As medical costs continue to rise, employers are weighing a return to policies that shift additional expense to workers, according to a new survey.
Mercer surveyed 604 U.S.-based employers in April and May of this year and found that 48% of those with at least 500 employees are planning to make changes to their benefits in the coming year that will likely lead to higher costs for employees, such as increasing deductibles or copayments.
Some also said they're mulling new benefit designs that may help mitigate the expenses, such as high-performance networks or variable copay options. Thirty-one percent of the large employers said they plan to offer a non-traditional plan in 2027.
In addition, 38% said they are considering the addition of a non-traditional option given the cost environment, according to the survey.
“Employers are under intense pressure to manage another year of elevated health benefit cost growth, but they also know that affordability matters deeply to employees,” said Simon Camaj, Mercer’s U.S. Health Leader, in a press release.
“What we’re seeing for 2027 is that employers are using different levers to manage costs—both traditional cost-sharing tactics and strategies that guide their people to higher-value care and provide support where it can have the greatest impact," Camaj said.
Based on Mercer's most recent survey on employer-sponsored coverage, which was released in November, employers expect their benefit costs to increase by 6.7% this year, averaging more than $18,500 for each employee and growing at a rate faster than wages or inflation.
Within that, they expect prescription drug pricing to escalate even more quickly, at a 9% rate. So the pharmacy benefit space is a key area of focus for employers, particularly around high-cost and high-demand therapies like GLP-1s.
About half (49%) of large employers offered coverage for GLP-1 drugs for weight loss, but 6% said they dropped coverage in 2026 and 5% either plan to drop coverage or are actively considering it for 2027.
And while many do intend to continue coverage of these products, they're looking to tighten up utilization to manage cost. Twenty-seven percent said that they put tighter utilization controls in place this year, or plan to for 2027.
Given the pressure around pharmacy costs, specifically, some employers are exploring new relationships with their PBMs, too. For instance, 41% said they are considering new contracting models through traditional PBMs, while 27% are looking into new and emerging firms.
“The pressure created by specialty drugs, gene therapies, and GLP-1 medications is forcing employers to take a much harder look at their pharmacy strategies,” Mercer U.S. Pharmacy Practice Leader Alysha Fluno said in the announcement. “For many plan sponsors, the priority now is not just managing pharmaceutical utilization by their health plan members, but gaining more transparency, control and confidence that every dollar spent is delivering maximum value.”