US employers are increasingly deferring to their advisors on benefits strategy, with the share describing their approach as "follow guidance" rising from 37% to 44% in a single year, according to Brown & Brown’s 2027 Employer Health and Benefits Strategy Survey of 998 companies with at least 200 US-based employees.
The shift reflects a broader reordering of priorities. Controlling healthcare costs is now the top employer priority, cited by 44% of respondents, ahead of controlling health benefit costs for employees (39%) and attracting and retaining talent, which ranked equally alongside organizational cost containment last year but has fallen to third.
“Just two years ago, attracting and retaining talent was employers’ top priority,” said Chana Bieker, senior vice president and national account leader at Brown & Brown. “This shift reflects the severity of evolving economic and market challenges, the mounting financial pressure organizations are under, and the growing urgency to find more sustainable approaches to healthcare spending.”
The survey, conducted by Brown & Brown, an insurance brokerage firm that provides benefits consulting services to employer clients, was fielded from July 21 to August 28.
Brown & Brown’s own analysis of its customer base projects costs will rise an average of 10% in both 2026 and 2027. That figure is consistent with Aon’s August 2026 cost analysis of more than 1,100 US employers, which projects a 9.5% increase for 2027, and Business Group on Health’s 2027 Employer Healthcare Strategy Survey of 127 employers, which put the median at 9.2%.
Pharmacy is the sharpest pressure point. The survey identifies managing overall pharmacy cost trend (46%), medication affordability (43%), and high-cost specialty drug strategy (35%) as employers’ top pharmacy concerns. That tracks with WTW’s 2026 Best Practices in Healthcare Survey, which found pharmacy costs projected to rise 11.5% in 2026 and, when drugs administered through medical benefits are included, estimated that pharmacy accounts for approximately 36% of total employer healthcare claims.
The GLP-1 picture illustrates how employers are navigating the tension between workforce expectations and budget reality. Nearly half of survey respondents (45%) cover GLP-1 medications for weight loss, but of those, 77% now have restrictions beyond standard prior authorization. Nearly half require members to meet clinical criteria above and beyond FDA labelling (45%), while 43% limit coverage to specific formulary products and 33% mandate participation in a lifestyle or weight management program.
This is an attempt to maintain access while containing the cost of a drug category that, according to survey data from the International Foundation of Employee Benefit Plans, accounted for 11.4% of annual employer claims in 2026, up from 6.9% in 2023. The restriction strategies employers are deploying now are the same conversations that advisors are walking clients through in advance of open enrollment cycles.
Cost scrutiny has not eliminated well-being investment. The survey’s cost-containment data points to where the advisory workload is growing. At least 83% of employers say they already have or plan to adopt claims, pharmacy, and clinical audits. Eighty-three percent plan to evaluate transparent PBM vendors or pricing models, while 82% are reviewing medical stop-loss plan design and conducting pharmacy RFPs. Each of those decisions requires advisors who understand PBM contract terms, formulary structures, and the legislative changes now reshaping how pharmacy benefits are priced and disclosed.
The pharmacy benefits advisor market is itself under pressure. A 2026 RxBenefits survey found three in four US employers had either changed their pharmacy benefits advisor in the past 12 months or planned to do so. The Brown & Brown data suggests those changes are happening precisely when employers most need the advisory relationship.
Well-being investment continues alongside the cost scrutiny. Seventy-eight percent of employers include well-being programs in their healthcare strategy, and 79% of those with a formal program plan to increase budgets in 2027. The focus, however, is narrowing. The share of employers with formal programs concentrated primarily on physical health rose from 36% to 47% year over year, while those maintaining a broader, multi-dimensional approach fell from 63% to 53%. That tightening reflects the same financial logic governing the rest of the survey.
