December has become a pivotal month for healthcare decisions. Employers are finalizing budgets and insurance renewals and looking for cost containment strategies, while individuals reassess coverage as deductibles reset and out-of-pocket costs come back into focus.
This year, those decisions are unfolding amid double-digit cost projections, rapid changes in prescription drug pricing, and growing interest in Direct Primary Care (DPC) as a more sustainable healthcare model.
Employers Are Facing Another Year of Steep Increases
Healthcare costs continue to rise, and the pace is accelerating. According to the International Foundation of Employee Benefit Plans, employers are projecting a 10% increase in healthcare costs for 2026. These increases are being driven by catastrophic claims, specialty and prescription drug spending, unmanaged chronic conditions, and ongoing provider price inflation.
At the same time, wage growth has slowed, leaving employers caught between rising benefit costs and the need to remain competitive. Many are entering 2026 with difficult trade-offs and growing uncertainty.
GLP-1 Medications Are Adding a New Layer of Pressure
GLP-1 medications have transformed treatment for diabetes, obesity, and cardiovascular disease, but they’ve also introduced significant financial strain. These drugs have historically cost around $1,000 per month per patient, making them one of the most expensive categories in employer-sponsored plans.
Recent announcements from the White House and pharmaceutical manufacturers Eli Lilly and Novo Nordisk aim to reduce GLP-1 pricing for Medicare, Medicaid, and a new direct-to-consumer program expected to launch in 2026. While these changes are meaningful, they do not directly set prices for employer health plans. Any benefit to employers is likely to be indirect and uncertain, particularly as demand continues to grow.
Why Drug Pricing Alone Won’t Fix the Problem
Even if GLP-1 costs come down, prescription drugs are only part of the equation. Employers are still dealing with delayed care caused by high deductibles, increased emergency room and specialty utilization, and cost-shifting strategies that raise employee expenses without improving outcomes.
More than a quarter of employers plan to increase cost-sharing in 2026, and nearly half of large employers are considering benefit design changes that move more costs to employees. While these steps may offer short-term relief, they often discourage early care and drive higher costs over time.
The Missing Link: Strong Primary Care Access
Claims data and employer surveys consistently point to the same issue: limited access to primary care leads to higher costs everywhere else. When employees can’t get timely appointments or meaningful time with a provider, conditions worsen, specialty referrals increase, and catastrophic claims become more likely.
This is where Direct Primary Care makes a measurable difference.
Why Direct Primary Care Matters More Than Ever
Most of our patients already understand that DPC is built around access, relationships, and time — without insurance billing getting in the way. Through a flat monthly membership, DPC removes common barriers to care and focuses on prevention and long-term health.
What’s becoming increasingly clear is how directly this model addresses employer cost pressures. Better access to primary care leads to earlier intervention, improved chronic disease management, fewer unnecessary ER visits, better medication oversight, and fewer avoidable high-cost claims. For employers facing rising utilization and specialty drug exposure, primary care isn’t an add-on — it’s foundational.
How DPC Works With Traditional Insurance
Direct Primary Care does not replace insurance. It works alongside it. DPC covers everyday primary care needs, while insurance protects against major medical events like hospitalizations, procedures, imaging, and specialty care.
Many employers pair DPC with high-deductible, level-funded, self-funded, or traditional group plans to improve utilization and outcomes while keeping insurance focused on catastrophic risk.
A Major Change Coming in 2026: HSA Use for DPC
Beginning in January 2026, individuals will be allowed to use Health Savings Account funds to pay for Direct Primary Care memberships. This removes a long-standing barrier that forced employees to choose between HSA eligibility and access to DPC.
For employers, this change allows DPC to be offered alongside HDHPs without jeopardizing HSA eligibility, while giving employees the option to use tax-advantaged dollars for primary care. For individuals, it means easier access to consistent, affordable care using funds they are already setting aside.
Planning Now Sets the Stage for a Stronger Year Ahead
Even as GLP-1 pricing evolves and new purchasing models emerge, employers still need solutions that improve outcomes, control downstream costs, and avoid simply shifting expenses to employees.
December is the moment to move from reaction to strategy. Employers who evaluate Direct Primary Care now are better positioned to launch benefits confidently, prepare for new HSA flexibility, and build a more sustainable healthcare approach with cost containment for the year ahead.
If you’re evaluating healthcare strategies for 2026, we’re happy to help. Email bwillis@welcomehealth.net to learn more about Direct Primary Care for employers.
References
International Foundation of Employee Benefit Plans (IFEBP). Employers Project Big Jump in Health Care Costs for 2026. SHRM.
https://www.shrm.org/topics-tools/news/benefits-compensation/employers-project-big-jump-health-care-costs-2026
Mercer. Trump Announces Lower GLP-1 Prices—Will Employer Plans See Them Too?
https://www.mercer.com/en-us/insights/us-health-news/trump-announces-lower-glp-1-prices-will-employer-plans-see-them-too/
Welcome Health. Congress Approves HSA Use for Direct Primary Care.
https://welcomehealth.net/congress-approves-hsa-use-for-direct-primary-care/