Nearly half of large U.S. employers expect to raise deductibles, copays, or other out-of-pocket healthcare costs in 2027 as benefit expenses continue to climb, according to a new Mercer survey. Total employer-sponsored health benefit costs are projected to rise 6.7% in 2026, pushing the average above $18,500 per employee.
Prescription drugs remain one of the fastest-growing expenses, with costs expected to increase about 9%. Specialty medicines, gene therapies, and GLP-1 weight-loss drugs are forcing employers to reassess coverage and tighten controls. Six percent of large employers dropped GLP-1 coverage in 2026, while another 5% plan to end coverage in 2027 or are considering it. More than a quarter have also tightened, or plan to tighten, utilization requirements.
Employers are looking beyond higher cost-sharing as they try to contain spending. Forty-one percent are evaluating alternative contracts from major pharmacy benefit managers, while 37% are considering newer PBMs. Nearly one-third already offer or plan to offer a nontraditional medical plan, such as a high-performance network or variable copay model, that lowers costs when workers use selected providers.
“Employers are using different levers to manage costs,” said Simon Camaj, U.S. Health Leader at Mercer. He said companies are combining traditional cost-sharing changes with plans designed to guide employees toward higher-value care.
Behavioral health benefits are also moving further online. Thirty-nine percent of employers offer therapy through text, 35% provide self-guided cognitive behavioral therapy, and 11% offer AI chatbot therapy or coaching.