The Top 5 Pharmacy Benefits Trends Plan Sponsors Must Prepare For in 2026

By Eric Levin, CEO, Scripta Insights

2026 is shaping up to be one of the most consequential years in pharmacy benefits in decades. Costs are accelerating. New channels are exploding. And GLP-1s are rewriting every budget model in HR and finance.

One of the biggest operational headaches will be something most plans are not prepared for: helping members navigate the growing confusion caused by cash-pay and direct-to-consumer (DTC) drug programs. With TrumpRx and others promising “massive savings,” employees will be more focused on their out-of-pocket costs than ever—and more frustrated when the system doesn’t make it easy.

For plan sponsors, HR leaders, and pharmacy executives, the challenge—and the opportunity—is the same: 2026 will reward those who get ahead of the disruption and stay relentlessly focused on the member.

Here are the five trends that will define pharmacy benefits in 2026, and what forward-thinking benefits leaders should be doing now.

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1. GLP-1 Overspend Moves from Crisis to Enterprise Priority

What started as a budget shock has become a multi-year enterprise risk.

In 2026, employers will face:

• Structural demand that isn’t slowing

• New entrants (oral GLP-1s, combination therapies, maintenance drugs)

• Mounting pressure to cover weight management as a standard benefit

• Rising employee expectations that these drugs are foundational to well-being—not optional

GLP-1 cost containment will move from a utilization tactic to full-funnel GLP-1 governance: optimization pathways, clinical accuracy, discount strategies, alternative channels, and continuous member navigation.

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2. Cash-Pay, MCCPD & Manufacturer-Direct Pricing Go Mainstream

2024–2025 was the experimentation phase.

2026 is the adoption phase.

Employers will increasingly lean on:

• Mark Cuban Cost Plus Drug (MCCPD)

• Manufacturer-direct programs (Lilly Direct, NovoCare, TrumpRx)

• Discount cards

• Cash pay when it beats insurance (which is shockingly often)

• Off-plan payment programs like RxSaveCard

PBMs will push to keep these channels.

Plan sponsors will need integrated cash-pay visibility inside their navigation platforms so members know when to use insurance, when to use cash, and how to make informed decisions.

If not managed properly, 2026 will become the year of cash-pay chaos.

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3. The Rise of Hybrid Pharmacy Benefits: Insurance + Cash + Direct + AI

2026 is the first year every employer will confront this reality: The “pharmacy benefit” is evolving away from a single channel.

It is becoming:

Insurance + Cash Pay + Direct-to-Manufacturer + Discount Networks + AI Guidance + Clinical Governance

Organizations that manage these channels as one integrated system for members will dramatically bend trend.

Those that don’t will see costs accelerate faster than ever.

This hybrid future is exactly why we built Scripta the way we did—clinically rigorous, channel-agnostic, data-transparent, and member-first.

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4. The Biosimilar Wave Hits Phase 2—With New Winners and Losers

2026 will bring:

• Highly impactful biosimilar launches

• Major disruption in oncology and autoimmune categories

• New payer strategies to drive adoption

• Pricing battles that create massive savings—if plans can identify and activate them

• Supply shortages

Plan sponsors will need targeted navigation campaigns to accelerate adoption of strategically preferred drugs that lower total plan cost.

Campaigns that include member incentives, particularly when manufacturer copay coupons already reduce OOP costs to near zero, will become an increasingly important tool to drive alignment and behavior change—without creating member confusion or provider friction.

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5. AI-Driven Pharmacy Navigation Becomes a Must-Have

2026 is the year Rx Navigation stops being a buzzword and becomes a critical operational requirement.

Why?

Because the complexity is now unmanageable without it.

Employers will expect:

• Automated identification of therapeutic alternatives

• Real-time price optimization

• Closed-loop reporting

• Clinical verification at scale

• Personalized member guidance

The companies that win will be those with doctor-driven + AI-powered models—and those that can keep pace with rapid innovation while continuously integrating market change into their clinical logic and member experience.

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Where This Leaves Employers Going Into 2026

By the time 2026 arrives, plan sponsors will no longer be debating whether pharmacy needs to be actively managed—they will be deciding how sophisticated their management strategy needs to be to stay ahead of trend.

The employers who win in 2026 will be those that:

• Treat GLP-1s as an enterprise-level financial and clinical category, not a utilization side project

• Build a deliberate strategy for cash-pay, manufacturer direct, and off-plan funding, instead of letting employees figure it out on their own

• Design benefits for a hybrid pharmacy world, not a single PBM channel

• Use AI and clinical intelligence to manage complexity at scale

• Actively steer behavior through navigation and incentives, not just formularies and prior auth

• Measure success by member outcomes and validated financial impact, not theoretical “savings”

Those who wait will continue to experience rising trend, growing member confusion, and shrinking control over one of the fastest-growing areas of healthcare spend.

2026 is the year pharmacy permanently shifts from a back-office benefit to a front-line strategic lever.

The only real question is whether employers lead that shift—or react to it.