EMPLOYEE BENEITS
Horizon of Healthcare Webinar Recap
Rising Health Costs, PBM Challenges, and 3 Employer Strategies
In a recent CCIG-hosted webinar, Taylor Rogers was joined by Connie Perry, PharmD, Managing Director at Ethica Pharmacy Advisors, and Blake Allison, CEO of Employer Health Network (EHN), for a data-driven discussion on the evolving landscape of healthcare costs, pharmacy benefit management, and strategies for employer-sponsored health plans.
Key Takeaways
Healthcare Costs Rising
Medical costs are projected to rise by 9% in 2026, driven by increased utilization, rising drug prices (especially in specialty categories) and growing administrative costs.
PBM Complexities Persist
Connie Perry highlighted shifts in PBM models from rebates to GPO fees and spread pricing. Despite biosimilars, brand-name drug use remains high, reinforcing the need for annual contract reviews with expert advisors.
Hospital Financial Strain
Blake Allison noted 40% of U.S. hospitals operate at a loss. Consolidation often increases local prices, but employer-health system partnerships can offer a path to more affordable care.
Mixed Approaches to Coverage for Weight Loss Medications
GLP-1 use for weight loss and diabetes management is rising, but many patients discontinue early. While coverage for diabetes is standard, employer support for weight loss remains uneven. Strategic coverage paired with engagement is key.
Recommendations for Employers
Actuarial analysis presented during the webinar emphasized three foundational areas for plan sponsors
- Data Access: Full transparency into claims, contracts, and trend drivers is critical to making informed decisions.
- Network Strategy: Leveraging high-performing or regional networks can help employers control costs while maintaining care access.
- Pharmacy Oversight: Employers should review PBM strategies annually, assess contract structures, and explore opportunities to optimize specialty drug spending.
While external factors continue to evolve, consistent data analysis, strategic contracting, and collaborative partnerships remain key levers for plan management.
If you have questions or want to explore your strategy, reach out to Taylor Rogers, CCIG Executive Vice President, Employee Benefits at Taylor.Rogers@thinkccig.com to connect with our team for a conversation.