More than a third of US employers saw health plan premiums rise 10% or more at their last renewal, even after making plan changes, according to Gallagher's 2026 Workforce Trends Report - Benefits Benchmarks. The survey drew on 3,717 US organisations polled from January to March 2026. Healthcare costs for employer-sponsored plans are projected to rise between 6.5% and 9.5% in 2026, according to separate forecasts from Mercer, PwC, and Aon - the largest projected increase in roughly 15 years. For employers that already adjusted their plan designs and still absorbed a double-digit premium increase, the old cost-management playbook is no longer sufficient.
Specialty drugs have become the most closely watched line item in employer health plans, with 49% of all employers surveyed citing rising specialty pharmaceutical costs as a top challenge. GLP-1 therapies for obesity and diabetes treatment are frequently cited as a significant contributor to that pressure.
Rather than raising employee cost-sharing, many employers are now examining PBM pricing, rebate arrangements, and formulary decisions more directly. That scrutiny has a regulatory dimension. The Consolidated Appropriations Act, 2026, signed into law on February 3, 2026, includes significant PBM reforms that will reshape how employers contract with their pharmacy benefit managers. The law requires PBMs to pass through 100% of rebates and related remuneration to ERISA-governed employer health plans, eliminates spread pricing models, and requires detailed semiannual drug pricing and compensation disclosures to plan sponsors. Most substantive provisions take effect for plan years beginning on or after January 1, 2029, for calendar-year plans - approximately 30 months after enactment. Separately, a Department of Labor proposed rule released January 30, 2026, would require PBMs to disclose all forms of compensation to self-funded employer plan sponsors, with federal officials estimating that change could save employers and workers $1 billion annually.
Those reforms change the renewal conversation for benefits brokers now, even with implementation years away. Under the new framework, employer plan sponsors carry heightened fiduciary obligation to evaluate whether their PBM arrangements will be reasonable and defensible under the incoming standards. The CAA 2026 does not require employers to become pharmacy experts, but it places a clear expectation on them to work with their brokers and benefit partners to assess compliance in advance of 2029.
"At a time when cost pressure is persistent and difficult to forecast, employers can't rely on periodic plan changes alone," said John Tournet, US CEO of Gallagher's Benefits & HR Consulting Division. "They're adopting a more disciplined approach built on stronger data, closer oversight and ongoing evaluation of plan performance."
37% of employers in the Gallagher survey now use analytics to inform workforce planning and benefits decision-making, reflecting a shift away from annual plan reviews toward continuous monitoring of claims trends, vendor performance, and emerging cost concentrations across the plan year rather than only at renewal.
Wellbeing programs face similar scrutiny. Nearly one in four employers - 23% - report that fewer than 20% of eligible employees participate in their wellbeing initiatives. Low participation is prompting many employers to integrate health and financial wellbeing support more directly into day-to-day benefit access rather than maintaining standalone programmes that few employees use.
As employers hold the line on core benefit costs, voluntary benefits are carrying more of the employee support load. Gallagher's data show 72% of employers cite offering a more complete package as a primary reason for providing voluntary benefits, with 66% citing addressing coverage gaps and 49% citing enhancing employee financial protection. The specific benefits gaining ground are telling: pet insurance is up 13 percentage points since 2023, identity theft protection up eight points, and employee perks and discount programmes up seven.
Voluntary benefit participation remains a challenge in its own right. A March 2026 survey of 170 benefits brokers conducted by the Employee Benefit Research Institute and Lincoln Financial found that administrative complexity and education gaps are the primary barriers slowing adoption - not employee disinterest or premium concerns. For brokers, that finding is specific: the value-add is not in sourcing a broader product menu but in simplifying the enrollment decision itself, giving employees a clear, targeted path through options rather than presenting them with an expanding catalogue.
The Gallagher data arrive at a moment when the benefits broker role is under direct pressure. Lockton's 2026 National Benefits Survey put cost reduction at the top of employer priorities for 54% of respondents, up from 38% in 2025, with talent attraction falling to 19% - behind cost for the second consecutive year, now by a much wider margin. That shift can narrow the conversation to quote comparison.
Employers investing in governance infrastructure, PBM oversight, and claims analytics are simultaneously creating the conditions where a broker's knowledge of vendor markets, funding strategy, and fiduciary obligation produces the most differentiated value. The broker who arrives at renewal already fluent in a client's PBM contract terms, claims trend data, and CAA 2026 compliance posture is the one whose role cannot be reduced to a competing quote.
