Washington, Aug. 19 – After two consecutive years in which real health care costs exceeded expectations, employers face increasing pressure to make changes and make quick and decisive strategic decisions in 2026. These statements are shown by the Survey of Employers’ Health Protection Strategies for 2026, published by the Business Group on Health.
According to the research participants, the overall growth trend health costs could reach about 9% this year, while adjusting the structure of health plans would partially mitigate that growth to approximately 7.6%. Nevertheless, the projections remain unfavorable because an increasing number of employees use drugs from the GLP-1 group for the treatment of obesity, while at the same time, the incidence of oncological and mental health services is increasing.
In the long term, the effects of these factors suggest that total health care costs in 2026 could be more than 60% higher than in 2017, further underscoring the depth of the structural problem. Although employers still emphasize the importance of commitment to employees’ health and well-being, research indicates that in the near future, it will be necessary to implement disruptive changes in the organization and financing of health care to curb the ongoing growth of costs.
Kelsey emphasized that employer strategies in the future will increasingly be based on rigorous evaluation of medical benefits, provider performance, and measurable treatment outcomes. A broader examination of alternative health plan models, as well as more innovative approaches to managing pharmaceutical benefits, including a departure from traditional PBM structures, is expected.
To reduce costs while maintaining quality, employers will encourage employees to use tools to navigate the health care system and identify high-value care. This approach could lead to a greater reliance on primary health care while simultaneously increasing the rate of preventive examinations and vaccinations.
Among the traditional, interconnected priorities that employers have highlighted for the coming year are sustainable health care affordability, from both a business and an employee perspective. In addition, increased management of health service use is expected, along with the development of integrated programs for body weight regulation using GLP-1 therapies, with the aim of improving outcomes in the treatment of obesity. Special attention will also be given to assessing the availability, quality, and appropriateness of mental health services.
The Business Group on Health research provides insight into the key directions for the development of employer-financed health care in the coming period. The data were collected in June and July 2025 from 121 employers across different sectors, including health insurance, serving more than 11.6 million policyholders.
Therapies for the treatment of obesity, especially GLP-1 drugs, are becoming one of the dominant sources of growth in healthcare costs. The high price of drugs for this indication is increasingly affecting the overall healthcare spending and represents a long-term challenge for employers. As many as 79% of companies report a growing use of GLP-1 therapies, while an additional 15% expect a similar trend in the near future. In an attempt to stabilize budgets, employers are increasingly unlikely to extend coverage for these therapies to indications outside Type 2 Diabetes mellitus.
At the same time, those covering GLP-1 weight management drugs are increasingly implementing strict spending management mechanisms, including prescribed limits, mandatory participation in structured weight-loss programs, and greater demands on partners to provide sustainable, predictable financial models.
Without structural reforms to the pharmaceutical supply chain, pressure on drug costs will persist. Although employers rely on cost management tools through health plan design and existing PBM strategies, pharmaceutical cost growth is also fueled by continued drug price increases, a surge of high-cost innovative therapies, and cost shifting due to planned changes to the Medicare and Medicaid systems.
In 2024, drug expenditures accounted for almost a quarter of employers’ total healthcare costs (24%). The outlook remains unfavourable, given projections of 11-12% growth in pharmaceutical costs through 2026. These trends cannot be mitigated solely through health plan changes, which is why employers are increasingly considering PBM models based on greater transparency and reduced reliance on rebates.
Rising US health care costs are affecting the global strategies of multinational companies.
The cost of health care in the US affects multinational employers’ ability to implement benefits in other countries consistently. 67% of companies claim that US costs directly affect global bids. Regarding cost controls outside the US, three-quarters of employers express concern, and 34% consider the situation particularly serious. Malignant diseases, musculoskeletal diseases, cardiovascular problems, and diabetes continue to be the essential global cost drivers.
Innovation and greater provider accountability are key to optimizing care. Employers must ask partners for bold and measurable proposals to improve the quality and experience of employee health care. Among the most effective techniques are: directing employees to high-quality providers (82%), greater transparency of quality data (82%), and coordination of integrated care teams (79%).
The success of these methods depends on the partners’ ability to offer innovative solutions that link quality of care with cost reduction. Employers are also experimenting with center-of-excellence (COE) programs, expanding them to conditions that are widespread among a larger portion of the workforce, improving outcomes and efficiency.
Cancer is still the primary cost driver for the fourth year in a row. The growth in the number of diagnoses, along with expensive therapies, imposes a focus on prevention and early screening. Employers are expanding coverage for mammograms, removing age restrictions, and exploring alternatives to colonoscopy. Access to quality therapies is a priority: around half of companies plan to establish a Cancer Center of Excellence (COE) in 2026, while an additional 23% are considering it by 2028.
Mental health is increasingly seen as a key challenge. The majority of employers note an increase in the use of mental health and addiction services, while 17% expect an even greater increase. Employers strive for broader access to these services, but with an emphasis on quality and appropriate application.
Women’s health care and reproductive health support are getting stronger. Employers are expanding prevention programs for women, with 58% planning to in 2026, up 22 percentage points from 2024. Menopause support is growing (58%, with an additional 25% plan by 2028), while coverage for doula services (36%), postpartum depression (55%), high-risk pregnancies in vulnerable populations (43%), and group prenatal care (30%) is also increasing.
ERISA protection and tax benefits are key for employers. Nearly all employers (99%) consider compliance with ERISA laws to be crucial to providing quality, comprehensive, and affordable health care plans. When ranking their priorities according to the US government, 85% cited protecting the tax exemption, while 81% highlighted the importance of ERISA preemption. More than 60% of companies plan to focus on pharmaceutical supply chain reforms to control drug costs better.
About Business Group on Health
The Business Group on Health is a non-profit organization that represents employers in developing strategies for employee health and well-being. The organization provides insight into the latest approaches in cost control, financing, affordability, and quality of healthcare services. Members include most Fortune 100 companies and public-sector employers, who together offer health and wellness programs for more than 60 million people in 200 countries.
