Happy New Year! We are still within the Larry David statute of limitations for saying that.

We asked leaders in managed care, including members of our editorial advisory board, to make some predictions about what the important developments in U.S. healthcare in 2026 might be. Here are three responses.

Specialty pharmacy will continue to simplify experiences

We will continue to see technology used in new ways to advance the practice of pharmacy. We are already using technology to help simplify the specialty pharmacy experience for patients, providers and payers. In 2026, artificial intelligence has the potential to make significant process improvements that allow our greatest asset — our CVS Specialty colleagues — to focus on the reason why so many of us began practicing pharmacy in the first place: to deliver excellent patient care.

All-encompassing health benefit managers will take hold

Smart, sophisticated payers (plan sponsors) will stop managing pharmacy and medical plans on separate islands. Or they’ll make the decision to stop in 2026 (effective Jan. 1, 2027). Segmenting healthcare discussions causes member abrasion, increases plan costs, and yields suboptimal patient outcomes. Furthermore, requiring separate consulting teams to discuss pharmacy and medical benefits is not only a waste of resources (time and money) but is the equivalent of putting two steering wheels in a car. The notion of plan sponsors engaging a separate PBM, TPA [third-party administrator], benefits administrator, care navigation, etc., is coming to an end and will be replaced by the health benefit manager. By managing things on one "healthcare operating system" that is independent and agnostic, payers will be able to reduce costs, while patients have superior care.

More employers will select transparent, nonlegacy PBMs

The PBM industry seems to be waiting with bated breath for federal legislation to take shape around the regulation of legacy PBMs. We might continue to wait. In the meantime, we’ve seen real progress at the state level, including in California, Iowa, and Arkansas. The Trump administration has moved towards a position of leaning on the industry to “self-regulate.” This has been embraced by the legacy PBMs as they put forward proposed “new models” that lack substance but may be enough to fend off government-enforced regulation. As a result, it’s up to company leaders to drive the adoption of transparent, modern PBM alternatives, ones that prioritize affordability and member experience over their own bottom line. Employers of all sizes are seeing through the legacy PBM lip service. We’re already seeing this trend take shape and companies take cost control and greater financial visibility into their own hands: Tyson Foods switched to Rightway; UnitedAg (a 55,000-plus-member organization) recently partnered with us at SmithRx; UPenn partnered with Liviniti; and 7-11 chose AffirmedRx. At SmithRx, we have more and more of these conversations with large employers every day. It’s only a matter of time before the dam breaks and this shift becomes a full-blown movement.

Some other likely developments this year are biosimilars entering the market at low list prices, like Stelara’s biosimilars did this year. This strategy aims to counter the narrative that high costs are necessary and bypass the traditional rebate structure that has historically blocked biosimilar adoption.  The FDA is also expected to ease requirements for biosimilars to achieve "interchangeable" status, removing the need for extensive, separate studies.

We’ll also see more employers carve out coverage for GLP-1-based weight management because of the lack of flexibility and transparency into net pricing under the legacy PBM model. It’s clear that GLP-1s are here to stay and will continue to see widespread adoption for weight management and a growing number of new indications (everything from heart and kidney disease to fertility, addiction, and Alzheimer’s disease). For legacy PBMs, this is great news. They make money on rebates and distribution through their own pharmacies. But the high list price of these products is still making it hard for employers to grasp open coverage.