Pulse of the Purchaser data shows continued pressure on drug and hospital prices and accelerating shifts to non-traditional PBMs

WASHINGTON, Sept. 9, 2025 /PRNewswire/ -- Employers with complete and transparent claims access are not only nearly twice as likely to engage in federal and state health policy (56% vs. 31%) but are also more likely to actively implement value strategies – especially when managing pharmacy benefits, hospital value, and high-cost claim management. These are among the findings of the latest survey of 324 employers conducted by the National Alliance of Healthcare Purchaser Coalitions (National Alliance) and its member coalitions.

The Pulse of the Purchaser survey gauged concerns and approaches of employers to address the workforce environment; women's health; obesity management and emerging therapies; mental health; equity; pharmaceutical and pharmacy benefit management strategies; hospital prices; high-cost claims; data rights and access; fiduciary responsibility; and policy priorities and potential health reforms.

"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. "US 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 price and equitable access."

Key findings include:

Affordability and Access

• 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.
• Consistent with surveys over the last five years, 99% of employers rank drug prices, hospital prices, and high-cost claims as the biggest threats to affordability.
• A third of employers still can't get complete claims data and 4 in 10 said their vendors refused to provide access.
• Access to full claims data also increased with employer size as only 52% of small employers (<1,000) stated they have full data rights versus 74% of jumbo (50,000+) stating they have full access to their own data.
• Purchasers with complete claims access are substantially more confident in fiduciary safeguards across hospital billing and pricing and PBM practices than those without full access (e.g., hospital billing integrity is 71% with access vs 37% without).

Pharmacy Benefit Management

• Nearly two-thirds of employers (61%) have either changed vendors from the Big Three in the past year or are considering a change within the next 1-3 years and those working with transparent PBMs were more likely to report lower premiums (42% vs. 27%).
• In the last year, the share of employers using transparent PBMs more than doubled – rising from 12% to 31% (+19 pts), while Big Three usage fell from 72% to 61% (–11 pts), and other PBMs declined from 16% to 8%.

Hospital Fair Price

• When asked about market consolidation, 6 out of 10 employers disagree that it has improved cost and quality.
• Hospital fair price value strategy adoption climbs with scale—especially with centers of excellence (CoE) (50,000+ 65% currently engaging CoEs vs. <1,000 22% currently engaging CoEs), site of care redirection (50,000+ 48% currently doing vs. <1,000 28% currently doing), and direct contracting with high value hospitals (50,000+ 44% currently doing vs. <1,000 20% currently doing).

Health Policy

• The top two 2025 "very helpful" healthcare policy reforms are PBM reform (56%) and drug price regulation (56%), both increased since 2024 (PBM 51% to 56%; drug pricing a big jump from 37% to 56%).
• Employers who view Interest in shrinking the 340B Drug Pricing Program as "very helpful" rose nearly 20% (5% in 2024 to 24% in 2025).

Obesity Management

• There was a slight dip in coverage of obesity management drugs as 65% offer coverage of branded GLP-1s in 2025 (67% in 2024).
• GLP-1 coverage remains steady, but program design is evolving. Compared with last year, fewer report limiting eligibility to specific populations (86% vs 91%, –5 pts) or requiring lifestyle adherence (78% vs 86%, –8 pts), while more are using point-solution vendors to manage access (79% vs 67%, +12 pts) and slightly more allow compounded GLP-1s (69% vs 64%, +5 pts).

The online poll of 324 employers that are members of coalitions affiliated with the National Alliance was conducted in July and August. Organizations represented include manufacturing; educational services; public administration; finance and insurance; and healthcare and social assistance institutions. Purchasers ranged in size with 10% having 50,000+ employees; 17% 10,000-49,999; 46% 1,000-9,999; 10% 500-999; and 17% less than 500. The full Pulse of the Purchaser results can be found here.

Pulse of the Purchaser Findings Webinar

On September 22 at 2:30 p.m. ET the National Alliance will host a discussion on the key findings and offer insight into strategies that employers are undertaking (or considering) to address mounting benefit challenges and cost pressures. Register here. 

About National Alliance of Healthcare Purchaser Coalitions

For more than 30 years, the National Alliance has brought together business coalitions and their employer and purchaser members to drive high-quality healthcare that enhances patient experience, promotes health equity, and improves outcomes while lowering costs. Its members represent public and private sectors, nonprofits, and labor unions that provide health benefits to over 90 million Americans—more than half of the employer-sponsored insurance market—spending over $850 billion annually. To learn more, visit nationalalliancehealth.org and connect on LinkedIn.

The National Alliance is hosting its 2025 Annual Forum – Ignite Courage: Employers Disrupting Healthcare – November 10-12 at the Crystal Gateway Marriott in Arlington, VA. Registration is discounted for employers and other healthcare purchasers affiliated with a National Alliance member coalition.

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SOURCE National Alliance of Healthcare Purchaser Coalitions