Rising drug costs and a small pool of high-cost claimants are now the main forces behind employer health benefit spend. The finding comes from the State of Employee Benefits Report 2026 by Benefitfocus, a Voya Financial company.
The report draws on anonymized data from more than 1.8 million enrollees across 316 large employers. It also pulls claims from 68 employers covering roughly 600,000 people.
The study finds that employers increasingly need help reading their own claims data, and the gap is widening.
"With rising costs, economic pressure, and growing mental health needs, employers are under real scrutiny to decide where benefit dollars will have the greatest impact," said Andrew Stocker, president of employee benefits at Voya. "The most effective organizations are using data and real employee insights to determine what to offer - and then making those benefits easy to understand and use. When benefits are aligned to actual employee needs, employers can help drive and support healthier behaviors, stronger engagement, and better productivity without simply increasing spend."
Pharmacy expenses now make up 29.5% of total claim spending in 2025. The figure stood at 27.2% a year earlier. Prescription spending rose 10.9% per covered individual, well ahead of inflation and wage growth.
Brand and specialty drugs explain much of the jump. These medications were only 14% of prescriptions filled, yet they made up 87.6% of total prescription spend.
GLP-1 medications stood out in the data. The share of members taking them rose to 6% from 5.1%. Members on the drugs cost their plans close to $7,400 a year. GLP-1s reached 20.3% of overall prescription spend, up from 17.5%.
Other research points the same way. NFP’s 2026 US Benefits Trend Report shows 70% of employers expect pharmacy cost increases, and 51% named GLP-1s as a top driver. The report also notes 29% of employees would change jobs for GLP-1 coverage. Pharmacy carve-outs to a PBM rose to 49% from 27%.
The Benefitfocus data also shows spending tightly concentrated. In 2025, 1% of members accounted for 33.4% of total medical and pharmacy spend.
Employers that worked with brokers to apply claims data fared better on cost. Their total medical and prescription spend rose just 2.4% per member, against an 8% industry average.
This 8% benchmark comes from Mercer’s National Survey of Employer-Sponsored Health Plans. Mercer projected employer health costs would pass $18,500 per worker in 2026. The forecast 6.7% rise is the steepest in 15 years, with drug spending up 9.4%.
Cost now sits above talent as the top concern. Lockton’s 2026 National Benefits Survey found 54% of employers rank cost reduction first, up from 38% in 2025. Talent retention fell to 19%. Nearly half of self-funded sponsors said they would weigh international drug sourcing.
Smaller clients depend on brokers most. A study from The Hartford found 58% of small employers turn to brokers for open enrollment guidance. The figure compares with 42% of larger employers. It also found 95% of employers upgrading their 2026 enrollment tools.
The pattern points to the value of year-round guidance. Pat Tupper, head of Benefitfocus at Voya, said the work starts long before employees pick a plan.
"Feeling confident about benefits starts with being informed, educated, and connected, not just during open enrollment, but year round," Tupper said. "Every benefits decision has the potential to affect an employee's budget and well being, and with data from more than 1.8 million enrollees, we see clearly how personalized guidance can help employees make optimal, informed choices while helping employers manage costs."
