Employers Lean on Data Transparency to Contain Rising Health Care Costs

Employers facing rising health care costs are increasingly turning to strategies built around data access and transparency, according to the Pulse of the Purchaser 2025 report released by the National Alliance of Healthcare Purchaser Coalitions.1

The new survey of 324 employers highlighted how rising health care costs are pushing organizations to adopt new purchasing strategies focused on data access and transparency. The researchers found that comprehensive claims data and transparent pharmacy benefit managers (PBMs) are becoming central tools for managing employer-sponsored health plans.

A new report from the National Alliance of Healthcare Purchaser Coalitions calls on more data transparency and PBM reform to combat rising health care costs, enhance health equity, and improve employee well-being. | Image credit: Drazen - stock.adobe.com

PBMs are often criticized as “middlemen” driving up drug costs by prioritizing higher-priced innovator drugs over cheaper biosimilars and generics, discouraging their use.2 The Federal Trade Commission has released multiple reports accusing large PBMs of harming independent pharmacies, despite their original goal of reducing expenses, as well as helping create an unaffordable market for patients looking for life-saving treatments.2,3

Data Access Drives Strategic Decisions

The survey, conducted from July to August 2025, included employers of all sizes, with most representing mid-sized organizations of 1000 to 50,000 employees.1 Respondents consistently pointed to claims data as a crucial resource for managing spending.

According to the report, “Employers with complete access to their claims data are up to four times more likely to have adopted high-value strategies across PBM contracting and hospital payment models.” These strategies included direct provider contracting, centers of excellence, and site-of-care redirection—all aimed at improving care quality and controlling costs.

While nearly one-third of employers still lacked full access to claims data, those with complete information were more likely to use these high-value approaches. As the report noted, “Employers with complete claims data access are far more likely to deploy high-value hospital strategies—especially direct contracting (+29 points), centers of excellence (+27 points), and site-of-care redirection (+25 points).”

The report also tracked a significant shift in the PBM marketplace. Use of transparent PBMs grew from 12% in 2024 to 31% in 2025, while reliance on the traditional “Big 3” PBMs (CVS Caremark, Express Scripts, and OptumRx) declined from 72% to 61%. Employers using transparent PBMs more often reported lower-than-average premiums.

“Employers using transparent PBMs were approximately 1.6 times more likely to report lower premiums than those relying on traditional models,” the report stated. Increased transparency and stronger audit rights were cited as key factors behind these savings.

Hospital Pricing and Expanding Focus on Health Equity

Employers also voiced skepticism about hospital efficiency and the benefits of consolidation. Six in 10 plan sponsors reported doubts about hospital pricing and efficiency. In response, many expanded strategies, such as centers of excellence, site-of-care redirection, and direct contracting—particularly larger organizations that could leverage scale.

Confidence in fiduciary oversight was higher among employers with full claims data and transparent PBMs. “Purchasers with complete claims access and transparent PBMs reported significantly higher confidence in PBM integrity and hospital billing safeguards,” the report said. This confidence was linked to greater use of third-party audits and safeguards designed to protect both employers and employees.

Beyond cost containment, the survey showed continued employer attention to equity and employee well-being. Nearly three-quarters of employers (72%) reported that they were already surveying employees on access to care, service quality, and patient experience, or planned to do so within the next 3 years.

“Nearly three out of four employers are actively assessing health equity issues,” the report noted. Many employers also reported expanding initiatives in women’s health and mental health, such as menopause support and behavioral health integration.

Coverage of GLP-1s for Obesity Management

In the drug benefit space, coverage of glucagon-like peptide 1 (GLP-1) receptor agonists for obesity management stabilized in 2025. About two-thirds of employers either offered or were considering coverage, a figure largely unchanged from 2024. However, there was a shift toward vendor-managed programs and compounded formulations, suggesting employers were adapting strategies to better manage the high costs associated with these therapies.

The report concluded with a call for employers to take a more active role in shaping their benefit strategies. “Taking ownership of health plan relationships and applying more assertive, sophisticated, value-driven approaches are key to lowering cost trends,” the authors wrote.

Overall, the survey underscored how access to claims data and transparent PBMs are enabling employers to pursue more effective cost and quality strategies. However, gaps in data access remain, leaving some employers without the tools needed to fully contain rising health care costs.

References

1. Pulse of the purchaser 2025 survey results. The National Alliance of Healthcare Purchaser Coalitions. September 8, 2025. Accessed September 10, 2025. https://www.nationalalliancehealth.org/resources/pulse-of-the-purchaser-2025-survey-results/

2. Jeremias S. FTC releases second report on PBMs meddling in generic drug markets. The Center for Biosimilars®. January 19, 2025. Accessed September 10, 2025. https://www.centerforbiosimilars.com/view/ftc-releases-second-report-on-pbms-meddling-in-generic-drug-markets

3. Caffrey M. FTC finds PBMs drive up drug costs, squeeze out competitors. AJMC®. July 9, 2024. Accessed September 10, 2025. https://www.ajmc.com/view/ftc-finds-pbms-drive-up-drug-costs-squeeze-out-competitors