Prescription Drug Costs Becoming a Major Challenge for Employer Health Plans
|April 29, 2026


How some employers are tackling the challenge
For many employers, managing the cost of health benefits has always been a balancing act. Companies want to offer competitive coverage that supports employee health and retention, but they must also keep benefit costs sustainable. In recent years, one area has become increasingly difficult to control: prescription drug spending.
While overall healthcare costs continue to rise, prescription drugs—particularly specialty medications—are now one of the fastest-growing components of employer health plan costs. As a result, many employers are rethinking how pharmacy benefits are designed and managed.
Prescription Drug Costs Are Rising Faster Than Overall Healthcare Spending
Recent employer health benefit surveys show that prescription drug spending is not only rising—it is growing faster than overall healthcare costs in many employer-sponsored plans. Pharmacy expenses have become one of the most rapidly increasing components of employer healthcare spending.
For example, Mercer’s National Survey of Employer-Sponsored Health Plans found that prescription drug spending increased about 9.4% among large employers in 2025, while the overall cost of employer health benefits rose about 6% per employee.
Several factors are contributing to this trend. New medications are entering the market at higher price points, more patients are using specialty drugs to treat complex conditions, and certain high-demand medications have become widely prescribed in recent years.
Specialty medications in particular play a large role. Although they represent a relatively small share of prescriptions, they account for a significant portion of total drug spending because of their high cost.
For employers sponsoring group health plans, this means pharmacy benefits can have an outsized impact on overall healthcare spending. Even a modest increase in prescription drug utilization—or the addition of a single high-cost therapy—can noticeably affect premiums and total benefit costs.
Specialty Drugs Drive a Large Share of Spending
One of the biggest drivers of prescription drug costs is the growing use of specialty medications. These drugs are often used to treat complex or chronic conditions such as cancer, autoimmune disorders, multiple sclerosis, and rare diseases.
Although specialty drugs represent a small percentage of total prescriptions, they account for a disproportionate share of overall drug spending. Many of these medications can cost tens of thousands of dollars per year for a single patient.
For employer-sponsored health plans, this means that even one or two employees requiring specialty medications can significantly increase pharmacy costs.
New Drug Categories Are Increasing Demand
In addition to specialty medications, newer categories of drugs are also attracting attention from employers and health plans. One example is the growing use of GLP-1 medications that are used to treat diabetes and obesity.
Drugs in this category have shown promising health outcomes for many patients, but they also come with substantial costs. Some treatments can cost hundreds or even thousands of dollars per month without insurance discounts.
As a result, employers are evaluating whether and how to cover these medications. Some plans cover them broadly, while others apply additional medical criteria or prior authorization requirements.
Increased Focus on Pharmacy Benefit Management
Another area receiving attention is how prescription drug benefits are administered. Most employer health plans rely on pharmacy benefit managers (PBMs) to negotiate prices with manufacturers, manage formularies, and process pharmacy claims.
However, there has been growing discussion about transparency in the PBM system. Employers and policymakers are increasingly interested in understanding how rebates, discounts, and pricing structures affect the actual cost of medications.
In response, some employers are exploring new PBM arrangements that emphasize clearer pricing models and greater visibility into drug spending.
Strategies Employers Are Using to Manage Costs
To address rising prescription drug spending, many employers are adopting new pharmacy management strategies. These approaches aim to balance cost control with appropriate access to medications.
Some common strategies include:
- Encouraging the use of generics and biosimilars. These alternatives can provide similar therapeutic benefits at a lower cost than brand-name medications.
- Prior authorization and step therapy. These programs help ensure that lower-cost treatment options are considered before higher-cost medications are approved.
- Specialty pharmacy programs. These programs help control costs by directing certain high-cost medications to pharmacies that may have negotiated pricing with manufacturers or pharmacy benefit managers. These pharmacies also provide clinical oversight and patient support to help ensure medications are used appropriately and efficiently.
- Employee education. Helping employees understand how their pharmacy benefits options, such as using preferred pharmacies or choosing generic medications, can also reduce overall plan costs.
Looking Ahead
Prescription drug costs will likely remain a major topic in employer health benefits discussions. As new therapies continue to emerge and demand for certain medications grows, employers will need to carefully evaluate how their pharmacy benefits are structured.
The challenge is finding the right balance: controlling costs while ensuring employees have access to the medications they need to stay healthy.
For employers, working closely with benefits advisors, pharmacy benefit managers, and carriers can help identify strategies that support both goals. By taking a proactive approach to pharmacy management, companies can better navigate one of the fastest-growing areas of healthcare spending.
Sources:
Mercer. 2025 National Survey of Employer-Sponsored Health Plans.
Business Group on Health. 2025 Employer Health Care Strategy Survey.
Kaiser Family Foundation (KFF). Employer Health Benefits Survey.
Healthcare Finance News. “Employers anticipate 6.7% jump in health benefits costs, finds Mercer.”
HR Dive. “Employers, workers to face healthcare ‘affordability crunch,’ Mercer warns.”




