The leading leaders of the largest employers in the country manage increases in mass medical care costs, and that is promoting the change in how they design their health benefits offers. I have spoken with more than 100 benefits leaders in recent months, and a topic is clear: employers are willing to make bold movements and consider approaches that had previously ruled out. These are the days of placing in new programs and hoping that they drive the commitment. Your approach now? Less high -impact solutions that improve employee health and offer hard dollars. For many, that means eliminating solutions.
It is difficult, but the leaders of the benefits should not allow the issues to be consumed by the problems of the buttons that dominate the news cycle, such as LPG1, the therapy and cancer of cells and genes. These are large and growing sources of spending, true, but they are also sources for which it is difficult to control costs, so they are not the first place to look for the cost curve. Employers need a strategy, but those cubes are more about the benefits of culture and health results, without reducing spending. To do that, the biggest liver that can be thrown are shocking cost drivers, and those who jump from the page are surgery and infusions. Control them and eliminate a lot of waste, reduce costs and improvements the experience of employees.
If you are still evaluating the benefits in the same way that it did five years ago, it is already behind. Here are six ways to get ahead.
Fiduciary responsibility
Fiduciary pressures are being built for employers. The new administration has shown that they want to be aggressive on several fronts, including price transparency, PBM reform and preventive services. President Trump signed 76 executive orders in his first 100 days, more than any acting president since 1985. Simultaneous regulations are increasing while shooting regulators, leaving many confused. The leaders of the benefits tell me that they go to the offensive, intensifying their fiduciary government, including: Commission similar to executive compensation managers; Fiduciary training; Add insurance policies; Increase external review even with a solid internal team; and execute more supplier audits.
Less is more
For years, benefits teams have been pressed to increase their investment in total rewards programs to stay competitive. But increases in historical trends threaten that approach. Actually, more options do not always translate into better results. Employers are cutting ties with solutions that do not show a hard Dollar ROI and are inclined to a “less” strategy quality that prioritizes the amount over the amount.
Leaders also prioritize stronger marketing and communication plans to ensure that people know what benefits are available and how to use them. “We are leaders of great benefit, but we have to start thinking as great sellers,” one of them told me.
Rethink specialized attention: a new approach to cost containment
Specialized care is 50% of an employer’s health spending: the 2x pharmacy expense and growing at a faster rate, but few have designed a specialized care strategy. It is one of the only benefit solutions that can implement that will affect a fraction of the population, only around 15% will need specialized attention in a certain year, and can deliver twice as much savings compared to more disruptive changes such as politication P. Employers are increasingly moving towards supplementary specialized networks and designs of mandatory plans, with column surgery, joint replacement and bariatric procedures that They advance the way. Companies that demand the use of networks of excellence are seeing more than $ 50 per employee, savings per month while improving clinical results.
LPG1S – Should we or should we?
Barastric surgery is the gold standard for weight loss, but an advisor with whom I talked, that we respect highly, predicts that surgery will not exist by 2031. With 50% of Americans forecast to have an BMI greater than obesity.
The LPG1 are dominating the conversation, but half of the benefits with which the leaders with whom I have spoken do not cover them to lose weight. Many who are not delighted with that, and who can blame them, with compliance rates of around 30% after 3 months. According to a recent study published in JAMA, the price of LPG-1 would have to fall to $ 70 per week, almost a week, a reduction of 3x costs, only to achieve barastric surgery.
The LPG1 will continue to improve and be approved to obtain more indications, but inject every day. That, combined with the side effects and the monthly cost, becomes a list of cons that can overcome the pros of weight loss. Ozempic will become a generic in 2031, but oral delivery is still far. The FDA has eliminated the scarcity label in the semaglutida, so it is not supposed to distribute compounds (the application soakes a question), which means that the pressure for the discount of Big Pharma is relieved, at least for now.
I have worked in specialized care, dream, mental and pharmaceutical health, and I say this all the time: the change in behavior is difficult; Very hard. Most in LPG1 are not changing their behaviors, such as eating better/less or exercising more. If that is the case and want to retain weight loss, you must remain in the drug to perpetuity. And if 70% renounce, no one will see the benefits downstream as a reduced cardiovascular risk, lower a1cs, etc. I think that bariatric surgery is here to stay for a while and employers shoulder analyzes a new look. Fifty percent of our new clients this year was launched with him as an application procedure.
Hospitals are real cost drivers
The pharmacy is very blamed, but does not ignore the price balance that is obtaining from some important health systems. Some hospitals charge 300-500% of Medicare’s rates, but their price fixing power remains without control. Even the country’s largest employers fight to influence the main hospital systems due to the lack of centralized population density. Employers and unions are adopting a bolder posture: eliminating specific health systems of their networks to control costs and association with direct contractual partners who can resort to a lot of employers distributed in the same geography to be intoothers. And if Medicaid is trimmed, what is anticipated, hospitals will look for their commercial payers to recover the loss of income, which means that employers will see higher hospital prices.
Emerging therapies
LPG1-S is today’s hot topic, but Cell and gene therapy and car-t therapy are tomorrow. A benefit leader called the topic “A category 5 hurricane just on the high seas”. With the advances in these therapies, employers can dramatically improve health results for patients living with some of the most difficult conditions to treat, including genetic disorders and rare cancers. Last year, the FDA approved 38 CGT, and is expected to grow at 50 in 2026.
Employers want to do the right thing and make new treatments available to employees. But because these land rest treatments are between one hundred thousand to millions of dollars, the cost is a real group. “We have the opportunity to have a great impact, but we have to start preparing now. This is the problem of specialized pharmacy for 15 years,” a benefits leader told me.
2026 is the year of impact. Employers who adopt this change will not only control costs, but will build a benefit strategy that really works, both for their people and their results.
Photo: Dny59, Getty Images
Dickon Waterfield is the president of Lantern, a specialized care platform that helps employers reduce spending for surgery, cancer and infusion and improve health results. It has spent the last 20 years in medical care consultations and new medical care companies and scale in specialized care, pharmacy, sleep and mental health. He lives in Connecticut with his wife and three children.
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