WTW 2026 Best Practices in Healthcare Survey: U.S. employer healthcare costs set to rise at fastest pace in more than two decades

Pharmacy costs climb 11.5% as employer ratings of PBMs plunge; nearly half say significant health plan changes are needed within three years

NEW YORK, Oct. 28, 2026 (GLOBE NEWSWIRE) -- High-cost claimants and pharmacy spending are the leading healthcare cost pressures facing U.S. employers, cited by 86% and 83%, respectively, according to the 2026 Best Practices in Healthcare Survey from WTW (NASDAQ: WTW), a leading global advisory, broking and solutions company. As those pressures intensify, employers are increasingly preparing for significant changes across their healthcare programs, including plan design, pharmacy strategy, vendor performance and overall healthcare spending.

The pressure extends across healthcare spending. U.S. employers project healthcare costs will rise 11.1% in 2027 before plan changes. Even after those changes, costs are still expected to rise 9.7%, only 1.4 percentage points lower. That is the highest rate since the early 2000s and nearly three times the pace of wage growth. With cost growth still near double digits, employers expect to take bolder action over the next few years.

Pharmacy costs are expected to increase 11.5% in 2026, up from 9% in 2025. When drugs paid through medical benefits are included, WTW estimates pharmacy accounts for approximately 36% of total healthcare claims.

Nearly half of employers (49%) now say significant changes to their healthcare programs will be necessary within three years, up sharply from 34% last year. Controlling costs and financial risk is the leading healthcare priority for 78% of employers, and 37% expect finance to take a larger role in managing healthcare costs over the next two years.

“Pharmacy has moved from a line item to the center of the healthcare cost conversation,” said Jeff Levin-Scherz, Population Health Leader, North America, WTW. “GLP-1s, specialty drugs and gene therapies can change patients’ lives, but the costs of these advances are hard to sustain. Removing coverage outright tends to fall hardest on the employees with the most to gain. Before making coverage changes, employers should consider clinical programs, risk protection such as stop-loss and lower-cost purchasing channels.”

The findings show employers are also rethinking both drug coverage and the vendors that manage it:

• GLP-1 coverage for weight loss declined for the first time in three years, from 57% of employers to 53%. Of those who still cover them, 30% are considering eliminating coverage. Among employers that have dropped or are weighing dropping coverage, 91% cite cost as a reason.
• The Net Promoter Score for pharmacy benefit managers (PBMs) fell from -10 in 2024 to -25 in 2026. Nearly two thirds of employers (64%) have taken, are planning or are considering action on their PBM relationships, such as taking services out to bid or using an alternative PBM.
  
  

Employees are likely to pay more.

Employers expect to ask employees to shoulder a larger share of healthcare costs over the next two years. Among U.S. employers surveyed:

• 85% are planning or considering shifting costs through employee premium contributions by 2028, nearly double the 44% doing so today.
• 71% are planning or considering shifting costs through out-of-pocket expenses, up from 30%.
• 41% are planning or considering eliminating some generous coverage provisions, almost four times the 11% doing so today.
  
  

At the same time, employers remain cautious about changes that could disrupt employees. Six in ten (61%) say they are unwilling to tolerate significant complexity and member pushback to reduce costs. Employees share that caution: in WTW’s 2026 Global Benefits Attitudes Survey, 58% of U.S. employees said they would rather pay higher out-of-pocket costs than accept a plan with more restrictions.

Employers are weighing bigger changes.

Most employers prefer a measured approach, with 80% favoring long-term, multiyear solutions over immediate savings. At the same time, employers are considering changes to plan design and coverage. By 2028:

• 22% are planning or considering restricting eligibility, up from 13% today.
• 63% are planning or considering lower out-of-pocket costs for using high value providers, those with higher quality and lower costs, triple the 21% doing so today.
  
  

Healthcare vendors and programs can expect scrutiny and will need to prove their value.

With costs remaining elevated, employers are increasingly examining whether existing programs and vendors are delivering sufficient value. Looking ahead to 2028:

• 84% are planning or considering taking health plans or vendors out to bid, up from 39% today.
• 55% are planning or considering evaluating fraud, waste and abuse, up from 23%.
• 38% are planning or considering cutting back the number of vendors they use, up from 14%.
  
  

The average employer now works with 13 health and wellbeing vendors, up from 11 in 2022. Yet only a third of employers (34%) evaluate the clinical impact of their point solutions, and 42% evaluate the financial impact.

“Plan design tweaking and cost-shifting can’t meet the objective,” said Courtney Stubblefield, Strategy & Specialty Leader, Health & Benefits, WTW. “Employers need a multi-year strategy with finance at the table that delivers a proactive plan for pharmacy and other high-cost risks and holds vendors accountable for results. Employers should start by asking whether they are getting enough value from the money already being spent.”

The complete findings are available in the WTW 2026 Best Practices in Healthcare report.

About the survey
The WTW Best Practices in Healthcare Survey, now in its 30th year, was conducted between June 22 and August 7, 2026. The 2026 survey is based on responses from 471 U.S. employers with at least 100 employees, together employing 7 million people. Healthcare trend figures are medians. Employee figures cited are from the WTW 2026 Global Benefits Attitudes Survey, based on responses from 6,000 full-time U.S. employees collected between February and May 2026.

About WTW
At WTW (NASDAQ: WTW), we provide data-driven, insight-led solutions in the areas of people, risk and capital. Leveraging the global view and local expertise of our colleagues serving 140 countries and markets, we help organizations sharpen their strategy, enhance organizational resilience, motivate their workforce and maximize performance. Working shoulder to shoulder with our clients, we uncover opportunities for sustainable success, and provide perspective that moves you. Learn more at wtwco.com.

Media contacts
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Ileana Feoli: Ileana.feoli@wtwco.com, 212.309.5504