5 Pharmacy Benefit Trends to Watch in 2026

The pharmacy benefit landscape is changing faster than ever. Drug prices are climbing, new federal policies are reshaping the market and specialty therapies are redefining what “high cost” really means. As 2026 approaches, plan sponsors will face the challenge of balancing cost control with the growing demand for transparency, while keeping both budgets and member outcomes in focus. 

Achieving that balance will take more than just awareness. It calls for proactive, insight-driven strategies that anticipate policy changes, pricing shifts and the continued evolution of specialty drugs.  

To help you navigate this evolving environment with greater visibility and confidence, we’ve outlined five pharmacy benefit trends that will define 2026. 

TREND 1: ESCALATING DRUG COSTS  

GLP-1 Drugs: Few medications have disrupted the pharmacy benefits industry like GLP-1s, and their influence is expected to grow. Drugs like Ozempic^® and Wegovy^® have surged in demand for weight management, doubling their share of pharmacy spend from 9% to 17% in just two years.¹ Employers will face ongoing pressures to balance access with affordability, especially for weight-loss and chronic condition management.   

Emerging Therapies: Cell and gene therapies also pose major financial risks. Nearly 73% of plans expect a moderate to major budget impact within the next two to three years.² Yet many employers still lack the infrastructure or financial protection to manage these high-cost treatments.   

Biosimilars: While biosimilars offer a promising cost-saving potential — typically 15–35% lower than biologics — their adoption remains slower than expected, as prescriber confidence and market education continue to evolve.  

Tariff Impact: The recently announced 100% tariff on branded and patented pharmaceutical imports, effective October 1, 2025, is expected to have far-reaching implications for drug prices and supply chains.³ Even with exemptions and pending legal challenges, branded drugs account for 90% of total drug spending, despite representing only 15% of prescriptions.⁴   

Inflation and Benefit Cost Pressures: Plan sponsors anticipate the steepest increase in health benefit costs in more than a decade. Industry reports project an average of 6.5% increase in 2026, driven by inflation and specialty trends. Some forecasts expect double-digit inflation projected for 2026.⁵ 

The drivers behind rising drug costs are only gaining speed. That’s why managing trend over time, not just today’s costs, will be critical in 2026. With the right pharmacy benefit manager (PBM) partner, plan sponsors can stay ahead of these pressures and build more sustainable benefit strategies. Discover how Navitus helps clients create measurable value and achieve lasting cost control in our latest article – Trend Over Time: Saving Money Isn’t a Race, It’s a Marathon 

TREND 2: INCREASED REGULATORY FOCUS ON DRUG TRANSPARENCY  

Regulators are sharpening their focus on transparency and accountability in drug pricing. More than 23 states have enacted drug transparency laws. In addition, 12 states have created prescription drug affordability boards to review the costs of specific prescription drugs.⁶   

At the federal level, new U.S. Department of Health and Human Services (HHS) rules that took effect on October 1, 2025, now require real-time access to prescription drug pricing and coverage information while streamlining prior authorization processes.⁷  

As regulation advances, transparent PBM models will no longer be a preference, they will be the industry standard. At Navitus, transparency isn’t new – it’s what we’ve championed for more than twenty years. It’s only now that the rest of the industry is catching up.  

TREND 3: MEDICATION COST BURDEN SHIFTING TO MEMBERS  

Despite new measures aimed at improving affordability, members are expected to pay a larger share of medication costs in 2026. The new $2,000 out-of-pocket cap under the Inflation Reduction Act (IRA), effective this year, was designed to lower costs for Medicare beneficiaries. While it provides relief for those with the highest drug expenses, most beneficiaries won’t reach that threshold and may actually see their costs go up.⁸  

Moreover, in mid-2025, the “One Big Beautiful Bill” introduced widespread coverage losses for individuals under Medicare and Medicaid. As overall drug prices continue to climb, commercial health plans and plan sponsors are likely to shift more costs to members, by increasing copays, coinsurance or deductibles, to offset the pressure.⁹  

TREND 4: GROWING CONSUMER ADVOCACY FOR LOWER COSTS AND DIRECT-TO-CONSUMER OPTIONS  

As out-of-pocket costs rise, consumers are looking for new ways to cover their medication expenses. Discount cards, patient assistance programs or manufacturer copay assistance programs are expected to see higher utilization in 2026. 

Adding to this momentum, the federal government has announced plans to launch TrumpRx.gov in 2026 — a direct-to-consumer website intended to connect patients with manufacturer discounts outside standard pharmacy benefits.¹⁰ While the long-term impact remains uncertain, it signals a broader shift toward greater consumer control and price transparency across the market. 

TREND 5: NONTRADITIONAL AND UNBUNDLED MODELS GAINING TRACTION  

New Cost-plus Models: Following the launch of Mark Cuban’s Cost Plus Drug Company, major pharmacy chains are adopting similar cost-plus models to provide greater transparency and better align actual costs and fees. Notably, effective January 1, 2026, Navitus clients will gain access to NavitusClear with Costco Cost Plus — an exclusive cost-plus pricing model that will deliver full visibility into drug acquisition costs, known markups and dispense fees, setting a new benchmark for clarity in pharmacy benefits. 

Unbundling of Pharmacy Services: Health plans are breaking free from the traditional “all-in-one” PBM approach. About 10% of health plans are exploring modular, unbundled models.¹¹ Rather than contracting with a single PBM for all pharmacy services, leading health plans — including Blue Shield of California — are unbundling traditional pharmacy benefit functions, such as rebates, adjudication, retail, mail and specialty pharmacy, to achieve greater savings.  

Medical Specialty Carve-outs: With specialty medications now accounting for more than half of total pharmacy spend,¹² plan sponsors are rethinking how they manage drugs billed under the medical benefit. Carve-out models are emerging as a smarter path forward, providing the visibility and oversight needed to control trends. At Navitus, we’ve been ahead of that movement. Through Archimedes, our medical specialty management solution, plan sponsors gain the clinical insight and cost control needed to manage high-cost therapies more effectively. 

PREPARE YOUR PHARMACY BENEFIT STRATEGY 

In a year defined by change, clarity will be the difference between short-term fixes and sustainable solutions. For plan sponsors, now is the time to reassess whether your PBM’s incentives truly align with your plan’s goals.  

LOOKING AHEAD 

The pharmacy landscape will keep shifting, but with the right PBM partner you can stay ahead of every turn. At Navitus, we deliver 100% clarity, alignment by design and the lowest net cost, empowering plan sponsors to be better positioned to control costs and deliver lasting value to their members.  

Prepare your plan for success in 2026 and beyond. Reach out to us at [email protected] to get started. 

References

1. Harris C. How rising drug costs are reshaping employer health plans. CBIZ. Published May 21, 2025. Accessed October 23, 2025. https://www.cbiz.com/insights/article/how-rising-drug-costs-are-reshaping-employer-health-plans 
2. Pharmaceutical Strategies Group (PSG). Press release: 2025 trends in Specialty Drug Benefits Report. Published April 28, 2025. Accessed October 23, 2025. https://www.psgconsults.com/press-release/payers-seeking-innovative-solutions-to-control-specialty-drug-costs-as-pharmacy-benefit-landscape-evolves-rapidly/ 
3. Saraceno N. Trump announces 100% tariff on branded drugs unless pharma builds US plants. Pharmaceutical Commerce. Published September 26, 2025. Accessed October 23, 2025. https://www.pharmaceuticalcommerce.com/view/trump-100-percent-tariff-branded-drugs 
4. Winny A. Tariffs and U.S. drug prices. Johns Hopkins Bloomberg School of Public Health. Published June 17, 2025. Accessed October 23, 2025. https://publichealth.jhu.edu/2025/tariffs-and-us-drug-prices 
5. HUB International. 2026 employee benefits cost trends report. Published August 12, 2025. Accessed October 23, 2025. https://www.hubinternational.com/blog/2025/08/2026-employee-benefits-cost-trends-report 
6. Ingram HR, Wetzel M, Strauss A. State drug transparency laws: 2025 update. Goodwin. Published June 2, 2025. Accessed October 23, 2025. https://www.goodwinlaw.com/en/insights/publications/2025/06/alerts-lifesciences-state-drug-transpar… 
7.  U.S. Department of Health and Human Services. Americans to gain new access to real-time prescription drug price information. Published September 2, 2025. Accessed October 23, 2025. https://www.hhs.gov/press-room/hhs-prescription-drug-price-transparency-rule.html 
8. Trish E, Blaylock B. Shifting cost-sharing burden to beneficiaries in Medicare Part D. USC Schaeffer Center for Health Policy & Economics. Published June 19, 2025. Accessed October 23, 2025. https://schaeffer.usc.edu/research/cost-sharing-burden-medicare-part-d/ 
9. Lee M, Gregg R, Herbert-Silvia B, Lonergran M, Medel M. 2025 trends in drug benefit design report. Pharmaceutical Strategies Group (PSG). Published June 10, 2025. Accessed October 23, 2025. https://www.psgconsults.com/industry-report/2025-trends-in-drug-benefit-design-report/ 
10. Lupkin S. President announces Trumprx website for drugs, and pricing deal with Pfizer. NPR. Published September 30, 2025. Accessed October 23, 2025. https://www.npr.org/sections/shots-health-news/2025/09/30/nx-s1-5558432/drug-prices-trumprx-pfizer 
11. Mercer. Survey on health & benefit strategies for 2026. Mercer. Published 2025. Accessed October 23, 2025. https://www.mercer.com/en-us/insights/total-rewards/employee-benefits-strategy/2026-benefit-strateg… 
12. Navitus. 2024 drug trend report. Published 2025. Accessed October 23, 2025. https://navitus.com/drug-trend-reports/2024-snapshot/2024-biosimilars/