2026 Group Benefits Drug Claim Trends

TelusHelath, Express Scripts and Blue Cross all have great drug claims reports, I compared the current editions for overlapping trends.

As employers are navigating more common drugs at a higher cost, government policy changes, and new economic pressures, I’m seeing lots of discussion around how prepared are employers for the impact of GLP-1 drugs, for specialty medications, for an increase in claims from government cost shifting, and from rising mental health utilization. Now, let’s dig into these overlapping trends.

Trend 1: specialty drugs continue to drive disproportionate costs

Nothing new here! This has been true for a decade now. The difference is today we have more tools in the box to help employers looking to reduce their claim spend or reduce their claim risk exposure. In the past employers who wanted predictability, cost management and protection from catastrophic claims needed to reply on complicated drug formularies (which are becoming less complicated) or drug maximums. Today newer tools like specialty drug carve outs with the assist of a third party to find coverage else ware, is a great option to discuss along with the more common biosimilar first strategy.

Trend 2: the rise of higher cost drugs for common conditions (like the GLP-1 medications) are reshaping drug plans

All reports identify the diabetes and weight management treatments as major drivers of utilization and spending growth. Ozempic took over the #1 drug spot, making a non-specialty drug the top dog since they first entered the market. Chronic disease management and obesity treatment are becoming central benefits discussions rather than something rarely discussed. Do you add coverage for obesity drugs? How much? Should they be standard in the drug plan? What level of prior authorization should there be? There’s lot’s to consider and it’s making treatment complex for plan members to navigate.

Trend 3: biosimilars and generics are the primary cost containment tool.

​With the launch of the generic for Ozempic, mandatory generics has become a popular topic of discussion again. It’s the lowest hanging fruit for drug management and many plans still don’t utilize it.

The underlying theme here is that workforce needs are evolving as drugs have become more complex. This means that the advice from benefit advisors is becoming more comprehensive and is key to carrier fit for employers. Employers want more then help just managing claims, they need help navigating the complexities of the drug word and increasingly they want solutions that help them manage workforce health risks that could impact productivity and talent retention. All this,  while focusing on solutions that achieve long term affordability compared to simply comparing on price.