Pulse of the Purchaser poll links claims visibility to more action on PBM transparency, hospital affordability and high-cost claims management
WASHINGTON, Aug. 12, 2026 /PRNewswire/ — Employers with full access to medical and pharmacy claims data are more likely to act on hospital affordability, high-cost claims and pharmacy benefit management transparency, according to the Pulse of the Purchaser survey conducted by the nonprofit National Alliance of Healthcare Purchaser Coalitions (National Alliance) and its members. The survey of 408 employers also finds that rising healthcare costs remain a workforce challenge, with employers identifying the high-value purchasing strategies they are using in response.
Nearly all employers surveyed say attracting and retaining employees is a top priority (97%) and that health and wellbeing benefits are crucial to that effort (98%). At the same time, 92% say healthcare costs hurt competitiveness, 83% say cost increases trade off with wage and salary increases, and 93% expect costs to shift to employees.
“Healthcare affordability is no longer just a benefits issue; it is a business issue, a workforce issue and a wage issue,” said Shawn Gremminger, National Alliance president and CEO. “Employers have the concern and the will to act, but too often lack the usable data, contractual rights and staff capacity to do so. When those barriers are removed, employers are better able to move from concern to action. In a challenging economic environment, healthcare costs continue to be a driving factor in inflation, the concern most often cited by Americans going into the pivotal 2026 midterm elections.”
The findings come as employers face another year of projected healthcare cost increases outstripping inflation and pressure to protect wages, benefits and competitiveness. For employers, the results point to a broader shift in benefits strategy: rising costs are no longer being treated only as an annual renewal challenge, but as a business issue tied to vendor accountability and usable data.
Key Findings
Affordability pressures remain concentrated in drug prices, high-cost claims and hospital prices. Employers cite drug prices (77%), high-cost claims (75%) and hospital prices (68%) as the top significant threats.Employers paying higher premiums expect sharper increases. Employers project an average 7.7% healthcare cost increase before plan design changes, and 33% of those providing an estimate expect increases of 9% or more. Fully insured employers were most likely to expect increases of 9% or more.Hospital/facility costs and prescription drugs are the largest shares of spending. Employers estimate hospital/facility costs represent 30.5% of total healthcare spend, followed by prescription drugs at 21.1% and professional fees at 19.1%.Data access helps employers move from intent to implementation. Employers with full claim-level access reported using nearly four more high-value purchasing strategies, on average, than employers with limited, no or uncertain access (11.9 versus 7.9). The two groups were considering similar strategies, suggesting that data access is a key factor separating concern from action.PBM transparency remains a major focus. Employers identify PBM reform as the most helpful policy reform tested in the survey, with 87.6% rating it very or somewhat helpful. In addition, 43% of respondents are considering a PBM change within the next one to three years.Hospital transparency and payment reforms are rising policy priorities. Employers rated hospital price transparency (84.6%), hospital rate regulation (82.6%) and hospital antitrust enforcement (72.2%) as very or somewhat helpful reforms.
Employers Moving from Concern to Action
The Pulse of the Purchaser study identifies the strategies employers are using or considering to address healthcare affordability, with usable claims data emerging as a key factor in moving from intent to implementation. Higher premiums or steeper expected increases do not predict strategy adoption as strongly as data access.
While data access alone does not automatically lower premiums, employers with better data rights are better positioned to evaluate networks, review hospital prices, manage vendors, audit claims and pursue strategies such as centers of excellence, site-of-care management, direct contracting and reference-based pricing.
PBM Market Pressure Continues
The 2026 survey also points to continued PBM market movement. Employers contracting with the Big Three fell from 63.4% in 2025 to 54.3% in 2026, driven largely by employers with fewer than 1,000 employees. Among current Big Three clients, 55.7% said they are considering a PBM change within the next one to three years, compared with 31.1% of employers using other PBMs. The largest employers — those with 10,000 or more employees — are slowest to move to alternative PBMs but show the greatest interest in changing vendors in the next three years.
Common PBM contract transparency features include 100% rebate pass-through, access to claims-level pharmacy data, disclosed administrative fees and full audit rights, including rebate audits. Nearly one in four Big Three clients (23.4%) answered “not sure” to what is in their contracts, nearly twice the ratio of those using other PBMs (11.7%).
Policy Priorities Reflect Market Frustration
Employers increasingly see transparency, pricing reform and stronger fiduciary oversight as part of the affordability solution. Support rose across every reform tested from 2023 to 2026, including PBM reform (68.0% to 87.6%), hospital rate regulation (65.6% to 82.6%), hospital price transparency (75% to 84.6%) and health savings account reforms (45.8% to 69.6%).
Employer policy engagement is also rising. Federal or state healthcare legislative engagement increased from 42.5% in 2025 to 51.3% in 2026. Employers with full pharmacy claims access were more likely to engage than those without full access (61.3% vs. 39.4%), linking data access to purchasing action and policy participation.
Beyond Cost: Emerging Priorities in GLP-1s, Mental Health, Equity and Women’s Health
The survey also finds employers moving toward more disciplined management, measurement and accountability in fast-evolving benefit areas. Employers covering or considering branded GLP-1 medications are more likely to use or consider vendor or point-solution management. Mental health strategies are moving beyond access and communications toward vendor accountability and behavioral health integration. In women’s health, maternity support and parental leave remain common, while menopause support and caregiving assistance are growing. In health equity, employers are increasingly focused on measurement and contractual accountability.
Pulse of the Purchaser is an annual survey of employers conducted by the National Alliance and its coalition members. The online survey of 408 employers was fielded in May and June 2026. The full Pulse of the Purchaser results are available here.
Webinar
On Wednesday, Aug. 19, at noon ET, the National Alliance will host a discussion of key findings and what they mean for employers and other healthcare purchasers. Register here.
About National Alliance of Healthcare Purchaser Coalitions
For more than 30 years, the National Alliance has brought together business coalitions and their employer and purchaser members to drive high-quality healthcare that enhances patient experience, promotes health equity, and improves outcomes while lowering costs. Its members represent public and private sectors, nonprofits, and labor unions that provide health benefits to more than 90 million Americans — more than half of the employer-sponsored insurance market — spending over $850 billion annually. To learn more, visit nationalalliancehealth.org and connect on LinkedIn.
The National Alliance will host its 2026 Annual Forum, Beyond Transparency – Seeing Clearly, Acting Boldly: Employers’ Moment of Truth, Nov. 16-18 at the Crystal Gateway Marriott in Arlington, VA.
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SOURCE National Alliance of Healthcare Purchaser Coalitions
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