Pharmacy forces shaping employer benefit strategies in 2026

Expanded demand and increased clinical acceptance around GLP-1s, indicated for chronic weight management, are accelerating uptake faster than many employers anticipated. This means HR and benefits teams will likely continue to face tough decisions as it relates to whether to cover these costly medications, or what other strategies they can pursue to address employee demand without derailing budgets. For instance, more employers are requiring prior authorizations or participation in lifestyle modification programs for use of GLP-1s. As efforts continue to make GLP-1s more affordable and accessible, such as with oral options, utilization is likely to increase, and employees may become more inclined to purchase these medications directly from pharmaceutical manufacturers rather than relying on their employer coverage.

Pharmacy cost pressures extend well beyond GLP-1s. Some newly launched specialty drugs, have high annual costs such as Jascayd® for for the treatment of pulmonary fibrosis with an estimated annual cost of about $200,000 per patient.¹ New therapies like this one can be clinically meaningful, but they create budget volatility — especially when a small number of high-cost claimants can materially affect total spend. For employers, the challenge is less about predicting unit costs and more about anticipating how many employees will need these therapies and when, especially since specialty medications drive about 55% of pharmacy spending.²

Beginning in January 2026, Medicare Maximum Fair Price began to apply to the first 10 negotiated Part D drugs.¹ An additional 15 drugs have been announced for Medicare price negotiation in 2027.¹ While these policies target Medicare beneficiaries, manufacturers may respond in ways that affect employer plans by adjusting rebates, shifting pricing or refocusing on non-negotiated products. For employers, this may impact Prescription Drug List changes or different rebate negotiations at renewal.

Beyond federal policy, states are intensifying oversight of pharmacy benefit managers. Several states are pursuing different mandates related to transparency, pricing and contracting. For employers operating in multiple states, this can mean navigating varied requirements and keeping up with regulatory changes that may affect how pharmacy benefits are managed and reported.

Biosimilars offer potential savings, but uptake depends on whether physicians prescribe them, patients are comfortable switching and manufacturers price them competitively. In the second half of 2026, 6 biosimilars for Eylea® alone are expected to launch.² For employers, the pace of biosimilar launches means more frequent Prescription Drug List reviews and more decisions about whether and when to make changes.

New formulations, expanded indications and novel therapies are entering the market faster than annual benefit planning cycles can keep up. What used to be predictable is now fluid. Employers who stay in closer contact with brokers, consultants and pharmacy partners throughout the year — not just at renewal — may be better positioned to respond as new products and competitive dynamics emerge.

The cumulative effect of innovation across multiple therapeutic areas is creating cost pressures that extend beyond any single drug launch. Expanded indications, new clinical guidelines and increased awareness are driving utilization patterns that exceed historical trends. For employers, this means pharmacy planning must account for both the cost of individual therapies and how many employees may need them — a dynamic that affects budget predictability, plan design and member communication.