Sedgwick
3 pharmacy and healthcare trends we’ll be watching in 2025
The Sedgwick clinical pharmacy team and our colleagues across managed care monitor the latest headlines and scientific literature for developments affecting employers and how they care for employees who become injured or ill on the job. As 2024 comes to an end, here are three noteworthy issues in the healthcare and pharmacy sector we’re keeping an eye on and anticipate will remain hot topics in the year ahead.
1. Evolution of the pharmacy market
The pharmacy sector, which plays a critical role in supplying Americans with prescription drugs and other health-related services, has changed dramatically in recent years. According to a recent study, one-third of retail pharmacies have closed their doors since 2010 — disproportionately affecting independent pharmacies and lower-income areas. Chain, supermarket and mass retailer pharmacies now dominate the market, comprising nearly two-thirds of all U.S. locations.
This shift can be attributed to multiple factors, including but not limited to:
- Corporate consolidation
- Reduced demand and profitability of the front-end of drugstores, as consumers now purchase more snacks, household staples and over-the-counter products from big-box stores or order them online
- Mass retailers’ ability to offer consumers low-cost generic drugs as loss leaders to draw people into their stores
- Lower prescription reimbursement rates due to regulations promoting affordability and the influence of pharmacy benefit managers (PBMs)
As consumers become accustomed to e-commerce and home delivery, mail-order pharmacies are also gaining significant market share. Amazon’s entry into the online pharmacy space earlier this year is expected to ramp up disruption to the brick-and-mortar pharmacy industry.
When it comes to workers’ compensation, the focus must be on employees getting the right medication at the right time. Industry consolidation may negatively impact workers’ proximity to a retail pharmacy, so employers and WC program administrators may want to partner with PBMs to ensure prescription drug access — whether by offering a searchable list of brick-and-mortar locations or options for home delivery. Further, increasing injured workers’ utilization of generics over name-brand medications where possible and appropriate is an effective strategy for controlling employers’ WC pharmacy spending. By enforcing generic utilization in mandated states and advocating for the medications that provide the most effective, value-based care, Sedgwick’s pharmacy clinicians ensure our clients pay the right price for workers’ prescription drugs.
2. New frontiers in medication and treatment
Each week, our pharmacy team reviews the latest clinical research and data to ensure we have the right medications included in our specialized formularies. One development we’re watching closely is a first-in-class pain medication called suzetrigine that’s working its way through clinical trials and is potentially up for approval by the U.S. Food and Drug Administration (FDA) in January 2025.
A non-opioid, suzetrigine may be the most promising new pharmaceutical approach to pain we’ve seen in 20 years. In contrast to other medications that directly impact the brain and spinal cord, this drug is designed to block pain signals in nerve cells in the body’s periphery and is therefore much less addictive. With a 2023 study by the National Institutes of Health (NIH) revealing that 21% of adult Americans live with chronic pain — and that number likely higher among those dealing with injuries — there is an urgent need for additional treatment options that are safe and effective. If approved, suzetrigine has the potential to improve the quality of life for millions and, hopefully, help injured workers return to pain-free productivity.
Another burgeoning area of research is medicinal use of psychedelics. Based on early studies, psilocybin, MDMA (ecstasy or “molly”) and ketamine are showing promise in addressing depression resistant to other treatments, as well as substance use disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and tobacco addiction. The U.S. Department of Veterans Affairs (VA) is also seeing some positive outcomes from the use of psychedelic-assisted therapy for PTSD, depression and suicidal ideation. (Because psychedelic experiences can be unpredictable and self-medication presents serious safety risks, treatments should always be administered under the supervision of an experienced clinician.) While this area merits further exploration, it’s worth noting that an FDA panel recently rejected the use of MDMA for PTSD treatment. Further, our industry has not widely accepted ketamine as an approved treatment in workers’ compensation, but we continue to monitor for new studies that may prove its value for injured workers.
3. Adoption of artificial intelligence (AI)
Nearly every industry is exploring the transformative potential of AI, and medicine is no exception. Many healthcare organizations are already implementing AI to automate routine and administrative tasks, with an eye toward promoting efficiency and enabling busy professionals to focus on patient care. More sophisticated applications leverage AI’s capacity to quickly analyze medical images, data sets and genetic information to improve diagnostic accuracy, detect health risks earlier, and support tailored and precise patient care.
For example, in the pharmacy space, drug researchers and manufacturers are experimenting with how AI might reduce the time and cost associated with development and testing by better predicting molecular interactions and treatment outcomes. The workers’ compensation arena is also adopting this technology. Tools like Sedgwick’s industry-leading Sidekick application produce near-instantaneous summaries of lengthy notes and medical documentation to keep claim stakeholders in the know and cases moving toward resolution. AI-powered models are also being used to recognize subtle patterns in claim files and detect early signs of severity, so injured and ill workers can be referred for timely clinical interventions where appropriate.
There are a lot of exciting possibilities for AI in healthcare but also potential pitfalls. Some are concerned AI may become a substitution for, rather than support, human connection and provider-patient communication. Because AI models “learn” from data sets produced by real-world systems, they may perpetuate existing biases; this could adversely affect patient populations based on their gender, race, socioeconomic status or other factors. Further, reliance on sensitive health data raises concerns about privacy, security and potential misuse of personal information. All applications of AI in healthcare should be developed and deployed with ethics, fairness, regulatory compliance and strong governance at their core.
Throughout 2025, we’ll continue to watch issues affecting the industry and our employer clients and to share our insights here on the Sedgwick blog.
> Learn more — explore our managed care offerings and how Sedgwick helps employers take care of injured and ill workers while controlling workers’ compensation program costs
For more on the industry trends Sedgwick’s subject-matter experts will be watching in the year ahead, see our Forecasting 2025 report at sedgwick.com/thoughtleadership
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