As we continue to review payer trends throughout 2026, two areas show significant momentum: Cell and gene therapies (CGTs) and GLP-1s. These categories have dominated the first half of the year, and they are here to stay. Both show strong clinical potential and substantial revenue opportunities.
Growth in Gene Therapy Centers
Specialized gene therapy centers in the United States continue to expand. For example, Casgevy, a one-time CRISPR-based gene therapy drug indicated for sickle cell disease and transfusion-dependent beta-thalassemia, is now available at more than 75 ATCs (Authorized Treatment Centers) globally, with a major presence in the U.S. in 2025.[1] Authorized treatment centers are medical centers that have the appropriate training and experience to administer the gene therapy product, as the drug cannot be given everywhere. Having the proper infrastructure is vital and essential for CGT growth, since CGTs require specialized handling and monitoring.
Payers are engaged as well, with Centers for Medicare & Medicaid Services’ (CMS’s) Cell and Gene Therapy Access Model being launched in 2025. CMS’s CGT Access Model is a multi-year, voluntary model for states and manufacturers. The model will test whether the CMS-led development and administration of outcomes-based agreements increases Medicaid beneficiary access to these therapies and improves their health outcomes. Although the model initially aimed to focus on improving access for patients with sickle cell disease, the hope is that it can enhance Medicaid coverage and outcomes tracking for additional high-cost CGTs, which are often multimillion-dollar products.[2]
The CGT market in the U.S. is positioned for strong growth. Payers may face challenges with high upfront costs, and newer innovations and faster approvals mean that more of these products are rapidly entering the market. However, if outcome-based agreements and value-based models become more of the norm, the potential for this market is quite intriguing.
GLP-1s: Volume and Access Dynamics
GLP-1s continue to drive high-volume growth to treat obesity, diabetes, sleep apnea, and other conditions and comorbidities. Seemingly everywhere you turn, there is a new GLP-1 commercial or ad; as indication expansions occur, the market is growing rapidly, and adoption becomes more commonplace.
Payers are adapting as well, mainly through the implementation of utilization management edits, application of prior authorizations, and selective formulary placement and coverage. Although coverage is a problem for many individuals, employer plans have increased access for weight management products. A recent article in Forbes noted that 43% of firms with more than 5,000 employees covered GLP-1s in 2025, which represents an increase from 28% in the previous year.[3]
Manufacturer competition is stiff though. Oral formulations are expected to improve access and moderate pricing in the coming years. The market dynamic will continue to shift, as 39 new GLP-1 drugs from 34 different companies are in the pipeline. [4]
These trends warrant close monitoring, as they will be the focal points that shape pharmacy, PBM, and manufacturing strategies. For more details, or a tailored analysis, please reach out to Pharmacy Healthcare Solutions as we continue to monitor these growing trends.
PHSL Summer 2026 Newsletter:
Cash Pay Models: Who Offers the Lowest Cost Products?
[1] CRISPR Therapeutics Provides Business Update and Reports Third Quarter 2025 Financial Results. CRISPR Therapeutics Investor Relations. Accessed June 2026. Available at: https://ir.crisprtx.com/news-releases/news-release-details/crispr-therapeutics-provides-business-update-and-reports-third-6
[2] Biden-Harris Administration Takes Next Steps to Increase Access to Sickle Cell Disease Treatments. Centers for Medicare & Medicaid Services. December 4, 2024. Available at: https://www.cms.gov/newsroom/press-releases/biden-harris-administration-takes-next-steps-increase-access-sickle-cell-disease-treatments
[3] GLP-1 Statistics & Trends: Usage, Market Size, Pricing & Research (2026) – Forbes Health
[4] Market Overview: GLP-1 Agonists and the Obesity Market. Ozmosi. December 16, 2025. Available at: https://www.ozmosi.com/market-overview-glp-1-agonists-and-the-obesity-market/