U.S. Employers Plan Cost-Sharing Changes in Health Benefits Amid Rising Drug Costs

Facing escalating healthcare costs, a significant number of large U.S. employers are planning to implement cost-sharing measures in their health benefit plans for 2026. This shift is largely driven by the rising expenses associated with specialty and weight-loss medications, particularly glucagon-like peptide 1 (GLP-1) drugs such as Novo Nordisk's Wegovy and Eli Lilly's Zepbound.

According to a recent survey by Mercer, a global consulting firm, 51% of large employers—those with 500 or more employees—are likely or very likely to make plan design changes in 2026 that would shift more healthcare costs to employees. This marks an increase from 45% in the previous year's survey. The primary concern cited by 77% of these employers is the escalating cost of GLP-1 medications, which are priced at approximately $1,000 per month per patient, excluding manufacturer rebates.

Ed Lehman, Mercer's U.S. Health and Benefits Leader, highlighted the dilemma employers face: "Employers are juggling faster cost growth with the need to offer attractive benefits and keep healthcare affordable for all employees." This balancing act has become increasingly challenging as healthcare costs continue to rise.

The surge in healthcare expenses is not limited to prescription drugs. Employers project an average health benefit cost increase of nearly 6% in 2025, marking the third consecutive year of increases above 5%. This trend follows a decade of cost increases averaging around 3%. Factors contributing to this escalation include a widening gap between the supply of healthcare workers and the demand for services, as well as ongoing consolidation within health systems, which can lead to higher prices due to increased negotiating power.

In response to these financial pressures, employers are exploring various strategies:

• Cost-Shifting Measures: Implementing plan design changes that increase deductibles or out-of-pocket maximums for employees.

• Alternative Pharmacy Benefit Management (PBM) Arrangements: Over half (61%) of large employers are actively considering alternatives to standard PBM contracts to gain greater transparency and control over drug costs.

• Outcome- or Acquisition-Based Drug Pricing Models: Employers are exploring pricing models that tie drug costs to patient outcomes or acquisition costs to better manage expenses.

Despite the high costs, some employers are expanding coverage for weight-loss medications. In 2024, 44% of large employers covered these drugs, up from 41% in 2023. However, the financial burden has led to increased scrutiny and adjustments in coverage policies.

The trend of increasing cost-sharing measures raises concerns about healthcare affordability for employees, potentially leading to reduced access to necessary treatments and medications. The high cost of GLP-1 drugs, in particular, poses challenges for both employers and employees in balancing effective treatment options with financial sustainability.

As employers navigate these complex issues, the future of employer-sponsored health plans remains uncertain. Balancing the provision of comprehensive health benefits with the need to manage rising costs will require innovative solutions and careful consideration of the long-term implications for both employers and employees.