On The Radar
By
While GLP-1s remain popular for weight management, 31% of employers are reconsidering coverage due to cost concerns. Many have added restrictions or are exploring alternative access models like direct-to-consumer programs.
➡ Why it matters: The long-term value of GLP-1s must be weighed against short-term cost pressures—especially in self-funded plans.
Cost-Shifting on the Rise in 2026
A majority of employers plan to raise deductibles and out-of-pocket maximums as health costs increase, especially for specialty medications. However, many are also exploring affordability measures like variable copays, HSAs, and digital mental health support.
➡ Why it matters: Brokers need to guide clients toward balanced plan designs that reduce spend without sacrificing support.
GLP-1s Drive Benefit Cutbacks
51% of employers say they’ll scale back health benefits in 2026, citing GLP-1 drugs like Wegovy as a primary budget concern. PBM relationships are also under new scrutiny, with many employers seeking new pricing models or switching vendors altogether.
➡ Why it matters: Employers are under pressure—and many are ready to explore bold alternatives.
U.S. Prescription Drug Spending Soars
Prescription drug sales in the U.S. hit $1.6 trillion in 2023. GLP-1s alone drove a 130% increase in Medicare Part D spend over two years, highlighting how demand for biologics and specialty drugs continues to surge.
➡ Why it matters: Employers must shift from reactive cost-cutting to proactive benefit strategy.
To build supply chain resilience and reduce foreign reliance, AstraZeneca is investing $50B in domestic manufacturing and R&D by 2030. This trend could help stabilize drug supply and create new opportunities for workforce development.
➡ Why it matters: A more secure U.S. supply chain could eventually reduce employer exposure to global disruptions.
Renewed Calls to Ban Drug Ads
Lawmakers and watchdogs continue to criticize direct-to-consumer drug ads for being misleading and contributing to high drug prices. A proposed bill to ban them is unlikely to pass, but the public sentiment is shifting.
➡ Why it matters: Advertising drives demand. Less noise could lead to more rational prescribing—and lower costs.
Why Americans Still Pay More
Efforts to introduce “Most Favored Nation” pricing and legalize drug importation face resistance, but the disparity remains: Americans pay 5–10x more than other countries for identical medications.
➡ Why it matters: Until domestic reform happens, international sourcing remains a critical option for self-funded plans.
Final Thoughts
Between rising drug costs, shifting plan designs, and an increasingly fragmented PBM landscape, one thing is clear: the employer-sponsored healthcare model is at an inflection point. At SHARx, we continue to deliver clarity and cost containment when it matters most.
We’ll be back in two weeks with more news you need to know. If you’d like a custom analysis or want to explore SHARx program options for your clients, contact us!
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