How to evaluate, optimize, and plan your pharmacy benefits for 2026 with a trusted Pharmacy Benefit Solutions partner
Table of Contents
- Why 2026 pharmacy benefits planning matters
- Step 1: Assess your current pharmacy benefit plan
- Step 2: Compare PBMs vs. Pharmacy Benefit Solutions
- Step 3: Optimize with an Rx Optimization Program
- Step 4: Align benefits with employee needs
- Step 5: Build your 2026 Pharmacy Benefits checklist
- Conclusion: Preparing for 2026 and beyond
- Key Takeaways
2026 pharmacy benefits planning: What employers need to know now
Pharmacy benefits are no longer a back-office detail, they are now one of the largest and fastest-growing components of employer health plans. Over the past few years, employers have faced escalating costs driven by specialty drugs, breakthrough therapies like GLP-1 medications, and increasingly complex PBM contracts. At the same time, employees expect more affordable, transparent, and accessible coverage that supports their health and well-being.
The financial pressure is real. According to IQVIA, prescription drug spending in the U.S. is projected to reach $605 billion by 2027 at invoice prices, highlighting how critical it is for employers to take a proactive approach to pharmacy benefits planning.¹ Rising costs not only strain company budgets but also contribute to higher out-of-pocket expenses for employees, undermining satisfaction and retention.
That’s why now is the time to think ahead. With 2026 on the horizon, employers can no longer afford to “set it and forget it” when it comes to pharmacy benefit management. Instead, they need a clear strategy, one that balances cost control, member support, and transparency. This is where a 2026 pharmacy benefits planning checklist comes in: a practical, step-by-step guide to evaluate your current plan, compare PBM vs. pharmacy benefit solutions, and implement tools like Rx optimization programs that deliver measurable savings and better outcomes.
Step 1: Assess your current pharmacy benefit plan
The first step in preparing for 2026 is to take a close look at the pharmacy benefits you already have in place. Many employers renew PBM contracts automatically without realizing how much hidden costs and outdated terms may be hurting their bottom line.
Start by reviewing your current contract. Are there clauses that make it difficult to understand how pricing is determined? Do you know exactly where your money is going or are rebates and fees buried in fine print?
Next, identify your biggest cost drivers. For many employers, specialty medications and GLP-1 drugs for weight loss and diabetes are at the top of the list. These treatments are effective but often extremely expensive, and they can quickly inflate overall pharmacy spend.
Finally, consider your employees. Are they struggling with high copays, limited access to necessary medications, or frustration over coverage rules? These pain points not only affect employee health but can also impact morale and retention.
👉 If you want more guidance on choosing the right plan structure, check out our resource: How to Switch Your Company to a Self-Funded Health Plan: A Step-by-Step Guide for 2025/2026.
Step 2: Compare PBMs vs. Pharmacy Benefit Solutions
Not all pharmacy benefit models are the same and the differences can have a huge impact on both costs and employee satisfaction. To plan effectively for 2026, it’s important to understand how a traditional PBM (Pharmacy Benefit Manager) compares to a modern Pharmacy Benefit Solutions approach.
Traditional PBM model
Traditional PBMs were designed to manage drug benefits by processing claims, creating formularies, and negotiating rebates with drug manufacturers. On the surface, they promise savings. But in reality, many operate with hidden fees, complex rebate structures, and little transparency. This makes it hard for employers to know what they’re truly paying for and harder still for employees to access affordable medications.
Pharmacy Benefit Solutions model
A Pharmacy Benefit Solutions model takes the role of the PBM further. Instead of focusing only on transactions, it focuses on outcomes, data, and advocacy. This approach emphasizes:
- Transparency: Clear contracts with no hidden costs. Employers know exactly how their money is being spent.
- Data Analytics: Tools to track spending, identify waste, and predict future pharmacy needs.
- Member Advocacy: Support for employees through $0 copay options, home delivery, and guidance to ensure they receive the right medication at the best price.
Why Intercept Rx fits both roles
At Intercept Rx, we operate as both a PBM and a Pharmacy Benefit Solutions provider. That means employers get the best of both worlds: the infrastructure of a PBM to handle claims and drug access, plus the added layer of transparency, smarter savings strategies, and member-focused solutions.
For employers planning ahead, this difference is crucial. Choosing a Pharmacy Benefit Solutions partner can help control costs today while building a benefits plan that truly supports employees in the years to come.
Step 3: Optimize with an Rx Optimization Program
Once you’ve assessed your current plan and compared PBM models, the next step is optimization. For 2026 planning, this means making sure your pharmacy benefits are not just functional but cost-efficient, transparent, and employee-friendly. That’s where an Rx Optimization Program comes in.
Why having an Rx Optimization Program?
Pharmacy spending continues to climb, and specialty medications in particular are a major driver of costs. According to the National Business Group on Health, pharmacy costs are projected to rise by double digits in 2025 and 2026, forcing employers to rethink their strategies.² Without a proactive approach, pharmacy benefits can quickly consume a disproportionate share of your health plan budget.
The benefits of optimization
An Rx Optimization Program helps employers take back control by focusing on:
- Reduced waste: Eliminating unnecessary or duplicative prescriptions.
- Better drug sourcing: Leveraging contracts, partnerships, and alternative sourcing to lower acquisition costs.
- Lower copays for employees: Ensuring employees have access to affordable medications, often with $0 copay options that reduce financial strain.
With these strategies in place, employers can save up to 20–30% on pharmacy costs while also improving employee satisfaction. Those savings can then be reinvested into other benefits or used to strengthen the company’s financial position.
Intercept Rx and Rx Optimization
At Intercept Rx, our Rx Optimization Program is designed to deliver exactly this kind of value. We go beyond the traditional PBM model to provide clear reporting, smarter sourcing, and member advocacy that reduces costs for both employers and employees.
It’s no surprise then that many companies are asking: Why wouldn’t a company use an Rx Optimization Program in 2025? For 2026 and beyond, optimization isn’t optional, it’s essential.
Step 4: Align benefits with employee needs
A successful pharmacy benefits strategy is about meeting the needs of the people who rely on your plan every day. Employees want affordable access to the medications that keep them healthy, and employers who deliver that support build stronger loyalty, morale, and retention.
Affordability matters
High out-of-pocket costs are one of the biggest pain points for employees. Even if your plan looks cost-effective on paper, high copays or limited coverage can discourage employees from filling prescriptions. This not only impacts health outcomes but can also drive higher long-term medical costs. Solutions like $0 copay programs make care accessible without adding financial stress.
Convenience builds trust
Today’s workforce expects healthcare benefits that fit into their busy lives. Features like free home delivery and digital access to benefit information show employees that their time matters. When pharmacy benefits are simple and seamless, employees are more likely to stay adherent to their treatment plans.
Advocacy improves experience
Pharmacy benefits can be confusing. That’s why having member advocates helping employees navigate coverage, prior authorizations, and prescription alternatives is so valuable.
Advocacy ensures employees feel supported instead of frustrated, and it strengthens the employer’s reputation as a company that truly cares.
By aligning your 2026 pharmacy benefits plan with employee needs, you create more than just savings, you build a workplace where people feel valued and supported. And in today’s competitive labor market, that’s a real differentiator.
Step 5: Build your 2026 Pharmacy Benefits checklist
Planning ahead is much easier when you have a clear checklist to guide your decisions. A structured approach ensures you don’t overlook critical details while preparing for the year ahead. That’s why a 2026 Pharmacy Benefits Planning Checklist is such a valuable tool for HR leaders, CFOs, and benefits managers.
Here are some essential items to include in your 2026 planning process:
- Review PBM contract renewal dates to avoid auto-renewals that lock you into unfavorable terms.
- Evaluate specialty drug costs and coverage, especially for high-cost categories like GLP-1 medications.
- Consider an Rx Optimization Program to reduce waste, improve sourcing, and control employee out-of-pocket costs.
- Assess employee satisfaction with current benefits to identify pain points and areas for improvement.
- Ensure plan flexibility for both self-funded and level-funded options, giving your company room to adapt as needs change.
- Implement transparency tools that make it easy to track pharmacy spend and measure real savings.
📌 To make this step even easier, we’ve created a free downloadable version of the 2026 Pharmacy Benefits Planning Checklist. It’s simple, visual, and printable. Perfect for sharing with your internal team or keeping as a reference throughout the year.
Conclusion: Preparing for 2026 and beyond
Pharmacy costs will continue to rise, but that doesn’t mean employers are powerless. By taking a proactive approach, reviewing your current plan, exploring Pharmacy Benefit Solutions, and leveraging an Rx Optimization Program you can regain control over your pharmacy spend while also supporting the employees who count on these benefits every day.
2026 presents both a challenge and an opportunity. Employers who plan ahead will be better positioned to manage costs, improve employee satisfaction, and stay competitive in today’s labor market.
📌 Next Step: Download your free 2026 Pharmacy Benefits Planning Checklist and see how Intercept Rx can simplify your planning with smarter savings, transparent solutions, and benefits that truly make a difference
Key Takeaways
- Pharmacy costs are projected to keep rising, with U.S. drug spending expected to reach over $600 billion by 2027.
- Employers can control costs by reviewing current PBM contracts and identifying high-cost drivers like specialty drugs and GLP-1 medications.
- Comparing traditional PBMs vs. Pharmacy Benefit Solutions highlights the importance of transparency, data, and member advocacy.
- An Rx Optimization Program can cut waste, lower drug costs, and save employers 20–30% on pharmacy spend.
- Aligning pharmacy benefits with employee needs through $0 copays, home delivery, and advocacy improves satisfaction and retention.
- The 2026 Pharmacy Benefits Planning Checklist offers a simple, step-by-step resource for building a cost-effective and employee-focused plan.
