Employers Eye Transparency, Data Access to Confront Rising Health Care Costs

Employers across the US continue to view health care affordability as their most pressing benefits challenge, with drug prices, hospital prices, and high-cost claims topping the list of concerns for the fifth consecutive year.1

That is one of several takeaways from the Pulse of the Purchaser 2025 survey conducted by the National Alliance of Healthcare Purchaser Coalitions, which collected 324 responses from private and public employers between July and August 2025.

The annual survey found that benefit leaders are increasingly turning to data access and transparent contracting models to regain leverage in a system that one respondent described as “a dumpster fire with unlimited fuel as long as employers and plan sponsors put up with the status quo.”

Affordability Threats Dominate Employer Concerns

Survey respondents overwhelmingly pointed to rising drug costs, hospital prices, and high-cost claims as the leading threats to affordability. Nine in 10 employers agreed that escalating health care costs are undermining their ability to compete; attracting and retaining talent is a top priority of 99% of employers, with 96% saying health and wellbeing benefits are crucial to that effort.

Survey participation grew from 188 to 324 respondents. | Image credit: jirsak – stock.adobe.com

Employers also expressed growing concern over the sustainability of high-cost therapies. Cell and gene therapies, as well as specialty drugs like glucagon-like peptide-1 (GLP-1) receptor agonists for obesity and diabetes, were cited as areas where costs are outpacing budgets.

“We already tried covering GLP-1 drugs for weight loss and the cost was not sustainable,” one respondent said.

Still, two-thirds of employers said they were offering or considering GLP-1 coverage in 2025—a 2% dip from 2024—with noticeable shifts toward vendor management and slightly higher reported use of compounded products.1,2 Meanwhile, fewer employers are limiting coverage to specific populations and requiring lifestyle changes than last year.1

Push Toward Transparency in PBM and Hospital Strategies

The survey showed a notable market shift in pharmacy benefit management (PBM). Reliance on the “Big 3” PBMs—CVS Caremark, Express Scripts, and OptumRx—fell from 72% in 2024 to 61% in 2025, while use of transparent PBMs more than doubled from 12% to 31%. The use of other PBMs dropped in half from 16% to 8%.

Employers using transparent PBMs reported much stronger confidence in fiduciary integrity than those using a Big 3 PBM; 85% of transparent users reported confidence in administration integrity vs 58% with a Big 3, and 91% had confidence in the reasonableness of PBM compensation compared with 57%. These employers were also 1.6 times more likely to report lower annual premiums than Big 3 users and about 30% less likely to report higher premiums.

Complete claims data access emerged as a key enabler. Employers with full data rights were far more likely to engage in high-value PBM and hospital strategies, including direct contracting, centers of excellence, and site-of-care redirection. Yet, a third of employers reported they still cannot access complete claims data in 2025, and 4 in 10 said vendors have refused to provide it.

Expanding Benefits in Women’s, Mental, and Equity Initiatives

Beyond affordability, the survey highlighted an expansion of employer focus on women’s health, mental health, and equity. Employers were 2.5 times more likely than in 2023 to offer or consider menopause support (41% vs 16%), and many reported growing investment in fertility solutions.

More than 7 in 10 employers are now integrating behavioral health into primary care or holding vendors accountable for cultural competency. Meanwhile, health equity initiatives are trending upward; nearly three-quarters of employers are surveying employees about access and quality of care, and many are incorporating accountability measures into provider contracts.

The Survey’s Call to Action

The Pulse of the Purchaser 2025 survey report urged employers to secure full rights to claims data, transition toward transparent PBM arrangements, and expand use of direct contracting and disease-specific vendors to rein in costs. “Taking ownership of health plan relationships and applying more assertive, sophisticated, value-driven approaches are key to lowering cost trends,” the report said.

With participation in the survey rising 72% over 2024—which had just 188 respondents—these findings underscore a broader recognition among benefit leaders that system-level reforms are needed to make employer-sponsored health care sustainable.2,1

References

1. Pulse of the Purchaser 2025 survey results. National Alliance of Healthcare Purchaser Coalitions. September 8, 2025. Accessed September 9, 2025. https://www.nationalalliancehealth.org/resources/pulse-of-the-purchaser-2025-survey-results/
2. Grossi G. Employers shift to equity-focused strategies as health costs outpace wages. AJMC®. October 31, 2024. Accessed September 9, 2025. https://www.ajmc.com/view/employers-shift-to-equity-focused-strategies-as-health-costs-outpace-wages