Articles
February 10, 2026
If your benefits budget feels like it’s being quietly squeezed by a very polite boa constrictor, you aren’t alone. What was once a clinical breakthrough for diabetes has evolved into a complex financial and governance challenge for 2026.
Between the skyrocketing demand for GLP-1s (like Wegovy and Zepbound), the Trump Administration’s drug-pricing agenda, and a push for PBM transparency, HR and benefits leaders are standing at a crossroads.
To make sense of what’s at stake and what’s next, we’re here to help separate the headlines from the bottom line.
GLP-1s are Steadily Driving Costs
According to the 2025 KFF Employer Health Benefits Survey, average annual premiums for family coverage have hit $26,993, a 6% increase from 2024.
While many factors are driving that increase, GLP-1s are significant contributors for many large organizations. Recent data highlights the magnitude of the shift:
- GLP-1 drug costs now average 10.5% of total annual claims, up from just 6.9% two years ago.
- For 29% of employers, weight-loss medications alone now account for more than 15% of their total annual claims.
- 59% of employers with 5,000+ employees report that GLP-1 costs have exceeded their original projections.
The Policy Landscape: Two Trump Moves Creating Ripples
As we enter 2026, two policy moves from the Trump Administration are shifting the landscape—and seeking to put downward pressure on rising costs.
Executive Order 14273: Strengthening PBM Oversight and Fiduciary Transparency
Executive Order 14273, titled “Lowering Drug Prices by Once Again Putting Americans First,” was issued on April 15, 2025. This order focuses on the structural transparency of the pharmacy supply chain by directing the Department of Labor to propose regulations requiring Pharmacy Benefit Managers (PBMs) to disclose both direct and indirect compensation received in connection with employer-sponsored plans.
For HR leaders, this is a fiduciary matter. It establishes a higher standard for oversight, requiring plan sponsors to have a clear understanding of the fees, rebates, and spread-pricing models that define their PBM contracts.
The “Most-Favored-Nation” Order: International Pricing and the TrumpRx Framework
On May 12, 2025, the White House issued another executive order, titled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients.” This order seeks to align U.S. drug prices with the lowest prices paid in other developed nations, a concept known as “Most-Favored-Nation” (MFN) pricing.
A primary outcome of this initiative is the proposed TrumpRx direct-to-consumer channel, which the Administration has indicated is targeted for an early-2026 rollout. Under the announced framework, certain GLP-1s would be offered at roughly $350/month on a cash-pay basis once the program launches (with some Medicare pricing and benefit changes described as taking effect mid-2026).
Making 2026 the ‘Year of Clarity’ for GLP-1 Coverage
Importantly, these headline prices don’t automatically flow through to commercial employer plans. Your actual cost will still be shaped by your PBM arrangement.
That gap can create a disconnect for employees. They may hear ‘GLP-1s are now $350’ and understandably wonder why their plan has a higher copay, tighter prior authorization, or different coverage criteria.
So, how will your team handle the inevitable questions? Here are three moves to help ensure clarity for 2026:
#1 Define Your Coverage Intent
Don’t let the “denial letter” be your policy. Decide if you are covering GLP-1s for diabetes only, obesity with strict clinical criteria, or a broader wellness-linked model. Document this intent clearly so that your clinical governance aligns with your financial reality.
#2 Pressure-Test Your PBM Contract
As regulators seek to push for greater transparency, you can do the same. Ask your PBM for a “clean” accounting of:
- Definitions: Are they using “rebate” and “fee” interchangeably?
- Audit Rights: Do you have the right to see the actual math behind your specialty spend?
- DTC Integration: How will they handle employees who choose to bypass the plan and use TrumpRx?
#3 Align Expectations with Your Plan Strategy – and Communicate Them Clearly
As news of “Most-Favored-Nation” pricing and the $350 TrumpRx price point reaches the workforce, HR leaders may face increased inquiries regarding why their plan’s copays or clinical requirements differ from those headlines.
Strategic communication can help bridge this gap by shifting the conversation from the price of a transaction to the value of a clinical program. Employers have an opportunity to clarify the logic behind their plan design—explaining that while a direct-to-consumer (DTC) channel offers a lower-cost prescription, it often lacks the integrated care, health coaching, and physician oversight that a comprehensive employer plan provides.
You don’t need to discourage employees from seeking lower-cost options, but you should take steps to ensure they understand the trade-offs. While a transactional purchase via a digital platform may offer immediate savings, employer-sponsored programs are typically designed to support long-term health outcomes through medication adherence, metabolic monitoring, and nutritional support.
By framing the plan as a partner in their long-term clinical journey (rather than just a gateway to a prescription), benefits leaders can maintain trust and minimize the friction caused by external price fluctuations.
The Bottom Line
GLP-1 strategy is no longer just a pharmacy line item; it is a blend of clinical governance, financial transparency, and employee trust. By addressing the PBM economics and the “headline pricing” head-on, you can ensure your 2026 plan is defensible, sustainable, and clear to everyone it serves.
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