What High-Cost Specialty Drugs Will Affect Premiums in 2026?

Specialty drugs have the highest projected rate of increase for health plan cost trends, with a spike of nearly 12% expected for 2026. While these medications can be life changing (and even life saving), they come with price tags that are much, much higher than traditional drugs. 

Understanding what drug prices are increasing and which categories are contributing the most to cost growth can help employers budget more effectively and mitigate the impact. We’ll break down the high-cost drug trends that will have the biggest impact on premiums in 2026.

How Specialty Drugs Are Impacting Premiums

Specialty drugs refer to high-priced, often brand-name medications typically used to treat chronic, rare, or complex conditions. In recent years, availability of these drugs has exploded. 

In the mid-1990s, there were fewer than 30 specialty drugs on the market. By 2024, they accounted for three quarters of new drugs developed. 

The prevalence of specialty drugs is also growing faster than other types of medications. In 2026, utilization of non-specialty drugs is expected to trend upward at a stable 2%. Utilization of specialty drugs, on the other hand, is seeing a 7.4% upward trend.

Rapid advances in technology and new drugs hitting the market combined with the rising popularity of certain types of specialty drugs have pushed usage and costs upward. Though they make up just a fraction of all prescriptions, specialty drugs account for a huge portion of overall drug spending. 

As one health plan executive in New York explains, “specialty medications are used by approximately 2 percent of our members, but they account for more than 50 percent of total drug spend.”

This spend tends to get passed on to employers and consumers in the form of higher premiums.

Product Driving Prescription Drug Trends

What Drug Prices Are Increasing?

GLP-1s

Few drug classes have reshaped the pharmacy landscape as dramatically or as quickly as GLP-1 medications. Initially approved for type 2 diabetes, these drugs have surged in popularity as research validated their effectiveness for weight loss. 

A Blue Cross Blue Shield plan in Massachusetts is a prime case study on the explosive growth of GLP-1s. In 2024, just five GLP-1 drugs accounted for over $300 million in spend for that plan. In the overall market, GLP-1 spending rose by more than 500% between 2018 and 2023. 

Demand shows no sign of slowing, and expanded GLP-1 use for treating obstructive sleep apnea and reducing cardiovascular risk will likely continue to increase growth in this category.

Biologics

Biologics are drugs made from living cells rather than chemical compounds. They dominate the FDA pipeline; in 2024 alone, the organization approved 16 new biologics. 

Biologics often come with high production costs and typically require ongoing, long-term treatment, making them a persistent source of elevated spend. The cost of biologics for a single patient can range from tens of thousands to hundreds of thousands of dollars a year. Though they make up only about 5% of all prescriptions in the U.S., they account for 51% of total drug spending. 

Biosimilars, which are highly similar to an original "reference" drug and produce the same effects, have offered some relief, but the development and adoption of biosimilars present barriers. For example, only 10% of brand-name biologics currently have a biosimilar in development. 

Cell and gene therapies

Cell and gene therapies (CGTs) are used to treat rare and often deadly diseases. They offer some of the most exciting advances in medicine, but they’re also among the most expensive, in some cases carrying a multi-million-dollar price tag. 

CGTs typically cost around $300,000 per treatment, but many drugs far surpass that benchmark. One of the most costly therapies on the market is Hemgenix, which treats hemophilia B. It has a list price of $3.5 million per patient. Lyfgenia and Casgevy, two drugs that treat sickle cell disease, cost $3.1 million and $2.2 million per patient, respectively. 

Because these therapies target rare diseases, they’re used infrequently, but due to their soaring costs, even a single patient can have an impact on premiums. With a growing number of CGTs in cynical trials, growing cost pressure is expected in the year ahead. 

Cancer treatments

For four years in a row, cancer has persisted as the top condition driving increased healthcare costs for employers. 

Spending on cancer-related care in the U.S. is projected to grow 34% by 2030, reaching an astounding $246 billion. Per-patient per-month oncology spend is expected to double by 2027, ranging from $8.24 to $15.24. The dramatic increase is driven by both existing and new treatments, with breast and ovarian cancer therapies leading pipeline activity. 

With cancer incidence rising, more indications at earlier stages of the disease, and survival outcomes improving, more patients are receiving this category of high-cost drugs for longer periods, compounding spending and increasing premiums.

Treatments for autoimmune diseases

Conditions like rheumatoid arthritis, Crohn’s disease, psoriasis, and lupus are a few of the autoimmune diseases commonly treated with high-cost specialty medications. Three of the top ten drugs driving increased prescription plan costs–Rinvoq, Cosentyx, and Skyrizi–fall into this category.

Like cancer, the prevalence of autoimmune disease continues to rise, meaning that spending in this category will likely remain a significant factor pushing 2026 premiums upward. 

Combat Rising Drug Costs with a Whole-Health Approach to Wellness 

While specialty drugs will continue to play a critical role in treating chronic and complex conditions, employers don’t have to rely solely on pharmacy cost controls to manage rising premiums. A holistic approach to employee wellness can help reduce risk factors, identify chronic conditions earlier, and provide support before high-cost interventions are needed. 

OpenLoop Health helps employers keep workers healthy and engaged with voluntary wellness offerings like weight loss. By using our infrastructure, you can stay up to date with healthcare trends without adding cost.

Employees only pay for the services they value and none they don’t. Employers are able to offer greater flexibility while managing utilization and keeping rising premiums in check. 

Interested in learning more? Contact our sales team now. 

*This content is intended for general informational purposes only and should not be construed as legal advice. For guidance on your specific situation, please consult a licensed attorney.