WTW 2026 Best Practices in Healthcare Survey: U.S. employer healthcare costs set to rise at fastest pace in more than two decades

US employers face double-digit healthcare cost hikes, with pharmacy spend driving urgent changes.

What the company is saying

WTW presents its 2026 Best Practices in Healthcare Survey as a comprehensive snapshot of escalating healthcare cost pressures on US employers. The narrative emphasizes that 86% and 83% of surveyed employers cite high-cost claimants and pharmacy spending as their top concerns, framing these as the central drivers of cost escalation. The company highlights that projected healthcare cost increases for 2027 are at 11.1% before plan changes and 9.7% after, the highest rates since the early 2000s and nearly triple wage growth. Pharmacy costs are singled out as a worsening factor, expected to rise 11.5% in 2026 from 9% in 2025, now comprising 36% of total healthcare claims. Executives Jeff Levin-Scherz and Courtney Stubblefield are quoted to underscore the need for multi-year strategies, finance involvement, and vendor accountability, while warning that blunt cost-cutting can harm employees most in need. The tone is factual but urgent, with a clear message that employers are preparing for significant, sometimes disruptive, changes to plan design, pharmacy coverage, and vendor relationships. The announcement foregrounds quantitative survey results and specific future intentions, while qualitative statements about vendor scrutiny and value are less substantiated.

What the data suggests

The disclosed figures show a rapidly deteriorating cost environment for employer-sponsored healthcare. US employers project healthcare costs to rise 11.1% in 2027 before plan changes and 9.7% after, far outpacing wage growth. Pharmacy costs are set to increase 11.5% in 2026, up from 9% in 2025, and now account for 36% of total healthcare claims. Nearly half of employers (49%) believe significant changes to their healthcare programs will be necessary within three years, up from 34% last year. Cost-shifting to employees is accelerating: 85% of employers are planning or considering raising employee premium contributions by 2028 (up from 44% today), and 71% are planning or considering raising out-of-pocket expenses (up from 30%). GLP-1 coverage for weight loss declined from 57% to 53% of employers, with 30% of those still covering considering elimination; 91% cite cost as the reason. The Net Promoter Score for pharmacy benefit managers fell from -10 in 2024 to -25 in 2026, and 64% of employers are re-evaluating PBM relationships. Employers are also planning more aggressive vendor management, with 84% considering taking health plans or vendors out to bid by 2028 (up from 39%), and 55% planning to evaluate fraud, waste, and abuse (up from 23%). The survey is based on responses from 471 employers covering 7 million people, and a parallel employee survey of 6,000 full-time workers. The data is comprehensive and supports the narrative of rising costs, eroding satisfaction, and a shift toward more disruptive cost-control measures.

Analysis

The announcement is a factual summary of WTW's 2026 Best Practices in Healthcare Survey, presenting a wide range of quantitative data on employer healthcare cost pressures, projected increases, and planned or considered actions. The tone is measured and does not overstate realised progress; most claims are survey results or projections, not promotional statements about WTW's own performance. While a majority of key claims are forward-looking (plans or considerations for 2027–2028), these are clearly presented as survey findings rather than guaranteed outcomes or company achievements. There is no evidence of exaggerated language or narrative inflation; the release does not claim immediate benefits or transformative impact for WTW. No large capital outlay or direct earnings impact is discussed. The gap between narrative and evidence is minimal, as all forward-looking statements are explicitly tied to survey responses and not positioned as realised facts.

Risk flags

• ●Healthcare cost inflation is accelerating, with projected increases of 11.1% in 2027 before plan changes and 9.7% after, the highest in over two decades. This creates substantial financial risk for both employers and employees, especially as cost growth far outpaces wage increases.
• ●Pharmacy spending is a major and growing driver of costs, with an 11.5% increase expected in 2026 and pharmacy now accounting for 36% of total claims. Employers face uncertainty in managing specialty drugs, GLP-1s, and gene therapies, which may force difficult coverage decisions and increase employee dissatisfaction.
• ●Employer willingness to shift costs to employees is rising sharply, with 85% considering higher premium contributions and 71% considering higher out-of-pocket costs by 2028. This could lead to employee pushback, reduced plan participation, or increased turnover, especially as 58% of employees prefer higher out-of-pocket costs to more restrictive plans.
• ●Vendor dissatisfaction is growing, as seen in the Net Promoter Score for PBMs dropping from -10 to -25 between 2024 and 2026, and 64% of employers re-evaluating PBM relationships. Disruption in vendor relationships may create operational risks and transition costs.
• ●Despite the proliferation of health and wellbeing vendors (average now 13 per employer), only 34% of employers evaluate clinical impact and 42% evaluate financial impact of point solutions. This suggests potential inefficiency, waste, and lack of accountability in current vendor management.

Bottom line

WTW's survey data signals a period of severe cost pressure and structural change for US employer healthcare plans. Double-digit projected cost increases, especially in pharmacy, are forcing employers to consider bolder and potentially disruptive actions, including shifting costs to employees, cutting coverage, and overhauling vendor relationships. The evidence is robust and quantitative, drawn from a large employer and employee sample, and points to a deteriorating financial outlook for employer-sponsored healthcare. While most employers prefer gradual, multi-year solutions, the magnitude of cost growth may force more immediate and aggressive measures. For investors, the most important takeaway is that healthcare cost management is entering a phase of heightened risk, with pharmacy spend and vendor performance under intense scrutiny. Watch for further announcements on realized cost-control actions, vendor contract changes, and employee response, as these will determine the pace and impact of the coming transformation.

Announcement summary

(NASDAQ:WTW) WTW released the results of its 2026 Best Practices in Healthcare Survey, highlighting that high-cost claimants and pharmacy spending are the top healthcare cost pressures for U.S. employers, cited by 86% and 83% of respondents, respectively. U.S. employers project healthcare costs will rise 11.1% in 2027 before plan changes, and 9.7% after plan changes, which is the highest rate since the early 2000s and nearly three times the pace of wage growth. Pharmacy costs are expected to increase 11.5% in 2026, up from 9% in 2025, and pharmacy accounts for approximately 36% of total healthcare claims when drugs paid through medical benefits are included. Nearly half of employers (49%) now say significant changes to their healthcare programs will be necessary within three years, up from 34% last year. Controlling costs and financial risk is the leading healthcare priority for 78% of employers, and 37% expect finance to take a larger role in managing healthcare costs over the next two years. GLP-1 coverage for weight loss declined from 57% of employers to 53%, and 30% of those still covering them are considering eliminating coverage; 91% of employers dropping or considering dropping coverage cite cost as a reason. The Net Promoter Score for pharmacy benefit managers (PBMs) fell from -10 in 2024 to -25 in 2026, and 64% of employers have taken, are planning, or are considering action on their PBM relationships. 85% of employers are planning or considering shifting costs through employee premium contributions by 2028, up from 44% today, and 71% are planning or considering shifting costs through out-of-pocket expenses, up from 30%. 41% are planning or considering eliminating some generous coverage provisions, up from 11% today. 61% of employers say they are unwilling to tolerate significant complexity and member pushback to reduce costs. 58% of U.S. employees said they would rather pay higher out-of-pocket costs than accept a plan with more restrictions. 80% of employers favor long-term, multiyear solutions over immediate savings. By 2028, 22% are planning or considering restricting eligibility, up from 13% today, and 63% are planning or considering lower out-of-pocket costs for using high value providers, up from 21%. 84% are planning or considering taking health plans or vendors out to bid, up from 39% today, 55% are planning or considering evaluating fraud, waste and abuse, up from 23%, and 38% are planning or considering cutting back the number of vendors they use, up from 14%. The average employer now works with 13 health and wellbeing vendors, up from 11 in 2022. Only 34% of employers evaluate the clinical impact of their point solutions, and 42% evaluate the financial impact. The 2026 survey was conducted between June 22 and August 7, 2026, based on responses from 471 U.S. employers with at least 100 employees, together employing 7 million people. Employee figures are from the WTW 2026 Global Benefits Attitudes Survey, based on responses from 6,000 full-time U.S. employees collected between February and May 2026. Jeff Levin-Scherz, Population Health Leader, North America, WTW, commented on the centrality of pharmacy costs and the need for employers to consider clinical programs and risk protection before making coverage changes. Courtney Stubblefield, Strategy & Specialty Leader, Health & Benefits, WTW, emphasized the need for a multi-year strategy with finance at the table and holding vendors accountable for results.

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