A new data point from Lockton's 2026 National Benefits Survey underscores how far employers are now willing to go to manage rising health care costs, with 46% of self-funded plan sponsors saying they would consider international drug sourcing for pharmacy benefits.
Drawn from 1,705 responses submitted by plan sponsors across industries, group sizes and ownership structures, the findings reflect a broader and more urgent shift in how US employers are approaching benefits strategy. For the second consecutive year, reducing costs has emerged as the top priority - but now by a much wider margin.
In the latest survey, 54% of employers 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 primary objective, has fallen to 19%.
Those results come against a backdrop of steep cost projections. Industry surveys suggest employers are bracing for mid- to high-single-digit increases in health plan costs for 2026,extending what has become a multi-year period of elevated trends for employer-sponsored coverage. That pressure is prompting some organizations to revisit strategies they might previously have viewed as too complex or high risk.
"With projected cost trends, employers face sustained challenges heading into 2027 and beyond, as the imperative to reduce costs is increasingly dominant," said Shannon Demaree, executive vice president and 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. Employers will need to rethink traditional approaches and reevaluate their role in the healthcare landscape.”
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 that range from foundational, lower-disruption changes to more progressive strategies aimed at securing deeper savings.
Among self-funded plan sponsors, who represent the majority of respondents and generally have the greatest flexibility to implement cost-saving measures, several tactics are already gaining traction. According to the survey, 30% offer cardiometabolic management programs beyond what is available through their medical carrier, targeting high-cost conditions and claims.
In the network arena, 39% are leveraging carrier narrow networks or high-performing networks to steer members toward preferred providers. On the eligibility front, 23% are using spousal surcharges as part of their cost-control toolkit, according to the survey.
In pharmacy, 7% of self-funded respondents reported they are already using international sourcing for pharmacy benefits, and an additional 46% said they are considering it. That level of interest highlights how aggressively some employers are now willing to push in pursuit of pharmacy savings, particularly as specialty drug spend and demand for GLP-1 medications continues to drive trend.
At the same time, there is no clearly established federal legal pathway for most employer plans to cover imported prescription drugs, and benefits attorneys have noted that poorly structured arrangements could raise issues under Food and Drug Administration rules and under employers' fiduciary obligations.
Despite the sharp pivot toward cost management, the survey suggests employers are not prepared to ignore the impact on employees. A total of 81% of respondents said employee impact remains an important consideration when evaluating plan changes. That finding highlights the central tension many plan sponsors are now trying to navigate: how to control costs without undermining the perceived value of their benefits package or eroding employee trust.
“The challenge for employers is not simply cutting spend,” said Chris Bartnik, senior vice president and 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 also indicates that employers are not converging around a single, dominant solution. Instead, they are testing and layering different approaches across benefit design, networks, eligibility rules, and pharmacy strategy, and weighing each against potential savings, operational complexity, compliance considerations, and the member experience.
Lockton’s findings point to a market entering a more experimental phase. With cost clearly moving to the foreground - and with a majority of large employers signaling that they will need to take further action to keep coverage affordable into 2027 and beyond - demand is likely to grow for models that blend traditional cost sharing with steerage, clinical programs, more transparent pharmacy arrangements, and, in some cases, more unconventional tactics such as international sourcing, all under closer regulatory and fiduciary scrutiny.
