PSG announces the results of its extensive research on the latest trends in drug benefit design.
Plan sponsors face complex decisions and challenges as they build and implement their drug benefit. PSG’s 2026 Trends in Drug Benefit Design Report provides a view into how plans work to achieve access and affordability for members while controlling their pharmacy spend.
The report contains valuable insights from benefits leaders representing plans nationwide.
Key Findings
- Unbundled PBM Service Arrangements: Payers’ perception of value in unbundled PBM service arrangements increased year-over-year, and over half say they would pursue a partially or fully unbundled model if they were to conduct a procurement today
- GLP-1 Therapy Coverage: Affordability continues to be a major concern for coverage of GLP-1s for obesity, but half of payers who don’t cover these drugs would not do so at any price, and high discontinuation rates are playing a substantial role in coverage decisions
- Alternative Pricing Models: 1 in 10 payers have a cost-plus arrangement or PMPM pricing guarantee, and the primary factors influencing decisions about these alternative pricing models are impact on total net pharmacy cost and member affordability and experience
- Cost Sharing: Many payers are contemplating increasing cost sharing for members, and while cost-sharing transparency tools aim to help members manage their cost sharing, most payers perceive only moderate value in these tools and believe they are used by small percentages of members
- Direct-to-Consumer Offerings: Approximately half of payers currently use strategies related to discount card or direct-to-consumer offerings and/or in some way engage with members about them
- Employers’ Fiduciary Responsibility: To meet their fiduciary responsibility, a growing percentage of employers are periodically evaluating the competitiveness of their PBM and performing PBM audits
Join our webinar later today to review key findings with our expert team. Register here!
Thank you to our research ambassadors:
