Costs, Coverage, Curtailment: What’s Trending in Prescription Drugs?

Prescription medication costs now make up both the fastest-growing and largest proportions of overall claim spending, and glucagon-like peptide-1 (GLP-1) drugs have made decisions about employer coverage more visible — and challenging — than ever before.

Accounting for nearly one-third of total benefit costs (29.5%) in 2025, pharmacy costs rose by 10.9% per member in 2025, according to a 2026 State of Employer Benefits Report, based on anonymous data from 1.8 million U.S. workers and released in May by healthcare and benefits administration platform Benefitfocus, a Voya company.

While pharmacy cost increases reflect broader trends, including the growing numbers of brand and specialty drugs with no generic alternatives, the growing use of GLP-1s for weight management has changed the dynamic.

“This question is playing out in public more than any other coverage decision I can remember,” said Magda Rusinowski, the vice president of Business Group on Health, a health- and benefits-focused nonprofit organization.

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• A Shot in the Arm? Ways You Can Manage Rising Pharmacy Costs

‘Wagging the Dog’

Prescription costs are projected to continue to grow. A survey of employer-sponsored health plans released in June by consulting firm Mercer found that prescription drug benefits rose about 9% in 2026, contributing to an overall 6.7% increase in total health benefit costs. The average cost of those health benefits now exceeds $18,500 per employee.

Mercer also predicted that, by 2030, 50 cents of every dollar spent on healthcare will be for some form of prescription medication, including both pharmacy medications and infusible drugs covered by medical benefits, said Alysha Fluno, the firm’s U.S. pharmacy practice leader. At the beginning of the decade, she noted this figure was around 20 to 25 cents per dollar.

“Year over year, pharmacy has outpaced the total healthcare trend for our employers,” she said. “This is no longer the dog wagging the tail; it is the tail wagging the dog.”

The GLP-1 Dilemma

While they are not the only specialty drugs driving up costs, GLP-1s are significant for both volume and visibility. Almost 6% of all American workers take the medications, according to the Benefitfocus survey. And, 5% is the median percentage of all healthcare dollars spent on GLP-1s “for a single therapy and a single drug,” said Rusinowski.

Significant numbers of employers cover GLP-1s for weight management, not just specific conditions like diabetes. The numbers vary — as many as 67% of employers, according to a May survey conducted by the Business Group on Health, while Mercer’s survey reported 49% of large employers cover the medications.

The reasons why — and the challenge for benefits managers — are clear.

“It is clinically accepted that GLP-1s may reduce future costs associated with obesity-related comorbidities,” said Amy Jo Fields, RN, CCM, RRT, a clinical underwriting consultant for stop loss at Voya. “However, the savings often occur years later, while pharmacy spend increases immediately.”

Ten percent of employers surveyed by Business Group on Health said they likely would not continue GLP-1 coverage for weight management, while Mercer’s data found 6% of large employers plan to drop coverage this year, with another 5% planning to do so in 2027. While many organizations are still determining their strategy for the next plan year, the health insurance giant Cigna recently made the decision to curtail GLP-1 coverage for its own employees.

In addition, GLP-1 coverage is changing how employers approach benefits. Decisions once made solely by the benefits team within HR now include C-suite leaders, who are weighing in on issues involving corporate culture, reputation and recruitment. Nearly 80% of employers now involve executive leadership in GLP-1 decisions, according to Rusinowski.

“With a category of drugs where coverage can be optional, the decision-makers are very different,” Fluno added. “If you’re using the benefits package as a mechanism to attract talent, the talent coordinators may want you to have coverage, but that may not align with financial conversations. It’s become an organizational decision.”

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