As Healthcare Costs Soar, Employers Search for Solutions — Including Unconventional Ones

KANSAS CITY, Mo.--(BUSINESS WIRE)--A striking new data point from the Lockton 2026 National Benefits Survey signals just how far employers are willing to go to manage rising healthcare costs: 46% of self-funded plan sponsors say they would consider international drug sourcing for pharmacy benefits — an approach that remains complex and may expose plan sponsors to legal and compliance risks if not properly designed and administered, although the risk is unclear based on the lack of regulatory enforcement.

That figure, drawn from 1,705 responses submitted by plan sponsors across industries, group sizes, and ownership structures, reflects a broader and more urgent shift in how U.S. employers are approaching benefits strategy. For the second consecutive year, reducing costs has emerged as the priority — but now by a more dominant margin: 54% of employers now identify cost reduction as the most important factor shaping their benefits decisions, up sharply from 38% in 2025. Attracting and retaining talent, which has historically rivaled cost as the top priority, has now declined to 19%.

“With projected cost trends, employers face sustained challenges heading into 2027 and beyond, as the imperative to reduce costs is increasingly dominant,” stated Shannon Demaree, Executive Vice President, People Solutions Regional Executive at Lockton. “With the labor market softening, priority on attracting and retaining talent plummeted from 44% in 2023 to just 19% in 2026, how plan sponsors are thinking has decidedly shifted. It’s a lot — organizations are grappling with cost-management strategies, striving to maintain employee experiences, ensure quality care accessibility, and limit disruptions. Employers will need to rethink traditional approaches and reevaluate their role in the healthcare landscape.”

A Wide Range of Strategies — With No Single Dominant Path

The report explores four key areas where employers are actively evaluating spend: plan optimization, network solutions, eligibility management, and pharmacy benefits. Within each, employers are weighing options ranging from foundational approaches with minimal disruption to more progressive strategies designed to achieve greater savings.

Among self-funded plan sponsors, who represent the majority of survey respondents and have the greatest flexibility to implement cost-saving measures, several tactics are already gaining traction:

• 30% offer cardiometabolic management programs beyond what’s offered by their medical carrier to help reduce high-cost claims.
• 39% are leveraging carrier narrow or high-performing networks.
• 23% are applying spousal surcharges as part of eligibility management.
• 7% are already using international sourcing for pharmacy benefits, while an additional 46% say they are considering it.

Cost Pressure Doesn't Mean Employee Impact Is Off the Table

Despite the sharp pivot toward cost management, employee impact remains a key variable in how employers are making decisions. According to the survey, 81% of respondents said employee impact is still an important consideration when evaluating changes, a finding that points to the central tension employers are trying to navigate: controlling costs without undermining the value of their benefits package or the trust of their workforce.

“The challenge for employers is not simply cutting spend,” said Chris Bartnik, Senior Vice President, People Solutions Growth and Innovation Leader at Lockton. “It's finding sustainable ways to manage cost while maintaining a competitive and meaningful benefits offering. This year's survey shows that employers are looking for practical strategies that deliver savings without sacrificing trust, access, or outcomes.”

The data suggests employers are not converging around a single solution. Instead, they are searching across multiple dimensions simultaneously, balancing potential savings against disruption, compliance considerations, and member experience.

About the Survey

The Lockton National Benefits Survey helps employers benchmark their benefits strategies against peers, identify emerging trends, and discover new approaches to plan design. The 2026 report is based on 1,705 aggregated responses collected in January and February 2026. The data above includes selected results and analysis from the compiled survey data. The full report explores additional findings on access to quality care, wellbeing benefits, and communications strategies.

For more information, please visit the executive summary here.

About Lockton

What makes Lockton stand apart is also what makes us better: independence. Lockton's private ownership empowers its 13,000+ Associates doing business in more than 160+ countries to focus solely on clients' risk and insurance needs. With expertise that reaches around the globe, Lockton delivers the deep understanding needed to accomplish remarkable results. For more information, visit www.lockton.com.