Transparency paves the way for lower costs and equitable access

Employer healthcare costs continue to rise, with high-cost claims and high drug and hospital prices being the biggest concerns, according to the most recent Pulse of the Purchaser survey by the National Alliance of Healthcare Purchaser Coalitions, released in September. (See Table Below)

The percentage of employers strongly agreeing that rising healthcare costs impact their ability to compete has steadily increased each year from 35% in 2022 to 53% in 2025. Self-insured employers are more likely to report lower-than-average annual premiums (41%), and fully insured employers are more likely to report higher-than-average annual premiums (64%). About 90% of employers said rising healthcare costs are impacting the organizations’ competitiveness.

“A survey respondent aptly described the current healthcare environment as a dumpster fire with unlimited fuel as long as employers continue to put up with the status quo,” said Shawn Gremminger, National Alliance president and CEO and an editorial board member of Managed Healthcare Executive, in a news release. “U.S. healthcare costs continue to grow exponentially and outpace economic growth, and it’s the innovative employers that have access to their claims data that are paving the way to fair prices and equitable access.

The survey of employers and purchasers found that they continue to want transparency from their pharmacy benefit managers (PBMs) and access to data; however, some are struggling to get the information they need. A third of employers said they cannot get complete claims data, and 4 in 10 said their vendors refused to provide access.

Employers said that transparency is linked to lower premiums. Employers using transparent PBMs were 1.6 times more likely to report lower premiums and 30% less likely to report higher premiums. Additionally, employers with transparent claims access say they are more likely to actively implement value strategies. The share of employers using transparent PBMs rose from 12% to 31%, and 61% of employers have either changed vendors from the largest PBMs or are considering working with transparent PBMs.

The Pulse of the Purchaser survey was conducted with member coalitions between July and August 2025 with 324 responses from private and public employers and purchasers across the country. It aimed to gauge concerns about several issues, including women's health; obesity management and emerging therapies; mental health; equity; pharmacy strategies; hospital prices; high-cost claims; and policy priorities and potential health reforms.