You don’t have to look far to see that rising drug costs have captured the national spotlight. Whether it is White House announcements about new drug discount programs and high-profile deals with pharmaceutical companies, or employer surveys about their biggest challenges, prescription drug affordability has been a dominant headline topic. For employers, this public conversation validates a challenge they have faced for years: balancing the need to provide quality care with the pressure of pharmacy benefits costs.
As we look to 2026, this core challenge is not just persisting – it’s intensifying. With total prescription drug spending expected to increase by $116 billion in 2029 compared to 2024, employers will need to shift beyond just budget management to ensure the long-term sustainability of their health plans.
Understanding the trends that are shaping healthcare and prescription drug development and spending is critical. From groundbreaking drug developments to regulatory shifts and new consumer-facing models, the pharmacy benefits world is in an era of significant transformation. Here are four forces that will shape how medications are accessed, priced, and delivered in 2026.
1. The GLP-1 Saga Expands
GLP-1s have become household names, with research showing that at least 18% of U.S. adults have tried these drugs. And the surge in demand shows no signs of slowing. Forward-looking projections estimate the market for these drugs soaring from $46.7 billion in 2024 to $471 billion by 2032.
And the influence of GLP-1s is far from over. Even as employers seek to control the ballooning impact of GLP-1s, manufacturers are exploring an array of avenues to help expand the patient pool for these drugs and maintain market share in a highly profitable but competitive category. That these drugs will continue to loom large in 2026 is beyond question. Just how much their impact on bottom lines grows will depend on how successful manufacturers are in a few of the areas currently being investigated including expanded indications to treat additional conditions, new mechanisms of actions that could extend patent exclusivity, and combination therapies.
For employers, this lends greater urgency than ever for new coverage and management strategies to ensure sustainable pharmacy benefits plans.
2. Continued Push for Transparency
The call for transparency in healthcare is not a new development, but an accelerating trend that is expected to reach a critical point in 2026. As costs continue to climb, employers are demanding clear insight into drug pricing, rebate structures, and the hidden fees that can inflate their costs with the share of employers using transparent pharmacy benefits managers (PBMs) more than doubling from 2024 to 2025, rising from 12% to 31%.
This evolution is about more than just finding the lowest-cost option. It’s about gaining control and flexibility. Employers are increasingly seeking partners that offer transparent, customizable choices that align with their specific goals. Strategies that give them greater control of their benefits plan design, such as “carving out” pharmacy benefits from general medical plans to enable more focused cost management, particularly for high-cost specialty drugs, are gaining traction. So are transparent contracts that eliminate hidden fees and clarify rebate arrangements to ensure pharmacy benefits managers (PBMs) act in employers’ best interests.
This clarion call for tailored solutions that meet each plan’s unique goals rather than rigid, cookie-cutter solutions is why we created Illuminate Rx, an innovative PBM that delivers unprecedented clarity and greater flexibility, putting employers in control of their benefits design and delivering savings while enhancing outcomes.
3. Legislative Scrutiny Creates Cost Unpredictability
The pharmacy benefits marketplace is bracing for significant disruption in 2026 as state and federal legislative scrutiny intensifies. While there have been several high-profile announcements aimed at curbing drug costs, it remains unclear how – or if – they will truly benefit employers. Many of these initiatives are targeted at specific populations or market segments, which can create more complexity and unpredictability for employer-sponsored health plans.
The patchwork of reforms that passed in 2025 adds a new layer of challenges. For multi-state employers, navigating a maze of conflicting state-level mandates on everything from rebate pass-throughs to network requirements complicates compliance and makes it harder to forecast costs. In some instances, recently passed legislation has actually raised costs for employers as PBMs seek to mitigate the impact of requirements such as minimum dispensing fees for pharmacies.
4. The Growth of Direct-to-Consumer Programs
Even as employers seek to gain better control over rising pharmacy costs with clinical utilization management strategies, manufacturers are seeking to circumvent benefits plan design and expand their reach to target populations with direct-to-consumer (DTC) models. These programs often use telehealth to qualify patients and operationalize medication delivery, bypassing traditional insurance and pharmacy benefits structures.
For employers, this shift presents both opportunities and challenges. On one hand, DTC platforms can offer lower-cost access to high-demand medications. On the other hand, the growth of DTC programs creates a parallel system outside of employer-sponsored plans. This separation can lead to significant clinical risks, as it fragments care and makes holistic health management more difficult, and undermines an employer’s efforts to manage the overall health of their workforce.
It will be crucial for employers to adapt their benefits strategies to address both the financial and clinical implications.
The Road Ahead
In 2026 and beyond, the pharmacy benefits landscape will continue to evolve.
Each of these forces directly impacts the ability to control spending, keep employees healthy, and offer a competitive benefits package. And that means the old ways of managing pharmacy benefits are no longer enough. Staying informed is just the first step. But, to turn disruption into an opportunity, stay ahead of emerging trends, and build more sustainable, transparent, and valuable pharmacy benefits, employers need to be proactive about implementing innovative strategies tailored for their plan goals and member population.
The one constant is change, but with the right strategy, employers can navigate it successfully.
