Predictions for 2026 from Tracy Baroni Allmon, Sharon Faust, Mike Kolodij, and others

Death knell of the ACA

Despite more than a decade of increasing success, the ACA’s gains in leveling the health insurance playing field are at serious risk in 2026. The threat is not only reductions in or dissolution of enhanced advanced premium tax credits. While a phased-down subsidy could theoretically be mitigated by marketplace adaptation and consumers who have learned to prioritize coverage in their budgets, changes in APTC [advance premium tax credit] levels will still drive younger, healthier people out of the market and sharply increase premiums. At the same time, legal and political attacks on the U.S. Preventive Services Task Force (USPSTF) and its expert recommendations will erode coverage requirements and reduce screenings, leading to more advanced disease at diagnosis and driving higher costs.

Efforts to roll back Medicaid expansion will open a coverage gap in low-income populations that again leads to more advanced disease at diagnosis and lost work due to unaffordable chronic and acute care. In the marketplace, expanding short-term, limited-duration plans will further weaken the risk pool and raise premiums as younger people opt for these skimpy products and exit comprehensive coverage. The ACA is far from perfect, but undermining these pillars will unravel many of its gains, and patients will pay the highest price.

Rethinking healthcare benefits

At Cigna Healthcare, 2026 will be a year defined by making healthcare simpler, more affordable and more intuitive for the people we serve. Employers and consumers are asking for the same thing: less complexity, more transparency and benefits designed for real life. We’re rethinking how health benefits work — using data, AI, and human insight to remove friction, personalize support and help people make confident decisions about their care.

As costs continue to rise, we’re focused on meaningful affordability through more precise care navigation, smarter benefit design and digital tools that help customers get answers quickly and avoid unnecessary spending. Our goal is straightforward: give people the information, support and predictability they need — in both everyday moments and during extraordinary health events. In 2026, we’re committed to delivering a simpler, more connected experience that meets people where they are and helps them stay healthier.

Biosimilars will become benchmark of PBM alignment

Biosimilars remain a strong opportunity for cost savings, but plan sponsors need to be aware of rebate-like revenue retention through private-label strategies. As affordability pressures continue, 2026 needs to be the year when those structures are broken open so biosimilars compete and serve as a true lowest-net-cost option. For plan sponsors, biosimilars are a path to exposing which PBMs are genuinely leaning into lower costs — and which ones are still holding onto practices that keep prices higher than they should be.

New pathways for prescription drug access

The pharmaceutical pricing paradigm in the United States will continue its shift away from privately negotiated net prices in 2026. We expect a material lowering of list prices for more brand-name drugs, as well as reduced rebates to PBMs and payers in 2026, all while manufacturers increase prices and rebates internationally. Patients will have a wide array of pricing options between direct-to-patient cash price, TrumpRx price, Most Favored Nation price, Maximum Fair Price, NADAC, Cost Plus, and on-benefit PBM negotiated price, creating new pathways for affordability and access. It will be interesting to see which of these benefit alternatives resonate with patients and consumers and how the pharmaceutical supply chain reacts.

A focus on tech solutions in pharmacy benefits

Over the next year, employers and unions will continue facing challenges balancing coverage and affordability for their prescription drug benefits. We’ll help them navigate the future by serving as an extension of their team — working to understand their unique priorities and challenges while delivering tech-forward solutions. We’ll continue to lead the transformation of the PBM industry with a focus on transparency, cost management, and member experience as the foundation of every action we take.