Laws Reduce Plan Sponsor ACA Reporting Burden
January 1, 2025
As health insurance costs continue to rise at an uncomfortable pace, employers in 2025 plan to shake up the status quo with their health care vendors, particularly those focused on reducing pharmacy spend, a main cost driver, according to a new report.
To address spiraling costs, they will also focus on educating their staff about the importance of prevention and immunizations and guiding them to use specialized services that focus on managing chronic conditions, says the “2025 Trends to Watch” report by the Business Group on Health (BGH).
Companies will also demand more data from their health plans and other health care vendors and look to float requests for proposals if they aren’t seeing results.
Here’s a look at the main strategies employers told the BGH they were likely to pursue this year.
Pharmacy spend
According to the report, if employers want to control their overall health care costs, they will have to address growing pharmacy expenditures, which now account for more than 25% of their health care budgets.
That percentage is forecast to increase with the advent of GLP-1 weight-loss and diabetes drugs like Wegovy and Ozempic, as well as specialized costly medications that can bust a health plan’s budget.
One-third of employers surveyed said they planned to revisit and reassess their pharmacy benefit manager relations, potentially holding new contract bids to get better pricing from current vendors or from new ones that offer competitive pricing and more transparency in their contracts.
GLP-1s loom large. Some employers are only willing to cover these drugs for diabetes and other Federal Drug Administration-approved indications like heart disease. Few will cover them for weight loss unless the patient is obese and with diabetes. Even then, they may require step therapy before prescribing them, which includes:
- Trying other established and proven anti-obesity medications.
- Engaging in lifestyle management programs.
Chronic conditions
Besides rising pharmaceutical costs, chronic and serious conditions such as cancer, heart disease, diabetes and autoimmune diseases are major contributors to high health care costs.
The report recommends a two-pronged approach to helping employees with chronic conditions: taking advantage of specialized integrated care networks, and wellness programs.
Specialty care — Many workers with chronic conditions are often not aware of the specialty care available to them through their health plan and as a result, don’t take advantage of these valuable services. The problem is that both employees and employers are often not aware of these specialty solutions that can improve staff health through care that provides valuable clinical support.
Employers surveyed by BGH said they would be focused on holding health plans, specialty insurance products and navigation partners accountable for helping their employees access this care.
“The first and most critical step is to address the lack of awareness of these new network-based solutions among employers as well as employees,” the report states.
Wellness plans — Chronic conditions are also prompting employers to revisit and evaluate their current wellness initiatives to ensure they are helping their employees manage these conditions and make lifestyle changes that can improve their illness.
Employers may start requiring vendors to agree to outcomes-based contracts that set expectations for results. “These agreements should require that vendors demonstrate improvement in health outcomes and deliver promised returns,” the report states.
The most popular wellness programs focus on helping employees lose weight and lead a healthier lifestyle through more exercise and healthy eating and habits.
To be successful, weight-management programs should use best practices and integrate treatments like anti-obesity medications and mental health services in their care models, the report says.
Getting control of plan costs
Employers will look to hold their health plans’ and benefits vendors’ feet to the fire for producing better health results at lower prices.
The key to this is employers having access to data from their health plans and other vendors that provides insights into cost and outcomes. This will be an evolving trend and some plans will be better than others in providing the desired information.
“Transparency of cost, quality and outcomes data is critical to both employer and employee decision-making; vendors will need to show how they enable access to this information in 2025,” BGH says in its report.
Additionally, employers that have sway with their insurers will push their health plans to get control on unit prices they pay for services, and press them to accept value-based contracts that reward for positive outcomes and quality of care.
Businesses that can afford it may contract directly with centers of excellence that provide very high quality or low-cost care, oftentimes for a particular service.
The takeaway
We know that the high cost of health care is weighing heavily and we are here to help you keep your health plan costs under control. It requires an integrated approach of pushing wellness and chronic condition management among your staff and evaluating your current vendors’ results.
