Navigating Rising Healthcare Costs: Insights for Employers
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As we approach 2025, employers are bracing for significant increases in healthcare costs driven by several factors, including soaring prescription drug expenses, inflation and worsening chronic health conditions among employees. Scott Insurance’s recent Milliman Benefits Benchmarking survey offered key insights into these trends. While the commercial health insurance market continues to experience increasing pricing pressure, there are strategies employers can deploy to mitigate costs and manage their health plans effectively.
The rising cost of healthcare
The Milliman survey indicates that the healthcare cost trend is projected to rise 6-11% in 2025, up from 5-10% in 2024. Since 2017, actual healthcare costs have skyrocketed by 50%, creating a pressing concern for employers and employees alike. Ellen Kelsay, CEO of the Business Group, attributes this jump in large part to rising prescription costs driven by a sharp increase in utilization for specialty medications.
The survey included responses from 156 VA-based employers, representing 60,000 workers. While the majority of employers intend to shield their employees from major cost increases, they are exploring various cost-management strategies to mitigate the impact.
Key findings from the survey
Pharmacy Costs on the Rise: The median percentage spent on pharmaceuticals has jumped to 27% in 2023, compared to 21% in 2021. This increase is largely due to heightened demand for GLP-1 medications and the growing use of high-priced cell and gene therapies.
Concerns About Drug Pricing: A staggering 76% of employers expressed being “very concerned” about rising pharmacy expenses. Only 1% believe the prescription drug market is competitive enough to promote affordability.
Growing Interest in GLP-1 Medications: 79% of employers reported increased interest from employees in obesity medications like GLP-1s. With 96% of employers covering these medications for diabetes treatment, it is clear that these drugs are becoming a significant component of employer health plans.
Utilization Management Strategies: Many employers are implementing measures to control costs, such as requiring prior authorization (87%) and considering mandating participation in weight management programs (52%) before approving GLP-1 prescriptions for weight loss.
The Cancer Challenge: Cancer continues to be the condition driving the highest costs, exacerbated by the increasing prevalence of diagnoses among younger employees. 72% of surveyed employers noted a higher occurrence of cancer diagnoses, a trend that many attribute to the delayed access to care during the pandemic.
Proactive strategies for employers
In light of these challenges, employers should consider the following strategies:
Evaluate Alternative Funding Strategies: Schedule an annual review with your benefits consultant to ensure your plan is using the most efficient funding strategy for your company’s risk tolerance (e.g., fully insured, self-funded or captive funding). A prospective analysis can give employers an idea of which funding method is most appropriate for the long term.
Explore Pharmacy Sourcing Options: On average, pharmacy accounts for 25% of claims; therefore, deploying alternative sourcing options, such as partnering with an international pharmacy, can greatly reduce overall costs.
Promote Preventive Care: Investing in prevention initiatives can help address the rising prevalence of chronic conditions and cancer diagnoses, ultimately reducing long-term costs.
Educate Employees: Ensuring employees understand their health benefits and available resources can improve health outcomes and decrease unnecessary expenses. One way to do this is by partnering with a knowledgeable benefits consultant to educate employees on strategies that encompass a “pull” strategy rather than a “push” strategy.
Explore Collaborative Solutions: Consider partnerships with the medical plan third-party administrator to create tailored programs aimed at steering employees to high-value sites of care, managing chronic conditions, and promoting overall well-being.
As healthcare costs continue to rise, employers must remain proactive in their approach to managing these expenses. By staying informed about trends and adopting strategic measures, businesses can foster a healthier workforce while navigating the complexities of rising healthcare costs. A knowledgeable benefits consultant can help you tackle these challenges and find solutions that work for your organization and your employees.
