Sustained cost pressure is forcing employers to reassess their approach to healthcare, according to a new survey.
The Business Group on Health released its annual Employer Healthcare Strategy Survey, which found that firms anticipate a median cost increase of 9.2% in 2027. Plan changes and updates would likely offset that, resulting in an 8% increase, according to the report.
For comparison, a median trend increase of 8.5% is expected this year, with that declining to 7% after plan changes. The Business Groups surveyed 127 employers representing 11 million people across the globe, including 8.7 million stateside.
If these trends hold, it would mean healthcare costs have risen a cumulative 76% over the past decade, the Business Group found. The survey also found that actual costs have exceeded employers' predictions over the past three years, with the difference rising.
"Volatility has contributed to employers as well as the health plan and consulting partners consistently underestimating healthcare cost growth, and the gap between projected and actual costs has continued to widen," Ellen Kelsay, CEO of the Business Group, said in a call with reporters on Tuesday.
In response, employers have become more aggressive in cost-containment strategies, and high-level executives have become more directly involved in healthcare decisions, the survey found.
For example, fewer firms are covering GLP-1s for weight loss this year compared to 2025. For 2026, 60% of employers surveyed said they cover these drugs for obesity, decreasing from 72% in 2025.
Kelsay said that employers have traditionally deployed an array of tools to support weight management, but GLP-1s have dominated the conversation over the past several years, with the drugs in high demand. As the direct-to-consumer market grows, it offers an avenue for employees to obtain GLPs even if their employer no longer covers them.
"GLP-1s have been a significant factor in that affordability equation, and for many employers, they're having to make some hard decisions about maintaining the viability of their overall plan and whether or not they can do so while still continuing GLP-1s," she said.
In addition, employers are mulling the switch to independent or alternative pharmacy benefit managers to address rising pharmaceutical costs, a major driver behind the overall increase in expenses. As of 2026, just 18% of those surveyed already had a relationship with an alternative PBM in place.
However, 14% said they're adding one for 2027 and 47% said they're considering a change for 2028 or 2029, the survey found.
Similarly, 18% of the employers included in the survey had an alternative health plan on offer in 2026, and 8% said they're adding one next year. Thirty-one percent of those surveyed said they are considering an alternative plan for 2028 or 2029.
Employers are also looking at low- or underperforming vendors as they identify solutions to address rising costs. Most (95%) said they had issued a request for proposal (RFP) in at least one vendor category, with more than half (58%) saying they would replace low-performing vendors and/or eliminate programs with low utilization.
And as costs rise, healthcare is becoming more of an enterprise-wide focus and concern. Eighty-eight percent of those surveyed said that senior leadership is paying closer attention to healthcare costs and health and wellbeing programs, with 79% saying that the C-suite's expectations around results are growing.
More than half (59%) said that the chief financial officer or finance team is taking a bigger role in healthcare, and 44% said the same of CEOs. In addition, 43% said their organization's general counsel or legal team is getting more involved in healthcare.
Kelsay added that these top leaders are also increasingly concerned with regulatory or legal risks tied to healthcare, and acknowledge that healthcare represents a key facet of the broader workforce strategy for a company.
"This is all leading to increasing involvement from executive leadership," she said.