CPI report that increases the inflation of health care
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The inflation of the healthcare system promotes insurance costs and determines the stage for the greatest increase in health expenditure by large employers in 15 years.
According to the consumer price index of the Ministry of Labor, the costs for medical care in August rose by 4.2% in the year compared to a total inflation rate of 2.9%. The costs of visiting doctors rose by 3.5%, while hospital and outpatient services rose by 5.3%.
These price increases contribute to higher health insurance costs for 2026. Consumers who do not qualify for state subsidies to buy health insurance on the stock exchanges of the Affordable Care Act could be exposed to double -digit premium increases for the next year.
Employees with health insurance with employers could also pay higher premium and cost costs next year.
According to several surveys of the Business Group, large employers who increase their total costs for health insurance in 2026 in 2026 will increase on average 9%, which has been the highest inflation of health care since 2010.
More than half of the companies surveyed by Benefits Consulting company Mercer at the beginning of this year stated that some of these increases to workers, but the Business Group on Health says that most major employers are looking for other options in their survey to reduce costs.
“The employers were spared in every respect, from the transfer of costs to the employees. This year we will see the first indication that they may want to pass on some of them to the employees, but only as a way out. They will try to pull as many other levers as possible,” said Ellen Kelsay, President and CEO of BGH and CEO.
Employer costs drivers: cancer medication and GLP-1S
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According to the consumer price index, prices for prescription drugs rose by 0.9%, which takes into account a number of widespread generic and brand medication.
For large employers, however, expensive drugs are the main drivers of higher health expenditure.
BGH surveyed by BGH forecast an increase in pharmaceutical costs next year by 12%, in addition to an increase of 11% this year, which is used by cancer medication and diabetes and obesity as treatments as treatments Novo Nordisks Wegovy and Ely Lilly’s Zepbound.
“Cancer diseases have taken place for the fourth year in a row, whereby the top state promotes health costs – cancer of the younger age and later stage diagnoses,” said Kelsay, who was added that medication for weight loss from weight loss is just under a second.
“When it comes to the treatment of obesity, this was the room that has been the most froth most of the foam for two to three years and heated up a large part of these pharmaceutical editions,” she said.
According to Mercer, almost two thirds of employers with 20,000 employees or more offer access to GLP-1 weight loss medication. Less than half of the small employers examined plan to offer access by 2026.
In view of the growing demand for medication, more companies tighten the authorization requirements and begins to explore cheaper opportunities in order to provide their employees, including the cash play market.
Cash-Pay-Glp-1S
A telemedicine manager, whose company offers compiled GLP-1, said CNBC said that some large employers let workers know quietly that they can use health savings accounts to buy the medication for less on the money market.
“You are worried about how much [the drugs] Cost, but that doesn’t mean that you do not believe that your employees should not have access to you. They just don’t want to have to pay for it, “said the manager, who spoke about the confidential nature of the discussions on the condition of anonymity.
Health Account data show that more workers turn to the direct options for the consumer, including Eli Lilly’s Lilly’s Lilly Direct and Novo Nordisks Novocare online pharmacies, which offer their weight loss medication at around half of the list prices of more than $ 1,000.
GLP-1 purchases are today the top category of cash expenses for flexible and health savings accounts before taxes for the costs not covered by insurance, according to the CEO of Health Payments processor Payient.
“We see a triple from last year to this year of use in GLP-1-oriented providers. These are places like Lilly Direct like Ro, like Hims & Hins, and that’s a growing segment,” said Payient founder and CEO Brian whorley.
However, employers fear that the cash-pay trend will let workers out of the equation with lower incomes because they cannot afford the costs out of their pockets. This leads to discussions about how your companies can receive cash prices in order to increase a fairer access for employees.
Self -insured employers have come together directly with so -called excellence centers for special medical care such as cancer treatment and shared exchange. But for many drugs you can’t do the same at the moment. As part of agreements with company performance companies or PBMS, both pharmaceutical manufacturers and employers would violate their contracts by using a direct cash Pay procedure.
But employers are increasingly pressing PBMS for better options, says Kelsay from BGH. They begin to take into account new types of performance managers that propose new payment models for medicines in the development pipeline.
“There are some new units – some start -ups in this area – that expand products and solutions in which they negotiate with manufacturers on behalf of a pooled group of employers about certain cell and gene therapies,” she said.
Paytients whorley calls the challenge of making GLP-1 more affordable into a stress test moment for employers and PBMs.
“You are in a perfect kind of Venn diagram of clinically effective medication that change people’s lives that are increasingly enforcing an election,” said whorley. “If we understand this correctly, a blueprint for all drugs such as GLP-1 can offer … challenges for health plans.”
