PBGH survey finds employers bracing for higher health premiums in 2026

• Key Insight: Learn how employer purchasers are leveraging transparency to shift healthcare buying strategies.  
• What's at Stake: Unchecked pricing volatility threatens employer budgets, plan design, and competitive labor costs.   
• Forward Look: Prepare for stricter PBM oversight under the Consolidated Appropriations Act 2026.
  Source: Bullets generated by AI with editorial review

Healthcare affordability remains the top concern for U.S. employers, with growing demand for transparency, according to a new report.

The Purchaser Business Group on Health's (PBGH) annual member survey reveals growing frustration over the persistent rise of healthcare premiums, which are expected to increase 6% to 7% in 2026 with some individual market plans going up by more than 20%.

According to the survey, 37% of members are conducting a medical request for proposals this year with another 23% pursuing a pharmacy RFP. Meanwhile, 27% of members are already using a nontraditional pharmacy benefit manager. 

With the passage of the federal Consolidated Appropriations Act 2026, which expands transparency and oversight of pharmacy benefit managers, pharmacy benefit reform remains a top priority for both policymakers and purchasers as they seek to rein in rising costs.

"These priorities coupled with the growing frustrations our members are expressing should be a wake-up call for many healthcare stakeholders who think the status quo is acceptable and that the days of blank checks will never end," Elizabeth Mitchell, president and CEO of PBGH, said in a press release. "Getting access to price and quality data to effectively evaluate whether employers and families are paying a fair price for healthcare services is still too hard, but PBGH and our members are taking action to combat these challenges."

Read more: How much employees pay for healthcare, by industry

The Purchaser Business Group on Health is a nonprofit coalition of nearly 40 of the nation's largest public and private employers and healthcare purchasers. Collectively, its members spend more than $350 billion annually providing coverage for roughly 21 million workers and their families.

The group focuses on improving healthcare affordability, transparency and quality by helping employers use data, purchasing strategies and policy advocacy to challenge rising costs. 

"Thanks to new legislation and transparency requirements, the days of rising healthcare costs with little to no accountability are rapidly coming to an end," Michael Costello, PBGH board member and total rewards commercial strategy director for NextEra Energy, said in the release. "Employers are taking their fiduciary obligations seriously, innovating their procurement strategies and seeking aligned partners that are truly interested in working to address employer needs, not just to maximize their own profits."

Other top concerns

In addition to affordability, PBGH members cited data and transparency as top concerns. Healthcare pricing varies significantly among providers and across geographic areas, with little to no correlation to the quality of services, according to a recent PBGH data project. 

As transparency data expands, employers are putting it to work in their purchasing strategies, from bundled payments and direct provider contracts to centers of excellence models.

Read more: Double-digit healthcare costs are here: 5 strategies for benefit managers to regain control

Advanced primary care also remains a top priority as benefits leaders focus on making preventive care easier to access and better coordinated with behavioral health services.

"The 2026 survey is an affirmation of our strategic road map," Mitchell said in the release. "PBGH's initiatives include tactical programs and services that focus on affordable, high-quality, whole-person health, to establish fair pricing, ensure accountability and enable fiduciary success; we'll be continuing to work with members to develop and refine these tools to enable them to fully leverage all newly available data and resources at their disposal."