Enrollment season is upon us, and U.S. employers are under intense pressure to manage 2026’s predicted 9% increase in health care costs. The increase is the steepest single year rise in over a decade, coming on the heels of two straight years where costs outpaced forecasts.
So, the question is how will employers contain costs while preserving good healthcare coverage for employees? We took a look at the recent data and formulated three predictions for 2026 benefit strategies:
1. More Cost-Sharing with Employees
Employers are signaling that higher deductibles, copays, and out-of-pocket maximums are on the way.
- Mercer’s employer survey found 51% plan to shift more health costs onto employees in 2026, up from 45% in 2025.
- Premium contributions are also expected to rise, hitting household budgets at a time when health care inflation is nearly double the general inflation rate.
Implication: Employees will be squeezed to cut personal healthcare costs.
2. A Shake-Up in Pharmacy Benefit Management (PBM)
Prescription drugs remain one of the fastest-growing line items. Drug costs spiked 8% last year, fueled by expensive specialty medications. Employers are reevaluating how they buy and manage pharmacy benefits:
- About 34% of employers are considering alternatives to traditional PBMs.
- 40% are exploring outcome-based or acquisition-cost pricing models that tie payment more closely to value delivered.
- New federal transparency rules are impacting employers.
Implication: Employers are under pressure to provide more transparency and accountability to their employees.
3. Tough Choices on High-Cost Drugs Like GLP-1s
GLP-1 medications remain in high demand as a weight loss tool, but at $1,000+ per member per month, they pose serious financial strain. What began as a promising tool to improve workforce health is now sparking coverage pullbacks. Employers are:
- Reassessing broad coverage for GLP-1s.
- Moving GLP1s off of prescription plans to medical plans.
- Stricter prior authorization and step therapy demands.
Implication: Employees may see narrower access to these drugs in 2026.
Balancing Cost and Care
“In this challenging environment, employers remain firmly committed to an ongoing investment in employee health and well-being,” said Ellen Kelsay, CEO of the Business Group on Health. “Yet they will need to make bold and strategic moves to contain costs, sometimes disrupting health care models along the way.”
That balancing act between affordability and sustainability is only getting tougher. For employers, the challenge will be finding the path that preserves value while at the same time contains costs. For employees, the challenge will be navigating rising cost-sharing and more complex benefit designs. 2026 will test how far both sides are willing to adapt.
One area ripe for immediate impact is prescription drug spending, which is where RazorMetrics helps employers stay ahead.
Our physician-directed platform identifies safe, clinically sound opportunities to switch members to lower-cost alternatives, including generics, biosimilars, and therapeutic equivalents without disrupting care. The result is measurable savings for employers and members alike.
- Proven ROI: Employers see millions in annual savings, often within the first year.
- Broader impact: We address more than just brand-to-generic switches. Our solution tackles specialty drug management, deprescribing, polypharmacy, and high-cost drug alerts.
- Member-friendly: Every switch begins with the prescriber, ensuring clinical integrity and keeping the member experience seamless.
As employers face tough choices on cost-sharing, PBM models, and high-cost drugs, RazorMetrics provides an easy path forward that contains drug spend while protecting employee health.
