Pharmaceutical Strategies Group (“PSG”), an EPIC company, today released its 2026 Trends in Drug Benefit Design Report, sponsored by Transcarent, highlighting how payers are adjusting pharmacy benefit strategies amid evolving GLP-1 utilization, heightened focus on alternative pharmacy benefit management (PBM) models, and rising pressure around drug pricing and member cost sharing. PSG’s annual research has tracked trends shaping drug benefit design and management for more than three decades.
“As drug costs climb, payers are under pressure to re-evaluate benefit design and cost management strategies,” said Morgan Lee, Vice President of Research and Marketing at PSG. “The debate around GLP-1 coverage is a prime example of the balancing act benefits leaders face as they navigate skyrocketing demand, affordability concerns, and uncertainty around long-term patient outcomes.”
Affordability and Discontinuation Rates Influence GLP-1 Coverage Decisions
Payers are expressing hesitancy around obesity-related GLP-1 coverage decisions and long-term cost management as GLP-1 indications expand and new therapies enter the market. Affordability remains a major concern: PSG’s report found that 9 in 10 respondents were moderately or very concerned about the affordability of GLP-1 therapies for the plan. The report also found that nearly half (49%) of payers who do not currently cover GLP-1s for obesity would not do so at any price.
Additionally, high discontinuation rates are now playing a major role in coverage decisions, as nearly two-thirds of patients without type 2 diabetes who take GLP-1s discontinue treatment within one year. 72% of respondents indicated that discontinuation rates and weight regain were at least moderately influential in their GLP-1 coverage decisions.
Unbundled PBM Approaches Gain Attention
With the PBM market expanding and increasing scrutiny of vertically integrated models, payers are increasingly exploring partially or fully unbundling PBM services to control costs and gain greater transparency. PSG’s report found that almost two-thirds (60%) of health plans and approximately half (51%) of employers would pursue a partially or fully unbundled PBM model if conducting a procurement today, while overall perceived value of these arrangements increased year-over-year.
“We’re seeing payers turn to carveouts and unbundled PBM models as they look for more transparency and control in how their pharmacy benefits are managed,” said Josh Van Ginkel, Vice President, Plan Sponsor Consulting at PSG. “These arrangements have the potential to reshape how organizations approach vendor coordination, pricing visibility, and benefit oversight.”
Direct-to-Consumer Offerings Bring Both Opportunities and Concerns
The rapid growth of direct-to-consumer pharmacy offerings is raising new questions for payers around member engagement and pharmacy benefit strategies.
According to PSG’s report, awareness of established programs like GoodRx is high (91%) among respondents, while familiarity with newer offerings like TrumpRx (66%) and Cost Plus Drugs (64%) is lower. Additionally, approximately half of respondents said they currently use strategies related to discount card or direct-to-consumer programs, and a similar share engages with members about these offerings in some way.
Despite growing availability of direct-to-consumer offerings, many payers are still uncertain about how they fit into their existing pharmacy benefit strategies: 65% of respondents cited member confusion as a concern regarding discount cards and direct-to-consumer pricing programs, and another 49% expressed concern about loss of claims visibility.
Payers Consider Cost-Sharing Changes and Alternative Pricing Models Amid Rising Drug Costs
In response to rising drug costs and dynamic pricing models, payers are considering changes to their cost-sharing arrangements and exploring alternative pricing models. PSG’s report found that 69% of payers are now considering changes to their cost-sharing arrangements, with higher copays, coinsurance, and deductibles among the most frequently considered changes.
The research also found that alternative pricing arrangements are drawing increased attention, with 9% of payers reporting use of a cost-plus pricing arrangement and 11% utilizing a per-member-per-month (PMPM) pricing guarantee.
The findings highlight that many organizations are still navigating limited visibility into pharmacy pricing and manufacturer revenue streams: 26% of payers were unsure which manufacturer revenue streams they currently have access to, while 24% said they have negotiated or are in negotiations for direct rebate contract carveout rights.
The report also contains a section specific to employers’ drug benefit considerations. “This report highlights the difficult tradeoffs employers face as they work to balance affordability, access, and quality,” said Snezana Mahon, PharmD, President at Transcarent. “The findings point to a growing focus on transparency, accountability, and the importance of having pharmacy at the center of an employer’s benefits strategy for better health and care.”
The full report is available here: www.psgconsults.com/2026-trends-in-drug-benefit-design-report
The 2026 Trends in Drug Benefits Report is based on a survey of 237 benefits leaders representing employers, health plans, and unions with a median of 14,000 covered lives. Additional PSG research and prior reports can be found here.
About Pharmaceutical Strategies Group (PSG)
Pharmaceutical Strategies Group (PSG) is an independent pharmacy benefits consultant, relentlessly advocating for healthcare payers as they navigate complex and ever-changing drug cost management challenges. As a strategic partner, PSG empowers clients by providing industry-leading intelligence and technologies to improve clinical outcomes and realize billions of dollars in drug cost savings for clients every year.
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