Surveys found that one-third of employers have no access to suppliers' medical claims data

A new survey by the National Alliance of Health Care Buyers shows that many employers cannot access their medical claim data from health providers such as PBMs and insurance companies.

One-third of employers are working to get full claims data from their suppliers, while four in 10 said their suppliers refused to provide access. Employers use this data to analyze healthcare utilization patterns and costs. This is as employers hit rising medical expenses. More than half say these costs affect their competitiveness, while 99% of employers say drug prices, hospital prices and high cost claims are the biggest threat to affordability.

National Alliance is an employer advocacy organization. It released a pulse of the buyer survey on Tuesday received responses from 324 employers. It is conducted in July and August.

The investigation also found that those who do have access to their claim data are more likely to implement strategies to combat costs, such as reviewing their PBM agreements, confirming that consultants will not implement a center of excellence from their PBM, implement a center of excellence and utilize compensation for direct contracts with providers.

“A survey respondent appropriately described the current health care environment as a waste bin fire with unlimited fuel, as long as employers continue to endure the status quo,” Shawn Gremminger, president and CEO of the National Alliance, said in a statement. “The cost of health care in the United States continues to grow exponentially and exceeds economic growth, while innovative employers can access their claim data, paving the way for fair prices and fair access.”

Larger employers are more likely to access their claim data: 74% of those with more than 50,000 employees have full access, while 52% of those with less than 1,000 employees.

Other findings from the investigation include:

• About two-thirds of employers have already changed suppliers from the three major PBMs (CVS Caremark, Express Scripts and Optum RX), or are considering changing suppliers in the near future. Many people choose to use it with transparent PBM.
• Employers have a negative view of the hospital merger, with about 60% saying they disagree with it improving cost and quality.
• When asked which policy changes will be the most helpful for their plans, the best options are PBM reform, drug price adjustment, protection of ERISA preemptive, hospital price transparency and hospital rate adjustment.
• About 65% of employers offer coverage of brand GLP-1 in 2025, compared with 67% in 2024. The highest cost reduction strategies for GLP-1 include limiting coverage to specific populations, requiring point-breaking suppliers and coverage of GLP-1S, requiring lifestyle support such as nutrition and exercise. However, the composite GLP-1 is controversial because they are not approved by the FDA.

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