Employers Rank Health Care Cost Control as No. 1 Priority

Employers have bumped health benefit cost-containment to the top of their strategic priorities list, according to Brown & Brown Inc.’s Employer Health and Benefits Strategy Survey, 2026, released Monday.

Going into next year, 42% of employers cited health care cost control for both the organization and its employees as their No. 1 objective, moving last year’s top goal, “attracting and retaining a competitive workforce,” down to third.

“Employers are sharpening their focus on cost control with a long-term, disciplined commitment to managing rising healthcare costs and modernizing a diverse benefits ecosystem,” wrote Chana Bieker, senior vice president of benefits and national account leader at Brown & Brown, in an emailed response to questions.

Meanwhile, according to the Business Group on Health’s December 2 “Trends to Watch in 2026” report, 2026 will be characterized by “one of the most challenging affordability and cost management years in recent history.” The organization reported in August that employers anticipate a median 9% health care cost increase for 2026 in the U.S., which is expected to drop to only 7.6% after plan design changes. The rising-cost trend follows two consecutive years of actual health care costs exceeding employer forecasts.

The “volatile cost environment” is the result of many factors, including vast chronic condition needs and increasing medical and pharmacy prices, according to the Business Group on Health’s report. Meanwhile, more than half of employers (56%) who responded to Brown & Brown’s survey reported that inflation and economic volatility have substantially impacted their health and welfare strategies. Brown & Brown’s report projected that in the coming years, medical and prescription drug benefits could be key focus areas when implementing cost savings initiatives.

Plan Design and Management

“In 2026, employers will need to act with heightened urgency and a willingness to pursue approaches that more effectively disrupt their benefits program—and improve outcomes for employees as well as for their business,” Business Group on Health’s forecast stated. “This approach must start with benefit leaders initiating frank discussions with their leadership on the cost reality and need for change.”

The Business Group on Health’s trend report recommended that employers rigorously evaluate all programs, vendors and delivery partners to ensure that their investments deliver value. The evaluation could drive:

• The elimination of underperforming vendors;
• A reconsideration of future enhancements to the benefits organizations offer; and
• The pursuit of fundamentally different arrangements with key partners, especially in areas linked to high-cost drivers.

On the plan management front, 81% of employers who responded to Brown & Brown’s survey said that within the next two years, they would evaluate medical stop-loss plan designs, which serve as insurance that protects employers from unexpectedly high medical costs. Almost the same proportion (79%) said they would perform claims, pharmacy or clinic audits, within the same timeframe.

Popular strategic initiatives to better curb costs include partnering with digital health or wellness solutions providers (80%) and measuring the success of these solutions and adding or enhancing cost transparency tools (79%), according to Brown & Brown’s survey.

GLP-1s and Direct-to-Consumer Sales

The popularity of glucagon-like peptide medications for weight loss and diabetes control has exploded across the U.S.—placing cost pressures on employers who cover these drugs as part of their pharmacy benefit plans. In an August study by Mercer, 77% of employers surveyed named managing GLP-1 costs as their top health benefit issue.

Nearly half (48%) of employers said they cover GLP-1 medications for weight loss, and the vast majority (89%) said they plan to continue covering it in the next one to two years, Brown & Brown’s research found. Of those employers that cover GLP-1s, 63% reported having restrictions in place for GLP-1 coverage for weight loss, and many said they were looking beyond prior authorization to better balance access and cost challenges. Among all respondents, 49% said participants must meet certain clinical criteria above and beyond U.S. Food and Drug Administration guidelines to qualify for coverage of the medications, 38% said participation in a lifestyle of behavior management program is required, and 25% said they limit coverage to prescriptions from a designated or sole prescriber.

Recently, employers have begun to purchase obesity medications straight from the drug makers, bypassing pharmacy benefit managers, which have come under scrutiny for the influence they have on setting medication prices. On November 21, health care and drug companies Eli Lilly & Co., Waltz Health, Goodpath, 9amHealth and Ilant Health all announced new obesity-management drug models intended to cut costs for employers and their plan participants. Several of the firms’ planned cost cuts will take effect in 2026, indicating the direct-from-drug-maker market could continue to gain steam into the new year.

According to the Business Group on Health’s forecast, the direct-to-consumer approach is likely to expand to drug classes beyond GLP-1s. The U.S. government is moving in this direction through efforts such as “TrumpRx,” a website slated to launch in early 2026 that would allow consumers to search for their prescriptions and direct them to the manufacturer’s own DTC platform.

“While it is unclear the extent to which such programs will be available to people with employer-sponsored health coverage, employers will be called upon to debate, and establish, their organizational philosophy regarding employee use of cash-pay/DTC sources of pharmaceuticals,” the Business Group on Health’s report concluded. “Some employers may embrace the disruption of the supply chain; some may see it as undermining their own benefits value and utilization management efforts.”

From July 31 through September 5, Brown & Brown surveyed 1,241 employers with at least 200 employees based in the U.S.