Affordability, AI, and PBM Reform Set to Reshape Employer Benefits
Employer-sponsored benefits are approaching a breaking point on cost, and brokers see little stability ahead.
The Council of Insurance Agents & Brokers surveyed 166 employee benefits brokers, account managers, practice leaders, and executives for its 2026 employee benefits survey, finding that 64% of respondents believe affordability pressures will fundamentally reshape plan design over the next three to five years. Only 21% expect the employer-sponsored employee benefits market to remain largely stable, the survey report said.
Cost Containment Dominates Client Conversations
Pharmacy spending is the focal point of employer cost containment efforts, the CIAB found. Pharmacy benefit manager contract optimization ranked as the top cost containment lever used by clients across all client segments combined, and 58% of respondents said it delivers either a 3:1 or 4:1 return on investment. Well-being programs ranked second, followed by a tie between contribution strategy and high-performance networks.
The preferred approach varies by employer size. Contribution strategy is the leading solution for employers with fewer than 1,000 employees, while larger employers gravitate toward PBM optimization, according to the survey. Looking ahead, 57% of respondents identified PBM reform and pharmacy cost regulation as one of the top three trends likely to most significantly affect their business over the next three years, ranking it higher than any other issue, including AI or transparency requirements.
On the benefits vendor side, employer clients are moving toward consolidation, the report said. Most respondents said their clients on average are currently using three to four point solutions — which are specialized, standalone products or services designed to fill gaps in an organization’s medical plan or benefits package— and nearly three-quarters said those clients are either actively trying to consolidate vendors or considering doing so.
Pharmacy cost management point solutions — including discount card programs and price transparency tools — topped the list of most commonly used point solutions at 63%, followed by wellness and well-being platforms at 61% and telehealth at 59%.
AI Strategy Is Widespread but Maturing Unevenly
The CIAB also surveyed brokers on AI use within their brokerage firms. Seven in 10 brokers reported having an AI strategy, though the level of development varies considerably, from early proof-of-concept testing to implementations showing measurable impact across multiple use cases. Investment levels reflect that range: 55% of firms reported limited to moderate annual AI spending of less than $1 million, while larger-scale enterprise investment above $5 million annually was reported by just 6% of respondents.
AI is increasingly becoming part of client-facing conversations, not just internal operations, the report said. Sixty percent of respondents said they actively discuss AI use cases in health benefit design with clients. Employers, as characterized by brokers, believe AI will significantly impact personalized health and wellness advice for employees — cited by 67% of respondents — and benefits personalization, in which employees are offered tailored care delivery recommendations, cited by 66%.
Among the 30% of respondents without a formal AI strategy, most work with smaller employer clients: half had a median client size of 100 to 999 employees, and another 38% had a median client size of fewer than 100 employees.
Alternative Plan Designs Gaining Ground Amid Funding Pressure
Employers are increasingly turning to non-traditional benefit structures to manage risk and cost, the report said. Level-funded products are the most widely reported alternative design in use, with 64% of brokers saying they deploy them with clients.
Independent, non-carrier-owned TPA models were cited by 62%, captive arrangements by 57%, and stop-loss by 55%. When asked which of these products is most broadly adopted across their client books, respondents pointed to stop-loss, with 35% saying the majority of their clients use it.
The financial outlook is shifting risk toward plan members as well. More than half, or 54%, of respondents said employers will increasingly shift financial risk to employees, a sentiment shared across all employer size segments.
Meanwhile, 48% said brokers will take on a greater role in risk mitigation and governance over the next three to five years, and 49% identified AI-enabled care navigation and cost management as a top issue likely to reshape the market alongside PBM reform and transparency requirements.
View the full survey results here. &

