A report from American Society of Health-System Pharmacists projects U.S. prescription drug spending to surpass $1T in 2026, driven largely by surging demand for GLP-1 weight-loss therapies.
U.S. prescription drug spending is on track to surpass $1 trillion for the first time in 2026.
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The historic increase is driven primarily by explosive growth in GLP-1 weight-loss medications, according to the annual drug expenditures report from the American Society of Health-System Pharmacists.1
"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, PharmD, senior vice president of professional development and publishing at ASHP. "This report has become an essential annual benchmark for pharmacy and other healthcare leaders."
According to the annual drug expenditures report from American Society of Health-System Pharmacists (ASHP), total U.S. prescription drug spending rose 12.7% in 2025 to $915 billion, one of the fastest growth rates in two decades, outpacing increases in both overall healthcare spending and the broader economy.2
The ASHP report projects 2026 spending will exceed $1 trillion, with overall growth forecast at 10 to 12%, clinic spending up 14 to 16%, and hospital spending up 4 to 6%.2 ASHP’s report attributes the growth primarily to more patients using more medications rather than rising drug prices.
One of the key takeaways from the report was GLP-1 medications becoming a dominant force. Tirzepatide and semaglutide each topped approximately $60 billion in spending, more than double the $29 billion spent on apixaban, the third-highest drug.1 Together, GLP-1 drugs accounted for roughly 14% of all U.S. prescription drug spending and nearly one-third of all spending growth in 2025.2 That figure does not include direct-to-consumer sales, meaning the true market impact is larger still.
"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. And we are still on the steep part of the curve."
According to the report, clinics saw the fastest growth of any care setting at 19%, driven by specialty and injectable drugs, particularly cancer biologics and newly available treatments for rare diseases including ALS and amyloidosis that had few or no approved options until recently.2
Hospital spending grew 9.6%, driven by high-cost injectable oncology and immune-modulating therapies. Cancer drugs remained the largest and fastest-growing category across both clinics and hospitals, with spending shifting toward precision oncology, immune checkpoint inhibitors, and antibody-drug conjugates. Biosimilar adoption increased meaningfully in 2025, particularly in oncology and immunology, with savings building gradually as utilization patterns vary by drug, site of care, and contracting dynamics.1
The report warns that spending growth is expected to vary significantly by institution. Organizations focused on cancer care, specialty medicine, and rare diseases will face far higher cost pressures than those centered on routine care, making local data analysis essential for financial planning. Federal policy changes, including Medicare drug price negotiations and Part D benefit redesign, are expected to reduce patient out-of-pocket costs, which may in turn further increase medication utilization and system-level spending.1
Tichy says the challenge for health systems is ensuring patients can actually access these therapies regardless of where they live or who their employer is. "For many health systems, rising drug expenditures aren't just a cost story," he said. "These therapies are increasingly central to how patient care is delivered across clinics and hospitals."
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