Six of 26 years: The biggest focus of welfare leaders entering the 2026 program

Welfare leaders of the country’s largest employers are managing a significant increase in health care costs, which is driving changes in their design of health benefits products. I've talked to more than 100 welfare leaders in recent months, and one topic is clear: employers are willing to make bold moves and consider the methods they've been fired before. The days of layering on new plans and hoping they drive engagement are over. What is their focus now? Fewer high-impact solutions can improve employee health and provide hard savings. For many, this means eliminating the solution.

It's difficult, but the beneficiary leaders shouldn't let themselves be consumed by hot ass issues in the news cycle, such as GLP1, cell and gene therapy and cancer. These are an increasing source of spending, but they are also sources of difficulty in controlling costs, so they are not the first places to seek to bending the cost curve. Employers need a strategy, but these buckets are more about the benefits of cultural and health outcomes than reducing spending. To do this, the biggest leverage you can pull is the cost driver that can affect, while the drives that jump out of the page are surgery and infusion. Control these and you reduce a lot of waste, reduce costs and improve employee experience.

If you still evaluate the benefits as you did five years ago, you are already behind. Here are six ways to succeed.

Trust responsibility

Trust pressure is being established for employers. The new government shows that they want to be aggressive in many ways, including price transparency, PBM reform and preventive services. President Trump signed 76 execution orders in his first 100 days, more than any incumbent president since 1985. He also raised regulations while launching regulators, confusing many. Welfare leaders told me they are on the offensive to strengthen their trust governance, including: similar to committees that manage executive compensation; trust training; adding insurance policies; adding external reviews even with a strong internal team; and running more vendor reviews.

Less more

Welfare teams have been under pressure for years to increase their investment in total rewards programs to remain competitive. But the increase in historical trends is threatening this approach. In fact, more options don't always translate into better results. Employers are connecting with solutions that fail to show hard ROI, and tend toward a “less is more” strategy – prioritizing quality over quantity.

Leaders are also prioritizing stronger marketing and communication programs to ensure their employees know what benefits are and how to use them. One of them told me: “We are great interest leaders, but we have to start thinking like great marketers.”

Rethinking Professional Care: A New Cost Containment Approach

Professional care is 50% – 2 times the pharmacy spending of employers and grows at a faster rate, but few people have designed professional care strategies. This is one of the only benefits you can implement that affects a small portion of the population – only professional care is required in a given year – savings can be doubled compared to more destructive changes such as PBM or carrier changes that affect 100% of the population. Employers are increasingly moving towards complementary professional networking and mandatory program design, with spinal surgery, joint replacement and bariatric surgery leading the way. Companies that mandate the excellence network have seen monthly savings for over $50, while also improving clinical outcomes.

GLP1 – Should we, or shouldn't?

Bariatric surgery is the gold standard for weight loss, but one of the consultants I spoke with, we respected it very much and predicted that the surgery will not exist by 2031. With 50% of Americans expecting a BMI greater than 30 by 2030, our obesity problem will get worse and then get better.

GLP1 leads the conversation, but half of the welfare leaders I talked to this year are not covering weight loss. Many are really not excited about it and can blame them, and the compliance rate is about 30% after 3 months. According to a recent study published by JAMA, the price of GLP-1 must drop to $70 per week, almost three times the cost – which can be interrupted even during bariatric surgery.

GLP1 will continue to get better and be approved for more indications, but will be injected daily on its own. Combining side effects and monthly costs, this becomes the disadvantage that can outweigh the advantages of weight loss. Ozempic will become universal in 2031, but oral delivery is still a bit far away. The FDA has removed the shortage tag on Semaglutide, so compounds should not be able to be distributed (execution is still a problem), meaning at least for now the pressure on large-scale pharmaceutical discounts can be at least reduced.

I work in professional nursing, sleep, mental health and pharmaceutical work, and I always say that – behavior change is hard; it's really hard. Most people on GLP1 don't change their behavior, such as eating better/less or exercising more. If this is the case and you want to keep weight loss, you must keep the medication permanently. And, if 70% exits, no one will see downstream benefits such as reduced cardiovascular risk, reduced A1CS, etc. I think bariatric surgery will stay here for a while and employers should look closely at how they cover these surgeries. This year, we have 50% of new customers started as required programs.

Hospitals are the real cost driver

Pharmacy is subject to a lot of responsibility, but don't ignore the price you get from some of the major health systems. Some hospitals charge 300-500% medical insurance rates, but their pricing power is still not examined. Due to the lack of centralized population density, it is difficult for even the country’s largest employers to affect major hospital systems. Employers and unions are taking a bolder stance – removing specific health systems from their networks to control costs and work with direct contract partners who can mass-sized mass-distributed employer populations in the same geographical location for better negotiating capabilities. And, if Medicaid is cut (expected), hospitals will seek their commercial payers to cover lost income, meaning employers will see higher hospital prices.

Emerging Therapies

GLP1-S is a hot topic today, but cell and gene therapy and CAR-T therapy are tomorrow. A welfare leader called them a “Category 5 hurricane only at sea.” As these therapies advance, employers can greatly improve their health for patients with some of the most difficult conditions to treat, including genetic diseases and rare cancers. Last year, the FDA approved 38 CGTs, which are expected to grow to 50 in 2026.

Employers want to do the right thing and provide new treatments for employees. But because these groundbreaking treatments range from hundreds of thousands to millions of dollars, the cost is a real problem. A welfare leader told me: “We have the opportunity to make a big impact, but we have to start preparing immediately. This is a professional pharmacy problem 15 years ago.”

2026 is a year of influence. Employers who embrace this transformation will not only control costs, but will also establish truly effective welfare strategies, namely their people and their bottom line.

Photo: DNY59, Getty Images

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