Geisinger Pharmacy value creation in a pluralistic healthcare environment
Jonathan Brady, Allison Cebulko and Seth Gazes
Each year, Enterprise Pharmacy develops a strategic project portfolio aimed at improving organizational financial performance as part of the Geisinger Transformation (GT) program.
The pharmacy team operates under a dual mandate:
- To mitigate overall drug trend while maintaining the quality of care
- To drive bottom-line financial performance for the organization
In 2025, the Pharmacy GT portfolio focused on biosimilar conversion, glucagon-like peptide-1 (GLP-1) utilization management and oncology drug spend. Through July 2025, pharmacy contributed $39.8 million in savings for Geisinger Health Plan (GHP), with total annual savings projected to exceed $50 million. This strong financial performance was driven by several key initiatives:
Humira and Stelara biosimilars: Conversion efforts reached 77% and 86%, respectively, through a combination of GHP formulary changes, direct outreach to patients and prescribers, and therapeutic interchange within Geisinger’s distribution channels. These efforts were supported by coordinated communication strategies and clinical alignment across pharmacy and provider teams.
White-bagging: Oncology drug spend at external health systems was transitioned from the medical benefit to the pharmacy benefit and dispensed via Geisinger Specialty Pharmacy.
For health systems opting out of the white-bagging program, medical benefit rates were restructured to align costs and maintain financial sustainability. This approach allowed for greater control over drug sourcing and improved transparency in pricing.
GLP-1 utilization management: Clinical best practice criteria were developed for the initiation and maintenance of GLP-1 therapy in the Clinical Enterprise. These criteria were designed to ensure appropriate use of therapy based on evidence and patient need.
Pharmacy-led coordination of patient financial assistance programs helped offset GHP spend for eligible patients, improving access while managing cost exposure.
OncoHealth: Evidence-based prior authorization protocols, real-time clinical decision support and peer-to-peer oncologist engagement were implemented for guideline-concordant cancer therapies. These efforts helped reduce unnecessary costs across both medical and pharmacy benefits while maintaining clinical integrity and patient-centered care.
Formulary changes: A comprehensive benefit redesign was executed, including conversion from high-cost to low-cost generic medications, repositioning of tiering for high-cost drugs and alignment of benefit design with market competitors. These changes were informed by utilization data and market analysis with the goals of competitiveness and affordability.
While the Pharmacy GT portfolio delivered substantial savings for GHP, approximately 50% of the value was offset by a reduction in operating margin in the Clinical Enterprise. This impact was most notably attributed to biosimilar conversion, which shifted revenue away from traditional channels. Despite this financial offset, Pharmacy distribution channels continued to demonstrate strong growth and resilience.
Through July 2025, Enterprise Pharmacy revenue exceeded $634 million, driven by 14% growth in specialty pharmacy and 11% growth in mail-order services. Continued financial expansion across the enterprise has been supported by improved prescription capture, expanded access to payors and limited distribution drugs, and enhanced integration with Medication Therapy Disease Management and Central Medication Hub programs. These operational enhancements have strengthened the pharmacy’s ability to deliver value across both clinical and financial domains.
Enterprise Pharmacy’s GT portfolio reflects a balanced approach to cost containment and clinical value, positioning the department as a key contributor to systemwide transformation and sustainable financial performance. The portfolio continues to evolve in response to emerging trends, regulatory changes and patient needs, reinforcing Geisinger’s commitment to innovation and excellence in pharmacy practice.
