U.S. prescription drug spending is projected to exceed $1 trillion in 2026, driven largely by increased use of weight-loss medications, according to the annual drug expenditures report from ASHP (American Society of Health-System Pharmacists). The report notes that U.S. prescription drug spending rose 12.7% in 2025 to $915 billion, one of the fastest growth rates in the past two decades and higher than growth in overall healthcare spending and the broader economy. Weight-loss drugs tirzepatide and semaglutide each accounted for approximately $60 billion in spending in 2025, more than double the $29 billion spent on apixaban, the third-highest drug by spending.
The report indicates that GLP‑1 drugs represented about 14% of all U.S. prescription drug spending in 2025, a figure that does not include direct-to-consumer sales. GLP‑1 agents accounted for $132 billion in spending and nearly one-third of overall prescription drug spending growth. Looking ahead, ASHP projects overall drug spending growth of 10–12% in 2026, with clinic spending expected to increase 14–16% and hospital spending projected to rise 4–6%. The report attributes the anticipated $1 trillion threshold primarily to more patients using more medications rather than to rising prices.
In 2025, clinics recorded the fastest drug spending growth at 19%, driven by specialty and injectable drugs, including cancer biologics and newly available treatments for rare diseases such as amyotrophic lateral sclerosis (ALS) and amyloidosis. Hospitals saw 9.6% growth in drug expenditures, led by high-cost injectable oncology and immune-modulating therapies that make up a large share of hospital formularies. Cancer therapies remained the largest and fastest-growing drug category across clinics and hospitals, with spending shifting toward precision oncology, immune checkpoint inhibitors, and antibody-drug conjugates.
The report found that biosimilar use increased meaningfully in 2025, especially in oncology and immunology, with adoption varying by product, care setting, and contracting dynamics, and that associated savings have been building gradually. ASHP also notes that local drug expenditure trends are expected to vary widely, with organizations focused on cancer care, specialty medicine, and rare diseases likely to experience higher drug-cost growth than those centered on routine care. The report states that detailed local data analysis will be important for planning.
Federal policy changes are expected to affect access and utilization more than near-term hospital costs, according to the report. Medicare drug-price negotiations and Part D benefit redesign are projected to reduce patient out-of-pocket costs, which may increase medication use. ASHP provides quarterly updates on new and anticipated drug approvals to supplement the annual projections, and the full report, “National Trends in Prescription Drug Expenditures and Projections for 2026,” is available online ahead of print in AJHP.
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