U.S. employers stand, often uncomfortably, at the center of a rapidly changing pharmacy landscape. With hundreds of prescription drugs advancing through Food and Drug Administration (FDA) review, 2026 is shaping up to be a landmark year. Forecasts point to dozens of highly anticipated approvals, from expanded GLP-1 (glucagon-like peptide-1 receptor antagonist) uses and simplified dosing options to cutting-edge specialty medicines, breakthrough gene therapies, and a powerful surge of new biosimilars. The ripple effects for employers could be significant, and impossible to ignore.
For HR leaders, the implications are clear: new approvals will affect drug spend, patient access, and workforce health outcomes. The real challenge isn’t reacting to new therapies as they appear, but staying ahead of them, understanding their implications and aligning benefit strategies proactively.
GLP-1 indications expand
Demand for GLP-1 is already high. As indications spread, employers will likely see increasing demand and cost exposure. Employers should ensure their PBM applies stringent prior authorization criteria to identify appropriate patient use and offers patient-centered programs that pair medication with lifestyle support to improve overall health.
Use of this blockbuster drug class will continue to grow beyond original indications, cementing GLP-1s as foundational in chronic care. Wegovy® is seeking FDA approval for heart failure, Mounjaro® for cardiovascular risk-reduction, and Ozempic® for peripheral artery disease.
Also in the 2026 pipeline is Orforglipron, an oral GLP-1 formulation for chronic weight management. While oral GLP-1s could be a gamechanger in diabetes management—depending on pricing and adherence—education will be key as patients consider transitioning from injectables.
Biosimilars present opportunities
While much of the innovation in the pipeline will push drug spend higher, biosimilars offer a welcome opportunity to ease cost pressures, especially for employers ready to move quickly. Some biosimilars hit the market with only modest discounts compared to the original product, while others can deliver meaningful, immediate savings. And makers of the original biologic product may respond with bigger rebates and price concessions to stay competitive. Acting early with smart contracting and thoughtful formulary placement can make a real difference in capturing those savings.
Looking ahead to 2026, several high-impact categories (such as osteoporosis, eye disease, and asthma) could see new biosimilar entrants. To make the most of these opportunities, employers need a PBM partner with a holistic, forward-thinking biosimilar strategy that aligns with the employer’s goals and helps them confidently navigate a fast-moving market.
Specialty drugs dominate the pipeline
Specialty medications will account for more than 80% of expected 2026 approvals, including many for rare conditions. Two examples highlight how quickly this space is evolving:
- Anaphylm™, a potential non-injectable epinephrine option, could make emergency treatment more accessible if priced competitively.
- Uplizna®, anticipated to expand into generalized myasthenia gravis, offers a less frequent dosing schedule than current alternatives—though still at a significant cost.
We explore both of these developments in greater detail during our webinar, including how they may influence plan design and member education.
For HR leaders, the message is clear: specialty drugs typically fall under the medical benefit, and employers need a PBM partner who proactively tracks the pipeline, provides early alerts, and recommends strategies like site-of-care optimization and appropriate billing oversight.
Gene therapy breakthroughs can break the bank
The FDA is monitoring a growing number of gene therapies, with several possible approvals on the horizon for 2026. These treatments represent major clinical advancements, but their extremely high price tags can create significant financial strain for health plan sponsors.
Although gene therapies fall under the medical benefit, employers shouldn’t navigate these decisions alone. A proactive PBM partner can monitor the pipeline, flag emerging risks, and help employers prepare for potential high-cost claims. Even with stop-loss coverage, HR leaders benefit from understanding their population’s exposure and ensuring plan documents and coverage decisions are aligned to prevent surprises.
Cancer care continues to be a major focus:
Oncology treatments consistently account for a substantial portion of new drug approvals each year. As new therapies enter the market, often at higher price points, utilization naturally shifts towards these newer options. In 2026, employers can expect to see injectablealternatives to IV-administered therapies for breast, ovarian, colorectal, and lung cancer.
Oncology drugs can cause significant side effects, and many patients struggle to stay on therapy long-term. Employers need a PBM with strong clinical oversight to strike the right balance between convenience, adherence, and safety, supporting both better outcomes and more predictable costs.
The bottom line
At True Rx, we know the drug pipeline isn’t just a clinical issue—it’s a workforce issue. Every new therapy affects your budget, employee expectations, and your ability to deliver a competitive benefits experience.
As Health Strategists first, we’re here to help you navigate what’s coming and turn uncertainty into opportunity. With proactive insights, personalized strategies, and a member-focused approach, we help you manage rising costs while supporting the health of your people.
You don’t have to prepare for 2026 alone. We’re right beside you.
