Oncology rising costs, bispecific growth, infusion shift, and notable drug approvals

This page highlights oncology therapeutic trends for spring 2025, including rising drug costs, increased use of bispecific agents, significant shifts in infusion site-of-care, biosimilar developments and impactful new and upcoming drug approvals.

Transformative trends

The oncology landscape has seen increased investment and approvals of advanced therapies, driving stakeholders to adjust strategies and clinical priorities, reflecting a dynamic pipeline that expands treatment options and improves patient outcomes.

Top medication spend and those with the greatest change in spend

Table 1 lists the top 10 oncology medications by Vizient client spend, highlighting market share and anticipated price adjustments. Oncology accounts for 23.51% of total purchases, and an average price increase of 3.91% is predicted for purchases from July 2025 through June 2026. Medication spend leading the oncology space include pembrolizumab (Keytruda, 2.90% share), daratumumab-hyaluronidase-fihj (Darzalex Faspro, 1.40%) and nivolumab (Opdivo, 1.17%).

Source: Vizient pharmacy program participant data, Oct. 2023 – Sept. 2024
*Portion of spend for the NDCs making up the top 85% of Vizient pharmacy program participant spend; top 10 medications for the Oncology therapeutic area comprise 8.93% of overall spend for that same period

Purchase volumes were compared to the timeframe of consideration from the summer Pharmacy Market Outlook, which analyzed purchases from April 2023 through March 2024. A handful of the top 10 oncology medications by total spend have seen significant changes since then.

• Fam-trastuzumab deruxtecan-nxki (Enhertu), with a 27% spend increase pushing it into the top 10, was approved as the first tumor-agnostic HER2-directed therapy for metastatic HER2-positive solid tumors (August 2024) and HER2-low or HER2-ultralow metastatic breast cancer (January 2025) (Figure 1).
• Osimertinib (Tagrisso) spend increased 38.9%, driven by two new 2024 indications for EGFR-mutated advanced and unresectable stage III non-small cell lung cancer.
• Pertuzumab (Perjeta) dropped from the top 10 oncology agents due to declining purchases (-20%), while spending on combination product Phesgo rose 23% (Figure 1).
• Brentuximab (Adcetris) dropped from the top 10 oncology medications, with utilization down nearly 15% due to newer immunotherapies and targeted agents.
• Atezolizumab (Tecentriq) has decreased in overall spend by 9.7%. Changing utilization for PD-L1 agents can result in competing therapies, physician preference as well as changes in payer strategies and reimbursement policies.

Source: IQVIA

Tables 2 and 3 show the top oncology provider-administered agents and self-administered agents respectively with the greatest change in spend.

Table 2. Top provider-administered medications with greatest change in spend

Source: Vizient pharmacy program participant data, calendar year 2024 vs. calendar year 2023

Increases in spend:

• Dostarlimab-gxly has increased in use partly based on the RUBY trial results, published in June 2024, showing a 16.4-month improvement in median overall survival with Jemperli plus chemotherapy compared to chemotherapy alone.
• Amivantamab-vmjw: In September 2024, the FDA approved amivantamab-vmjw in combination with standard chemotherapy (carboplatin and pemetrexed) for treating adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with specific EGFR mutations, whose disease progressed after prior EGFR tyrosine kinase inhibitor therapy.

Table 3. Top self-administered medications with greatest change in spend

Source: Vizient pharmacy program participant data, calendar year 2024 vs. calendar year 2023

Increases in spend:

• Ribociclib led the top self-administered medications for greatest increase in spend in the past as it received FDA approval in combination with an aromatase inhibitor for the adjuvant treatment of patients with HR+/HER2- early breast cancer at high risk of recurrence in September 2024. Now it is ranked seventh for total spend.
• Belzutifan, a hypoxia-inducible factor inhibitor, received FDA approval in December 2023 for the treatment of adult patients with advanced renal cell carcinoma (RCC) who have received prior therapy, as well as for von Hippel-Lindau (VHL) disease-associated tumors. These additional indications have kept it in top 3 of spend.

Bispecific utilization and site-of-care dynamics

Bispecific agents, which simultaneously target immune and malignant cells, have improved treatment specificity and efficacy. Since blinatumomab's (Blincyto) initial approval in 2019, nine agents across multiple oncology indications have been approved, with utilization trends shown in Figure 2.

Source: IQVIA

Blinatumomab continues to see increased utilization due to its first-line indication for adults with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia.

Pharmacists play a critical role in managing advanced bispecific therapies, with about 45 agents currently in phases I–III for oncology and autoimmune diseases like lupus, asthma and diabetic neuropathy.

While initial doses of bispecifics are typically given inpatient due to complex protocols, maintenance and step-up doses are shifting to outpatient settings, reflecting improved safety profiles, patient convenience and efficient resource allocation.

505(b)(2) market confusion

505(b)(2) pharmacy products streamline the approval process by leveraging existing clinical data, although they're not generics and often differ in dosage, formulation or indications without therapeutic equivalence granted by the FDA. These differences add complexity to the market, as the products are not therapeutically equivalent, present reimbursement challenges and can be difficult for providers to identify and distinguish.

Of approximately 70 approved 505(b)(2) molecules, 15 (21%) target oncology, with many others supporting oncology and hematology services.

Payer mandates and sites of care for oncology infusion

Oncology infusions remain primarily in hospital-based outpatient departments (HOPDs), but payers are increasingly encouraging clinic and freestanding center use. Regional trends vary, with the Northeast still heavily hospital-based (77%) and the South shifting toward office and clinic settings (45%), influenced by community practices and private equity groups (Table 4).

Table 4. National averages for oncology infusion sites of care due to payer demands

Source: 2024 Sg2 Impact of Change® report

Denosumab biosimilars

The denosumab market faces significant shifts with 10–15 biosimilars expected by 2026, starting May 2025, potentially lowering costs and improving patient access. However, adoption may initially be slow due to long dosing intervals and cautious provider attitudes toward switching stable patients.

Key adoption factors include:

• Payer policies: Formulary placement and rebate strategies could slow initial biosimilar uptake.
• Provider acceptance: Concerns about immunogenicity, bone density stability and real-world safety data will influence prescribing.
• Interchangeability and reimbursement: Biosimilar interchangeability status and reimbursement structures will significantly impact adoption.

Long-term, biosimilar adoption is anticipated to improve affordability and accessibility for osteoporosis and oncology-related bone loss treatments.

New and noteworthy novel drug approvals

Abbreviations: AML = acute myeloid leukemia; HSCT = hematopoietic stem-cell transplantation; MDS = myelodysplastic syndrome

Pipeline: Anticipated high-impact approvals

Abbreviations: IV = intravenous; SC = subcutaneous

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