Exclusive research: Benefit leaders face a pharmacy cost crisis in 2026

• Key Insight: Learn why employers favor utilization tactics over structural PBM reforms despite rising specialty drug spend.
• What's at Stake: Unsustainable specialty medication costs could erode benefits budgets and employee affordability.
• Supporting Data: 69% include pharmacy in medical plans; only 16% use pass-through PBMs.
• Source: Bullets generated by AI with editorial review

As employers head into 2026, managing pharmaceutical costs is becoming increasingly complex, driven by a convergence of rising drug prices, increased utilization of specialty medications, and continued friction within the pharmacy supply chain. 

Benefit managers are under pressure to balance cost containment with employee access and affordability, particularly as high-cost specialty medications account for a growing share of total pharmacy spend. At the same time, limited pricing transparency, rebate structures and contractual constraints with pharmacy benefits managers make it difficult for employers to fully understand where dollars are being spent — or where savings opportunities may exist.

Compounding these challenges are shifting employee expectations and regulatory uncertainty. Employees increasingly expect seamless access to medications, predictable out-of-pocket costs, and support for chronic conditions, while employers must evaluate alternative pharmacy models, clinical programs, and vendor partners with limited internal resources or expertise. As a result, many organizations find themselves aware of emerging strategies but slow to adopt them, creating a gap between interest and execution. 

Read more: 2026 healthcare trends: How access to better data can redefine benefits

Against this backdrop, EBN's exclusive research reveals how employers are currently navigating pharmacy cost management — and where challenges remain most pronounced. The EBN Pharmacy Management survey was fielded online during June and July, 2025 among 139 benefits professionals working at organizations with at least 50 employees. All respondents have responsibility or oversight into benefits and/or total rewards. Read on for more insights about cost containment and the trends shaping strategies for 2026 and beyond. 

Employers are bundling pharmacy costs into medical spend

Most employers continue to manage pharmacy costs through traditional, bundled approaches, with 69% currently including pharmacy coverage within major medical plans and 50% partnering with a traditional pharmacy benefits manager (PBM). While awareness of alternative strategies is growing, adoption remains relatively limited. Only 16% currently use a transparent or pass-through PBM, and 13% participate in coalition purchasing or group captives, though roughly one-third of respondents are aware of these options but not actively exploring them. 

Direct contracting with local or independent pharmacies and international pharmacy programs see even lower current usage, with many employers either only aware of these models or not aware of them at all. Overall, the data suggests employers largely rely on established pharmacy management models, while newer or more innovative cost-containment strategies remain in the exploratory or awareness phase rather than widespread implementation.

Generic drugs are the key to cost reduction

The chart reveals that employers across all organization sizes are most likely to focus on utilization and prevention-based strategies rather than structural changes to their pharmacy benefit models. Encouraging the use of generic drugs is the most common action, particularly among mid-sized employers, with roughly two-thirds to three-quarters reporting this approach. Many organizations are also investing in integrated well-being and preventive care programs and incentivizing preventive care to reduce long-term drug costs, with adoption generally increasing as company size grows.

Larger employers (2,000+ employees) are significantly more likely than smaller organizations to renegotiate terms with PBMs or brokers, adopt transparent or pass-through PBMs, or create separate plans to manage pharmacy costs, highlighting their greater leverage and resources. Overall, the data suggests employers prioritize incremental, lower-friction cost controls, while more complex or aggressive pharmacy management strategies are largely concentrated among the largest organizations.

Stay tuned for part 2 of this research, on how the increased popularity of GLP-1s and menopause medications will shape budgets in 2026.