Large U.S. employers are expecting median healthcare costs to rise 9% in 2026, according to new survey data from the Business Group on Health.

That’s up from an 8% employer increase forecast for 2025. It also appears to be the biggest annual increase forecast that the employers have provided since 2010, when the Business Group on Health began conducting the employer surveys.

The Washington-based group represents large employers. It received 121 employer responses to the latest survey; those employers provide health coverage for about 7.4 million people in the United States.

From employers’ perspective, the biggest drivers of cost increases now are the high price and increasing plan participant use of weight loss drugs like Wegovy and Zepbound and other weight-loss treatments; increased use of other pricey therapies and treatments; and an increased prevalence of mental health conditions.

Related: As weight loss drugs take off, here’s how to maximize ROI for all employees

Driving a hard bargain over healthcare costs?

The Business Group on Health found that 34% of the employer survey participants hope to cope with the cost increases by negotiating more favorable terms with vendors.

About 22% will limit or reduce coverage for weight loss drugs, including GLP-1 agonists and related medications.

Roughly 3% are strongly considering eliminating their current health benefits programs and providing stipends that workers can use to buy their own individual health coverage.

In connection with wellness and health improvement efforts, one significant change is coming to breast cancer screenings: In 2026, about 43% of the employers surveyed will cover all breast cancer screenings, including follow-up ultrasounds and mammograms, as preventive care. That’s up from 25% this year.

Plan design can’t solve this problem

The organization also noted that the “current unfavorable environment is a call to action for bolder moves to address healthcare costs,” according to its executive summary about the report. The group suggests that employers and employees work together to manage costs.

For employers, this could include evaluating offerings and then eliminating programs and vendors that provide less value. It could also mean communicating about and urging employees to seek less expensive options for screenings and vaccines and to find providers that deliver higher-value care, according to the summary.

Business Group on Health also suggests that the pharmacy supply chain needs a “macro-level overhaul” to help control the price of drugs. Costs have been increasing for several years, the summary authors wrote, and potential tariffs and changes to Medicare and Medicaid compound predictions for 2026.

“This is not—and has not been—a situation that can be remedied by plan design changes,” the report reads. The authors urge employers to “immediately explore” other options, including non-traditional pharmacy benefits managers.

The Business Group on Health concludes its summary with a strong statement for organizations. “This once-in-a-generation combination of events places employers at a crossroads. Employers need to take broader and bolder actions for themselves and their workforce.”

7 strategies to help employers manage rising healthcare costs

In addition to the ideas above, the call to action suggests these considerations for employers:

• Explore innovative models for health benefits management.
• Be open to emerging solutions and new pharmacy benefit management strategies.
• Call on consultant partners to comprehensively assess and explain alternative health plan and PBM models, including financial implications and participant change management.
• Hold vendors accountable for performance—and eliminate underperforming programs.
• Steer employees toward high-quality providers.
• Encourage vendors to detail and demonstrate how AI and data can support employers’ goals.
• Multinational employers should evaluate the implications of rising healthcare costs in the U.S.—and globally—on their multinational strategy and ability to offer benefits worldwide.

See also: The latest trends for retaining talent in today’s uncertain economy

This article was originally published on BenefitsPRO, a sister site of HR Executive. For more content like this delivered to your inbox, sign up for BenefitsPRO newsletters here.