More than half of large US employers plan higher cost-sharing in 2026 amid rising GLP-1 expenses
As the cost of GLP-1 weight-loss drugs climbs, more than half of large US employers plan to pass rising healthcare expenses on to employees in 2026, according to a new survey by Mercer.
Reuters reported that Mercer found that 51 percent of employers with 500 or more workers plan to increase cost-sharing measures such as higher deductibles and maximum out-of-pocket costs next year, up from 45 percent who planned increases for 2025.
The survey also revealed that 77 percent of employers cited the cost of GLP-1 medications—such as Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound—as a top concern.
Alysha Fluno, Mercer’s pharmacy innovation leader, said, “More clients are saying ... ‘I don’t know how much longer we can sustain covering these medications’.”
She added that while some employers initially offered GLP-1 coverage in hopes of long-term health savings, “some employers facing big cost increases in 2026 may feel this coverage is out of reach.”
According to Reuters, the financial strain is prompting employers to explore new approaches.
As per Mercer, 40 percent of employers are now considering alternative drug contracting models that base prices on the cost to the pharmacy.
Additionally, 34 percent are open to switching from traditional pharmacy benefit managers (PBMs) to emerging or transparent models.
CVS Caremark, Express Scripts (Cigna), and Optum Rx (UnitedHealthcare) currently dominate the PBM space by negotiating drug discounts and managing formularies.
However, manufacturers have accused these PBMs of withholding a portion of the discounts instead of sharing them with patients and payers.
Regulatory scrutiny has intensified, as per Reuters.
CalPERS, the second-largest public purchaser of health benefits in the US, announced it would replace Optum Rx with Caremark in 2026.
The five-year contract includes provisions requiring improved transparency and oversight.
Brown & Brown's June 2025 survey of 237 level- and self-funded employers offers further insight into this trend.
According to their findings, only 37 percent of self-funded employers currently cover GLP-1s for weight loss, with larger organizations more likely to offer coverage.
Of those covering GLP-1s, 31 percent are considering ending coverage or are uncertain about maintaining it over the next one to two years.
Brown & Brown also found that 59 percent of employers covering GLP-1s have already implemented restrictions.
According to the survey, 80 percent require prior authorization, 54 percent demand clinical criteria beyond FDA guidelines, and 43 percent limit coverage to specific GLP-1 drugs.
Beyond traditional plan structures, employers are also evaluating alternative distribution models.
Brown & Brown reported that 71 percent of employers are either actively exploring or open to Direct-to-Consumer programs, while 29 percent are unlikely to consider or remain undecided on such options.
Prescription drug costs rose 8 percent last year, as reported by Mercer, which forecasts a 5.8 percent increase in overall health benefit costs for 2025.
The potential for greater competition in the GLP-1 market may eventually allow PBMs to negotiate better pricing, but employers facing near-term pressures are already adjusting their benefit strategies.
