ASHP released its annual drug expenditures report on April 30, 2026, and the headline number stopped the healthcare industry cold. For the first time in history, U.S. prescription drug spending is on track to exceed $1 trillion in 2026. Every pharmacist in the country should know what’s inside that number and what it means for the profession’s business case.
The Headline Numbers
U.S. prescription drug spending surged 12.7% in 2025 to $915.2 billion, one of the fastest growth rates in the past two decades, outpacing increases in both overall healthcare spending and the broader economy. The report projects that in 2026, overall drug spending will exceed $1 trillion for the first time, a milestone driven primarily by more patients using more medications, not by rising prices. Spending growth is forecast at 10 to 12% overall, with clinics up 14 to 16% and hospitals up 4 to 6%.
U.S. spending on prescription drugs continues to significantly outpace other countries, with per capita costs reaching around $2,000 in 2022. Medicaid drug spending has also increased by 46% over the last five years, driven in part by high-cost GLP-1 medications and specialty therapies.
The GLP-1 Number Inside the Number
The GLP-1 story is no longer a niche specialty pharmacy topic. It is the central driver of the single largest spending shift in the history of American pharmacy.
Tirzepatide spending reached $62.8 billion in 2025 and semaglutide reached $59.1 billion. Together, GLP-1 drugs totaled $131.9 billion in spending and accounted for 14% of overall U.S. drug spend and nearly one-third of all spending growth in the year.
“GLP-1s have fundamentally reshaped the drug-spending landscape,” said Eric Tichy, PharmD, MBA, lead author of the report and division chair of supply chain management at Mayo Clinic. “At $132 billion, this single class of drugs accounted for nearly one-third of all growth and is moving the entire market.”
To put the magnitude in context: tirzepatide alone, at $62.8 billion, costs more than twice as much as apixaban, the third-highest spending drug at $29 billion. And these GLP-1 figures do not include direct-to-consumer sales, meaning the full economic footprint of the class is even larger than reported.
Where Else the Money Is Moving
The GLP-1 surge captured the headlines, but the second major story in the ASHP report is clinic-based specialty spending, and it is accelerating faster than any other category.
Clinic drug spending increased 19% to $190.5 billion in 2025, fueled by specialty and injectable agents including oncology biologics and newly available treatments for rare diseases like ALS and amyloidosis. Cancer therapies remained the largest and fastest-growing category across all care settings, led by precision oncology, immune checkpoint inhibitors, and antibody-drug conjugates, with biosimilar use increasing in 2025.
Specialty drugs are projected to exceed 60% of total pharmacy spend by 2026, despite representing less than 5% of all prescriptions. Oncology and rare-disease assets comprise more than 85% of pipelines, accelerating precision medicine while amplifying financial risk from ultra-high-cost, biomarker-driven therapies.
Organizations focused on cancer care, specialty medicine, and rare diseases will see far higher drug-cost growth than those centered on routine care, making local data analysis essential for planning. Federal policy changes are expected to influence access and utilization more than immediate hospital costs. Medicare drug-price negotiations and Part D benefit redesign are likely to reduce patient out-of-pocket costs, which may further increase medication use.
The Structural Misalignment the Trillion-Dollar Number Reveals
Here is what the ASHP data makes impossible to ignore: a $1 trillion drug market is managed primarily by pharmacists who are still reimbursed as if they are dispensing 1995 prescriptions. That gap is not sustainable, and it is not a negotiating posture. It is a structural misalignment with a documented financial consequence.
Every dollar of that trillion touches a pharmacist at some point in its journey. Prior authorization slows or accelerates patient access. Adherence counseling determines whether a $62.8 billion drug class delivers its clinical promise or generates waste. Biosimilar substitution captures or loses billions in avoidable spending. GLP-1 monitoring prevents or fails to prevent the nutritional deficiencies and muscle loss that turn a therapeutic win into a downstream cost.
With specialty drug utilization rising, payers must focus not only on access and affordability but also on the clinical programs that help members use these therapies effectively. Medication therapy management, comprehensive medication reviews, and adherence-focused interventions are essential tools in reducing avoidable hospitalizations, preventing medication errors, and helping members manage chronic conditions more confidently.
Specialty pharmacists remain pivotal advisors, helping patients avoid unnecessary hospitalizations and navigating the administrative complexity of prior authorizations. This perception among payers stands in contrast to the specialized expertise required to manage these drugs, which often involve unique administration routes, special handling, and intense patient education on side effects and adherence.
The gap between what pharmacists deliver and what they are paid to deliver is the business problem the profession must solve in this decade. The ASHP report provides the opening argument.
What Payers Are Actually Looking For
The payer perspective on pharmacy value in 2026 is clearer than it has ever been, and it aligns almost exactly with the clinical competencies PharmDs already hold.
High-impact therapeutic categories, from oncology and immunology to diabetes and emerging metabolic therapies, continue to shape payer strategy, budgets, and quality goals. This is where pharmacy plays a crucial role. Medication therapy management, comprehensive medication reviews, and adherence-focused interventions are essential tools in reducing avoidable hospitalizations, preventing medication errors, and helping members manage chronic conditions more confidently.
Pharmacists bring practical expertise to conversations about affordability, access, and value in medication use. In formulary leadership, they guide decisions to reflect evidence-based medicine, real-world outcomes, and total cost of care. In data analysis, they collaborate with finance and analytics teams to evaluate the impact of drug spending on patient access and adherence. In advocacy, they engage clinicians, administrators, and policymakers to illustrate how prescribing and access decisions affect both patient care and system sustainability.
That is a job description for the pharmacist who wants to be at the table, not watching from outside it.
The Conversation This Number Opens
The $1 trillion milestone is not just a data point. It is a door-opener in every conversation a pharmacist has with a hospital administrator, health plan representative, or payer contact.
The question to ask, plainly and consistently: “Given that pharmacists touch every dollar of this spend at the clinical level, what does your reimbursement model look like for pharmacist-delivered outcomes?”
That question, asked in the right room by a pharmacist who knows the ASHP data, changes the negotiation. Provider status recognition under Medicare would unlock billing for comprehensive medication management, medication therapy management, and clinical consultation services that pharmacists already deliver without compensation. Value-based contracts that include pharmacists in shared savings arrangements create financial alignment between the clinical work and the payment for it.
“In an environment where drug spending is accelerating at historic rates, it is crucial for decision makers to have reliable, data-driven projections,” said Daniel J. Cobaugh, senior vice president of professional development at ASHP. “This report has become an essential annual benchmark for pharmacy and other healthcare leaders.”
Pharmacy leaders who use this report as a benchmark for their own advocacy conversations, not just as news to read, will be the ones reshaping what pharmacist reimbursement looks like on the other side of the trillion-dollar milestone.
The Bottom Line
Drug spending will exceed $1 trillion in 2026. GLP-1s account for $132 billion of it and nearly one-third of all growth. Specialty drugs will exceed 60% of pharmacy spend. Clinic spending grew 19% last year and will grow another 14 to 16% this year.
The scale of what pharmacists manage is incontestable. The reimbursement that reflects that scale is the next frontier. Every conversation that connects the trillion-dollar number to the pharmacist’s clinical role moves the profession one step closer to closing the gap.
Sources: ASHP Press Release (U.S. Prescription Drug Spending Poised to Cross $1 Trillion, April 30, 2026), AJHP / Oxford Academic (National Trends in Prescription Drug Expenditures and Projections for 2026, Tichy et al., April 2026), Becker’s Hospital Review (U.S. Drug Spending to Surpass $1 Trillion in 2026), Chain Drug Review (U.S. Prescription Drug Spending On Track to Exceed $1 Trillion), Drug Store News (U.S. Prescription Drug Spending to Top $1 Trillion), PharmExec (U.S. Prescription Drug Spending Set to Exceed $1 Trillion in 2026), Drug Topics (Drug Cost Pressures and PBM Reform: Implications for Health Systems, April 2026), Drug Topics (Specialty Drug Costs and Complexity Steadily Rising Since 2025, May 2026), Outcomes.com (What Payers Want From Pharmacist-Provided Services in 2026)
