administered Drugs: What’s Driving Growth
- Oncology infusions are the main drivers.
- Key agents:
- Continued growth due to:
- Expanded indications
- Increased outpatient infusion utilization
- Oncology split by site of care:
- Inpatient: High-cost CAR T (e.g., Yescarta)
- Outpatient: Infusions, bispecifics, emerging cellular therapies
- Emphasizes importance of site of care strategy.
05:14 — Self-Administered Drugs: Utilization Over Inflation
- Five key drivers:
- Autoimmune / inflammatory: Skyrizi, Dupixent, Rinvoq
- Diabetes / metabolic / weight loss: Ozempic, Wegovy, Mounjaro, Zepbound
- Spend growth fueled by:
- Media exposure
- Expanded indications
- Increased patient demand
- Opportunity for:
- Retail & specialty pharmacy optimization
- Margin capture
- Patient support (adherence, counseling, benefits investigation)
06:45 — New Section: Dynamic Pharmacy Market Forces (2026–2030)
Seven strategic forces influencing pharmacy practice:
- Growth in specialty and cell & gene therapies
- Expansion of value- and outcomes-based contracting
- Siteofcare shifts toward ambulatory and home
- Digital transformation & automation
- Supply assurance and resilience
- Expanded pharmacist clinical scope & workforce models
- Regulatory and policy efforts to lower drug prices
- 340B changes
- IRA Medicare Part D negotiations
09:37 — Practical Takeaways for Pharmacy Leaders
- Use 2.84% inflation as a baseline — then customize using Vizient Pharmacy Analytics.
- Leverage segmented views to prioritize:
- Acute vs ambulatory strategies
- Provider-administered vs self-administered drugs
- Identify top spend movers and align them with long-term market forces.
- Consider:
- Specialty pharmacy expansion
- Site of care optimization
10:48 — Biosimilar Therapeutic Insights: 2025 Recap
Heather Pace highlights:
- Shift from biosimilar approval to active adoption management.
- Ustekinumab (Stelara) as defining example:
- Multiple biosimilars
- Uptake driven by payer and PBM strategy
- Utilization varies widely based on:
- Formulary design
- Benefit alignment
- Biosimilars now actively steered, not passively adopted.
11:50 — Why Stelara Was a Turning Point
- PBM-developed, private-label biosimilars drove adoption.
- Net cost and copay design outweighed:
- Interchangeability status
- Manufacturer differentiation
- Sets expectations for future biologic launches.
12:25 — Operational Impact for Health Systems
- Expect payer-specific product preferences.
- Frequent switching will become routine.
- Key considerations:
- Siteofcare mandates
- Product presentation
- Supply chain logistics
- Billing & reimbursement complexity
- Clinical barriers are decreasing; workflow flexibility is critical.
13:09 — What to Expect From Biosimilars in 2026
- Faster adoption timelines
- Earlier payer-driven switching
- Fewer preferred products
- Less reliance on reference product trial periods
13:45 — Biosimilars With Major 2026 Impact
- Eylea — multiple launches expected post-litigation
- Xolair — expansion into asthma/allergy and retail specialty
- Perjeta — oncology pathway disruption expected late 2026 / early 2027
15:01 — 2025 Biosimilars Impacting 2026
- Ustekinumab (Stelara): broader formulary shifts
- Denosumab (Prolia, Xgeva): full year of impact; all interchangeable
- Eculizumab (Soliris): first rare-disease biosimilar entry
15:58 — FDA Biosimilar Guidance to Watch
- Late-2025 FDA guidance:
- Reduced reliance on clinical efficacy trials
- Greater emphasis on analytical similarity
- Aims to:
- Reduce development cost
- Accelerate market entry
16:26 — Interchangeability: Where Things Are Headed
- Moving toward expectation that all biosimilars are interchangeable.
- Shifts responsibility to:
- Payers
- Health systems
- Pharmacists managing transitions and education
17:17 — Biggest Shift in the Biosimilar Landscape
- Faster launches
- Larger scale adoption
- Payer strategy more influential than timing of approval
- Success depends on:
- Formulary fit
- Channel alignment
- Operational simplicity
17:41 — Final Biosimilar Insight
- Biosimilar strategies must be molecule-specific.
- One-size-fits-all approaches are no longer effective.
18:13 — Final Thoughts on the SMO
- Inflation projections are a starting point.
- Leaders should:
- Focus on top spend drugs
- Understand siteofcare and specialty drivers
- Translate projections into actionable budgets
18:40 — Resources
- Winter 2026 Spend Management Outlook available on Vizient’s SMO Hub.
- Includes current and prior editions and related insights.
18:58 — Closing
- Carolyn thanks Jeni and Heather.
- Reminder to subscribe, like, and share feedback.
- Verified Rx is produced by the Vizient Center for Pharmacy Practice Excellence.
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