theexperts

insightsfrom

2025NFP

USBenefits

TrendReport

Tableof

Contents

Welcometothe2025NFPUSBenefitsTrendReport 2

KeyTakeaways 4

Healthcare:CostContainmentand

PriceTransparencyCompliance 6

MitigatingGrowingHealthand

WelfareBenefitPlanFiduciaryRisk 6

HowtoMitigatePlanSponsorRisk 8

ControllingPrescriptionDrugSpend:

StrategicAnalysis 16

CostControlProductsandPrograms 19

TakingAction 21

MindtheGap:WellbeingTrendsfor2025 24

MentalHealthandMentalWellbeing 30

CaregivingSupport 33

LeaveManagementIsComplex

andEmployersNeedHelp 36

LeaveManagementSolutions 41

1

Welcometothe2025NFP

USBenefitsTrendReport

Aswebegin2025,mostemployersfindthemselvesattheintersectionofcomplexandrapidlyevolvingeconomic,legislativeandpoliticallandscapes.Thisenvironmentpresentsuniquechallengesforemployersstrivingtooffercompetitivebenefitswhileeffectivelymanagingtheirfiduciaryresponsibilitiesandhealthcareexpenditures.

The2025NFPUSBenefitsTrendReportfocusesonpracticalandstrategicsolutionstoyourmostpressingbenefitschallenges.Inthisyear’sannualreport,weexaminehoworganizationsare:

?Strengtheningoversightofpharmacybenefitsandhealthcarecoststhroughinnovativenetworkstrategiesandenhancedfiduciarygovernance.

?Streamliningleavemanagementtoreduceadministrativeburdenwhileensuringcompliancewithrelatedfederalandstatelaw.

?Addressingemployeewellbeingneedsstrategically,particularlyinmentalhealthandcaregivingsupport,byfocusingresourceswherethey’llhavethegreatest

impact.

?Makingsmarterdecisionsaboutbenefitsinvestmentsthroughenhanceddataanalyticsandprogramevaluation.

Thechallengesof2025willrequireemployerstobeproactive,adaptableandinnova-tiveintheirapproachtoemployeebenefitsandhealthcarespending,whileatthesametimeremainingvigilantintheirfiduciaryobligations.Thetrendsandstrategiesoutlinedinthisreportaredesignedtohelpguideemployersthroughthoseprocessessothat

theycaneffectivelymanagecostswhileprovidingvaluablebenefitsthatsupportandengagetheirworkforce.

Asyoureviewtheseinsights,knowthatourteamofconsultativeexpertsstandsreadytohelpyounavigatethesechallengesandimplementsolutionsthatworkforyour

organization’sspecificneedsandgoals.

Allthebest,

KimBell

EVP,HeadofHealthandBenefits

NFP,anAoncompany

2

3

4

KeyTakeaways

Growingfiduciaryriskrequiresemployerstoimplementcomprehensiveevaluationprocessesforhealth/welfarevendors.

Cost

ContainmentandPrice

TransparencyCompliance

Organizationsareleveragingpricetransparencytoolsanddataanalyticsforbettercostmanagementandmitigationoffiduciaryrisk.

74%identifydataanalyticsasimportantorveryimportant.

Rx

ofemployersprioritizecontrollingprescriptiondrugspend.

Employersaremovingtowardcarve-out

pharmacyarrangements(64%choosingeitherdirectPBMcarve-outorcoalitionparticipation).

70%

5

Mentalhealthsupportisexpandingtoincludepediatric/dependent

careservices.

Wellbeing

Comprehensivecaregivingsupportisgrowingforthe“sandwichgeneration”whoare

managingbothchildrenandagingparents.

Leave

Management

ofemployersspendmorethanfourhoursperleaverequestonadministration.

Twomainsolutionsareemerging:

technology-supportedinternaladministrationandoutsourcedadministration.

71%

6

Healthcare:

CostContainmentandPriceTransparencyCompliance

MitigatingGrowingHealthand

WelfareBenefitPlanFiduciaryRisk

Employeebenefitsmanagement

isundergoingafundamental

transformation,largelydrivenby

increasedscrutinyoffiduciary

responsibilitiesandcost

containmentpressures.However,

havingnavigatedthesechallengesinretirementbenefitsmanagement,HRteamsshouldbewellpositionedtoaddresssimilaroversightand

accountabilitydemandsfortheirhealthandwelfarebenefitplans.

7

Recentlegalactionsstresstheimportanceofemployersasplansponsorstoestablishproperfiduciaryoversight.Incomparisontotheretirementlandscape,thetimelineforemergenceoflegalactionhasbeengreatlycondensedforhealthandwelfarelitigation.Theescalationofclassactionlawsuitsisprimarilyattributedtotechnologicalcapabil-ities.Attorneysareleveragingsocialmediatopromoteemployeedissatisfactionwithanemployer’sselectionprocessoftheirhealthandwelfarevendors.Thisispromptingtheneedforemployerstoexpeditetheirdevelopmentofacomprehensiveevaluationprocessforselectingtheirhealthandwelfarebenefitvendors.

Toprotectbothplanparticipantsandtheorganizationatlarge,HRteams

mustbeginimplementingcomprehensiveevaluationprocessesnowtoensurecom-pliancewithfiduciaryresponsibilitieswhilealsooptimizingplanperformanceandcostmanagement.Throughawell-designedreviewprocess,thisgrowingfiduciaryriskcanbemitigated.

TheFiduciaryRoleofaPlanSponsor

Aplansponsor’sroleasafiduciarycomeswithsignificantresponsibilitiesandlegalobligations.Anypartywithdiscretionarydecision-makingauthorityovertheplanorplanassetsmustadheretoERISAfiduciarystandardsandresponsibilities,includingactingsolelyinthebestinterestofplanparticipantsandbeneficiaries,carryingouttheirdutiesprudently,followingplandocumentsandensuringonlyreasonableplanexpensesareincurred.

Variouspiecesoftransparencylegislationhavesignificantlyexpandedandfurtheridentifiedforplansponsorsadditionalareasrequiringoversighttomeettheirfiduciaryresponsibilities.Therearevariouspiecesoftransparencylegislationgovern-ingthehealthcaredeliverysystem,includingpurchasersandpayersofhealthcare.

Specifically,thefederalConsolidatedAppropriationsActstrengthensoversightby

prohibitinggagclausesinserviceprovidercontractsandrequiringplanserviceprovid-erstodisclosebothdirectandindirectcompensation.Italsomandatescomprehensivereportingrequirementsforpharmacybenefitsandensuresparityincoveragefor

substanceabuseandmentalhealthbenefits,broadeningthescopeoffiduciaryobliga-tions.

Theserulesapplytoallemployer-sponsoredplansregardlessofthefunding

methodologyselected,whetherfullyinsuredorself-insured.Industrysurveysidentifythegrowingmigrationofsmallerandmid-marketemployersfromfullyinsuredtoalternative

formsoflevel-fundedorself-fundedplanswithappropriatestop-lossprotection.Employersrecognizethatchangesinthestop-lossmarket,includingthegrowthintheuseofcaptives,nowallowanemployergreaterparticipationincostcontainmentandqualityofcareinitia-tives,whilemitigatingtheirfinancialrisk.Annualevaluationoffundingoptionsshouldbeanintegralpartofanemployer’sfiduciaryduediligenceandevaluationprocess.

HowtoMitigatePlanSponsorRisk

Organizationsmustbeginbydesigningandimplementingastructuredevaluationpro-cessfortheirhealthandwelfarebenefitstrategy,andthevendorsselectedtodeploy

thosestrategies.Qualitativeandquantitativemetricsarenecessaryto:

1.Performcomprehensiveclaimsanalysis,includingintegratedpricetransparencydata.

2.Developfinancialstabilityassessments.

8

3.Validatevendorandproviderperformance.

4.Monitoroverallplaneffectiveness.

9

Establishingthesefundamentalmetricscreatestheframeworkforeffectiveongoingplanmanagement.

Tosupportthistypeofevaluationprocess,organizationsshouldfocusondevelopingrobustdataanalyticscapabilitiesappropriatetotheirsizeandresources.

Thisincludesintegratingmultipledatasourcessuchasclaimsdata,providerpricing

informationandqualitymetrics.Modernanalyticsplatformscanhelptracknetwork

utilizationpatterns,identifycostoutliersandmonitorqualityoutcomes.Pricetrans-

parencytoolshavebecomeparticularlycrucial,enablingreal-timecostcomparisons

andhelpingtoidentifyopportunitiesforsteerageandplandesignoptimization.Largeremployerscanenhancetheirmonitoringprotocolsbyadoptingfraudmonitoring

systems,alongwithprepaymentauditprocessesandpost-adjudicationreviewpro-cedures(whencontractuallyavailable),creatinga360-degreereviewtomakebetterinformeddecisions.

Figure1:

DocumentationProcessofSelectionandDueDiligence

FundingOptions

Employersrecognizethatchangesinthestop-loss

market,includingthe

growthintheuseofcap-tives,nowallowanem-

ployergreaterparticipationincostcontainment.

DocumentationProcessofSelectionandDueDiligence

MANAGINGDATA

PROCESSDEVELOPMENT

?RequestClaimsData

?DocumentRequest/ReceiptofData

?NegotiateCarrier/TPA/VendorDataRequirementatRenewal,IncludingPerformanceCriteria

?PriceTransparency&Disclosures

DEVELOPSELECTIONCRITERIA

REPEATTHEPROCESS

03

MEASUREOUTCOMESOFDEFINEDKPIs

?ValidateDeinedKPIs

?TakeActionAgainstNon-PerformingKPIs

?AdjustandRedeineKPIsAppropriately

?EstablishaCommittee

?DevelopaCharter/PolicyforEvaluation

?DevelopCriteriaforSelection

?Organize,TimeStampandSecureAllFiduciaryProcurementMaterials

?FinancialStabilityofVendor

?MarketBenchmarking/Analysis

?NetworkAnalysis

?MemberDisruptionAnalysis

?DeineKPIs–Quantiiable&MeasurableGoals

MONITORDEFINEDKPIs

?ManagePerformingKPIs

?AddressNon-PerformingKPIs

?Establish“WatchList”Criteria

?DocumentMonitoringProcess

ENGAGEEXPERTS

?Identify&EngageSubjectMatter

Expertsto

InterpretData

05

07

06

01

04

02

10

Figure2:

PlansforMedical/RxRenewal

43%

Increaseourmedical/RxBudget

53%

Remainthesame

4%

Decreaseourmedical/RxBudget

Figure3:

PercentageIncreasePlanned

(Amongthoseplanningtoincreasemedical/Rxbudget)

<5%

12%

53%

5-9%

10-14%

15%+

30%

5%

Arrowindicatesstatisticallysigniicantyear-over-yearincreaseordecrease.

VendorContractReviewandCompliance

Regularvendorcontractreviewstoensurecompliancetocontracttermsimprovescostcontainmentprovisionsoftheplanandareessentialtoproperplanoversight.

Organizationsshouldestablishclearprotocolsforcontractreview,focusingonboth

costandqualityaccountabilitybymonitoringthereasonabilityofadministrativefees,adherencetoperformanceguaranteesandmember-levelservicemetricswithinthe

agreement.Documentationofthereviewprocess,findingsandfollow-upactions

shouldbemaintained,withclearescalationproceduresforaddressingidentifiedissues.

IndustryResponseandEmployer-DrivenSolutions

Employersrecognizethevaluetheirmedical/Rxbenefitplanhasonrecruitingand

retainingemployees.Figure2showsthat53%ofemployersaremaintainingtheircur-rentbudget,while43%willincreasetheirbudget.However,inresponsetomountingpressures,organizationsareexploringinnovativeapproachestomaintainqualityandmembersatisfactionwhilepursuingalternativestocontrollingcosts.

Throughthepricetransparencylegislation,employersareempoweredtotakegreaterresponsibilityandcontroloftheirmedical/Rxspendbyvisibilityintotheproce-duralunitcostofcare.ThisisevidencedinFigure4.56%ofemployersstronglyagree/agreeintheirabilitytocontrolmedical/Rxexpensesthantrustinthegovernmentto

bringmarketalternatives.

Thereisfurthermarketevidenceofthistrendobservedinthegrowthof

employer-drivencoalitionswhicharegainingtractionaspowerfulnegotiatingentities,particularlyinregionalmarketswheretheycanleveragecollectivebargainingpower.

11

Figure4:

HaveGreaterTrustinAbilitytoControl

Medical/RxExpensesthanTrustin

GovernmenttoBringMarketAlternatives

StronglyAgree

Agree

20%

35%

Neutral

33%

Disagree

12%

Arrowindicatesstatisticallysigniicantyear-over-yearincreaseordecrease.

Figure5:

ConsiderationsforOfsettingCosts(Amongthoseplanningtokeepcoststhesame)

Value-basedbeneits

toincentbetter

healthcarebehaviors

Beneitmodiications (e.g.,toplandesign,thenumberofprogramsofered)

Directtohospital/providersagreementstoreducecosts

Passingalong

anyincreaseto

planparticipants

Highperformanceclinicalprograms

Changingcarriers, administrativeserviceorganization (ASO),third-partyadministrators(TPAs)

Changing

fundingapproach(e.g.,fullyinsuredtolevelorself-funding,captive,etc.)

Noneoftheabove

35%

28%

27%

24%

23%

23%

22%

12%

Arrowindicatesstatisticallysigniicantyear-over-yearincreaseordecrease.

Figure5showsthatemployersarealsochoosinginnovativesolutionslike

value-basedbenefitsanddirect-to-hospital/provideragreementstoreducecosts

versusmodifyingemployeebenefits.Manyofthesecoalitionsarepioneeringdirect-to-employerarrangementswithmajorhealthsystems,demonstratingpromisingresultsinbothcostcontrolandqualitymanagement.

Forself-fundedplans,direct-to-employerlimitedscopehospitalbundlesrep-resentanotherstrategicapproachtocostcontainment.Thesearrangementsestablishfixedpricingfordefinedepisodesofcarewhilemaintainingqualitythroughintegratedmetrics.Thesuccessoftheseprogramsdependsheavilyonclearservicedefinitions,

robustqualitymeasurementprotocolsandthoroughproviderreadinessassessmentsfortheimpactedmarket.

12

Throughpricetransparencylegislation,Figure6,clinicalqualityisgrowingasan

employer-drivenstrategy.Evidence-basedproviderappropriatenessofcarequalitymeasurementsisnowareality.PoweredbyAI,providersarebeingscoredbasedon

theirtreatmentpractices.Thesemodernqualitymeasuresarebecominganintegralcomponentofthecostcontainmentmechanismsbeingconsideredbyplansponsors.

InnovativeNetworkDesigns

Employer-drivencostcontainmentstrategiesareutilizinginnovativenetworkdesignslikehigh-performanceandnarrownetworks.Organizationsexploringanarrownet-workand/orhigh-performancenetworkstrategymustundertakeacomprehensive

Figure6:

LikelihoodtoConsiderCostContainmentMechanisms*

19%w32%w32%16%

IntroduceRxcostefectiveprograms

Improvedatawarehousing,advanceddataanalytics

Considerdirecttohospital/providercontractingifcostsavingscanbeachieved

Enhancebeneitprogramsthroughclinical,appropriatenessofcareAI

Reducebeneitcostsbyidentifying'non-valued'beneitprograms

Considerinnovative,cost-efectivewaystopersonalizebeneitsbasedondemographicdiference

18%w32%w33%17%

18%31%35%17%

18%29%35%19%

16%34%30%20%

14%35%36%15%

Arrowindicatesstatisticallysigniicantyear-over-yearincreaseordecrease.

ExtremelyWilling

Very

Moderately

Slightly/NotWilling

evaluationofkeyfactorstoensuresuccessfulimplementation.Effectiveexecutionrequiresrobustresourcecapabilities(internalorexternallycontracted),includingadvancedanalytictoolsfornetworkadequacyanalysisandgeo-accessevaluations.

Infrastructuretoassessqualitymetricsandanalyzememberimpactisessentialtoalignnetworkstrategieswithorganizationalgoalsandmemberneeds.

Whenexecutedeffectively,narrownetworksutilizinghigh-performance

providerscanyieldconsiderablebenefits.Organizationsoftenexperiencefacilitycostreductionsof15%to25%,drivenbyfocusedproviderpartnershipsandoptimized

resources.Thesestrategiesalsoenhancequalitymetricsandfosterimproveddata

*Duetoroundingconventions,datamaynotaddto100%.Formoredetailsaboutthedata,seePage46orcontact

marketing@

.

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NarrowNetworks

Whenexecutedeffectively,narrownetworkscanyieldconsiderablebenefits,suchasfacilitycostreductionsof15%to25%.

transparencyandreporting,positioningorganizationsforstrongernegotiationsin

futurenetworkarrangements.Byaddressingchallengesandleveragingstrategic

resources,organizationscanachievebothimmediatecostsavingsandlong-termcom-petitiveadvantages.

Thetransitiontoalternativenetworkarrangementsincludinghigh-perfor-

mancenetworksmaypresentsomechallengestomembers.Memberperceptionandengagementrequiretransparentandproactivecommunicationstrategiestobuild

trustandunderstanding.Someeffectivestrategieshaveusedclinicalcoachingtosup-portmemberstowardhigh-quality,low-orreasonable-costproviders.

ToolstoSupportEmployer-DrivenSolutions

Themarketinnovationnecessitatesadoptionofadvancedanalyticalcapabilities,whichhasbecomeanessentialtoolinthisnewlandscape.Figure7demonstratesthat74%ofemployersrecognizedataanalyticsisvery/extremelyimportant.Withpubliclyavailabledata,modernplatformscanprovidereal-timeaccesstotheunitcostofcareforapro-

cedure,throughthepricetransparencydata.Utilizingpricetransparencydataallowsemployerstoperformanindependentnetworkevaluationoftheirmedical/Rxvendorstodeterminethebestnegotiatedpricingfortheirmembers.

Plansponsorscannowmonitortheseinnovativesolutionsinanewway.

Thesemodernplatformsintegratequalitymeasureswithproceduralcostdata,analyzeclinicalappropriatenessandbenchmarkagainstMedicarerates.Thiscomprehensiveapproachenablesorganizationstomakebetterinformeddecisionsaboutnetwork

design,providerselectionandbenefitstructure.

Tosupportemployer-driveninitiativestowardbothcostandqualityaccount-ability,NFPcontinuestoimproveuponourpricetransparencycapabilitiesthroughaproprietarytoolcalledTPNet(TransparentPricingandNetworkAnalysis).ContactyourNFPrepresentativetoseehowthistoolcanpoweryoureffortsandmeetsomeofthenecessaryfiduciaryrequirements.

Figure7:

ImportanceofHavingAccesstoDataAnalytics

ExtremelyImportant

25%

49%

VeryImportant

Neutral

19%

NotToo/AtAllImportant

7%

Arrowindicatesstatisticallysigniicantyear-over-yearincreaseordecrease.

15

ImplementationandEngagementConsiderations

Whilemanyoftheseemployer-drivenstrategiesoffersignificantpotential

benefits,successfulimplementationrequirescarefulattentiontoemployeeandmemberchangemanagement.Thesechallengescanbeovercomethrough

effectivestakeholdercommunicationandeducation,maintainingstrongpro-viderrelationshipmanagement,andensuringrobustmemberengagementandfeedbacksystems.Carefulplanningandresourceallocationutilizingintegratedtechnologyandadvanceddataanalyticsarenecessarytoeasetheburdenof

changeandvalidatethevalueoftheapproachtomanagement.

MeasuringSuccess—ExpertEngagementandExternalResources

Aspartofacomprehensivehealthandwelfarebenefitprogram,organizations

mustimplementbroadriskmitigationstrategiesacrossallaspectsoftheirhealthandwelfarebenefitprograms.Frequently,thisrequirestheengagementofsub-jectmatterexperts(SMEs)andexternalresources.Duetothecomplexityofthe

pricetransparencyregulations,engagingappropriateexpertiseisrecommended.

Regardlessofthespecifichealthandwelfare,costcontainment,and

qualityapproacheschosen,properoversightandgovernanceareessential

tomeetfiduciaryobligationsandmanagethefinancialandlegalexposure.A

comprehensiveriskmanagementframeworkprovidesthefoundationforthe

successfulimplementationofanycostandqualityaccountabilityinitiativewhileensuringcompliancewithregulatoryrequirements.Thisincludesdetailedfinan-cialimpactmeasurementsandmembersatisfactionmetricstoensurebothcostefficiencyandprogrameffectiveness.Providerparticipationandengagementlevelsshouldbecloselymonitoredtomaintainnetworkstabilityandquality.

Qualityoutcomeindicatorshelpvalidatecaredeliveryeffectiveness,whileoper-ationalefficiencymetricsensuresmoothprogramadministration.Regularreviewofthesemeasuresenablesorganizationstoadjuststrategiesasneededand

demonstrateprogramvaluetostakeholders.

MovingForward

Ashealthcarecostscontinuetoriseandfiduciaryresponsibilitiesexpand,

organizationsmustbalanceeffectivecostcontainmentwiththeirobligationstoplanparticipants.Successrequiresamethodicalapproachthatcombinesrobustoversight,quality-of-caremeasuressupportedbydata-drivendecisionmaking,andstrategicpartnerships.

DataImpacts

Modernanalyticsplatformscanhelptracknetwork

utilizationpatterns,identifycostoutliersandmonitorqualityoutcomes.

16

ControllingPrescriptionDrugSpend:

StrategicAnalysis

Intoday’sworkplace,controllingprescriptiondrugspendhas

becomeacriticalpriority,with

70%ofemployersratingitasveryorextremelyimportant.Rising

costsaredrivingorganizationstoseekmoresophisticated

approachestopharmacybenefitmanagement.

17

18

FiduciaryRiskManagementinPharmacyBenefits

Recenthigh-profilelitigationinvolvingmajoremployershasheightenedawarenessoffiduciaryobligationsinpharmacybenefitmanagement.Giventheever-shiftingnatureofpharmacybenefitsadministrationaswellasnewinsightsintolegalprudence,theseresponsibilitiesarebecomingincreasinglyscrutinized.

Thescopeoffiduciarydutyinpharmacybenefitsextendsfarbeyondbasiccostmanagement.Muchlikeoverseeingthemedicalplan,plansponsorsmustdemonstratethattheirpharmacybenefitdecisionsprioritizeparticipantinterestswhilemaintainingprudentoversightofpharmacybenefitmanager(PBM)relationships.Thisincludes

ensuringtransparencyindrugpricing,evaluatingformularydecisionsandmonitoringtheimplementationofclinicalprograms.

WhatFundamentalStrategiesHelpaClientMeetTheirFiduciaryResponsibility?

Weareseeingthreefundamentalstrategiesdesignedtohelpemployersoptimizetheirpharmacybenefitsspend:pharmacybenefitarrangements,costcontrolproductsandprograms,andcomprehensiveauditframeworks.Eachapproachoffersdistinctadvan-tagesand,whenimplementedcohesively,cancreatearobustfoundationformanagingprescriptiondrugcostswhilemaintaininghigh-qualitypatientcare.

Figure1:

ImportanceofControllingRxSpend

ExtremelyImportant

23%

47%

VeryImportant

Neutral

21%

NotToo/AtAllImportant

9%

Arrowindicatesstatisticallysigniicantyear-over-yearincreaseordecrease.

Figure2:

PharmacyBeneitArrangementUsed

36%

Carved-In,withaTPAorCarrier

27%

Carved-Out,withaPBM

37%

InaConsortium/Coalition

19

Figure3:

ImportanceofEstablishingContinuousImprovement/BestPracticePolicyforMedical/RxPlanSelectionin2025*

28%

ExtremelyImportant

42%

VeryImportant

18%

Neutral

3%

8%

N/A;Unfamiliarwithlegislativechanges

Extremely/VeryUnimportant

Arrowindicatesstatisticallysigniicantyear-over-yearincreaseordecrease.

Carve-OutStrategy

Thepharmacybenefitmanagementlandscaperevealsagrowingshifttowardindependentbenefitmanagement,with64%of

employersnowchoosingeitherdirectPBMcarve-out(27%)or

coalitionparticipation(37%).Thistrendreflectsincreasingrecog-nitionofthevalueinstand-alonepharmacystrategies,while36%maintaintraditionalcarved-inrelationshipswiththeirthird-partyadministratororcarrier.Themarket’sevolutiondemonstrates

employers’growingpreferenceformodelsthatoffergreatercon-trolandspecializedpharmacymanagement,includingamore

robustsetoftoolsallowedforbothcostcontrolproductsandprogramsandauditing.

Implementingacarve-outstrategyallowsemployers

togaingreatervisibilityandcontrolovertheirprescriptiondrugspend.Recentlegislativepoliciesandlitigationhavehighlightedthecriticalneedfortransparencyindrugpricingdata,making

theseparationofpharmacyfrommedicalcarriersincreasinglyimportant.Bypeelingawaypharmacybenefitsfrommedicalcoverage,organizationshaveconsiderableopportunitiestoenhancetheirpharmacybenefitsbybetterutilizingtheirdata.

Whileorganizationsareincreasinglyrecognizingthevalueof

analyticsinidentifyingcost-savingopportunities,manyhaveyettofullyembracethepotentialpositiveeffectafullydata-drivenapproachcanhaveontheirpharmacyspend.

CostControlProductsandPrograms

Value-basedpharmacyproductsrepresentanovelshiftinhoworganizationsareapproachingpharmacybenefitmanagement.Thesepartnershipsleverageinnovativemanagementtoolstocreatemoresustainableandeffectivemodelsforcontrolling

drugspend.

With70%ofemployersprioritizingtheestablishment

ofbestpracticepoliciesforRxplanselection,thesevalue-basedpartnershipsarebecomingincreasinglycommon.Byleveragingpharmacists’comprehensiveconsultingexpertiseindruginfor-mation,industrytrendsandemergingtherapies,clientsareusingcostavoidancestrategiestolowerpercapitacarecosts.

Thecorestructureoftheseproductsandprogramsarebasedonperformance-basedcontracting.Thisapproachhasgainedsignificanttraction,with98.3%ofNFPclientsreportingthattheirRxcontractnegotiationsarefocusedonoptimal

pricingandcontractterms.Thesecontractsoftenincorporatequalitymetricsandfinancialrisk-sharingframeworks,creatingabalancedapproachtocostmanagementwhilemitigatingtheriskofstaleoruncompetitivepricingthatcanleadtohigher

downstreampremiums.

*Duetoroundingconventions,datamaynotaddto100%.Formoredetailsaboutthedata,seePage46orcontact

marketing@

.

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ComprehensiveAuditFramework

Contractcompliancereviewsserveasafoundationformaintainingaccountabilityandtransparencyinpharmacybenefitmanagement.Thesereviewsnotonly

ensureallstakeholdersfulfilltheircontractualobligationsbutalsoprovideorgani-zationswithvaluableinsightsintotheirPBMrelationships.Regularmonitoringandevaluationofcontractperformancehelpsidentifyopportunitiesforoptimization,supportsmoreeffectivenegotiationsandultimatelycontributestobettercost

management