According to recent study by Business Group on Health and the Kaiser Family Foundation, 90% of large employers believe that the cost of employee-sponsored healthcare and pharmacy benefits will become unsustainable within the next decade.
A major contributing factor is the cost of prescription drugs, which has risen 9% annually over the past ten years. For employers, this trend has increased the cost of healthcare for plans. For employees, it translates to higher deductibles and copays.
A Reality Check
As the healthcare marketplace continues to rapidly evolve, including rising costs, employers and benefit advisors are facing growing pressure to keep costs down while continuing to provide high-quality care to employees.
When it comes to controlling the cost of prescription drugs, pharmacy Benefit Managers (PBMs) have long been at the center of this challenge, but the traditional PBM model, often driven by profits, hasn’t always been in the best interest of member care or the employer’s bottom line.
This is where the fiduciary PBM model comes into play, offering a transformative solution that not only benefits the bottom line, but also prioritizes the well-being of members.
The Big Difference the ‘F’ Word Can Make
A fiduciary PBM is a one that is legally and ethically required to put the interests of its clients above all else, including its own profits. Unlike traditional PBMs, which may have conflicts of interest and profit incentives tied to formulary decisions, pricing, or rebates, fiduciary PBMs operate with complete transparency and a member-first philosophy, focusing solely on the best interest of the employer and plan members.
This means that there are no hidden rebates or kickbacks that benefit the PBM at the expense of plan nor any profits from dispensing medications. It’s about providing the most effective and affordable medications to employees and ensuring that they get them at the lowest possible cost. This typically results in a 30%-50% reduction in plan spend per member per month (PMPM)—with no change in benefit design—and a 30% (or more) reduction in out-of-pocket cost for plan enrollees.
Why is This Alignment with Member-First Principles So Important?
The importance of a member-first approach cannot be overstated. For employers, offering a benefits plan that focuses on the health and satisfaction of employees can improve workforce productivity, reduce absenteeism, and promote overall well-being.
In the long run, that means lower healthcare costs and a more engaged population.
Cost Savings and Transparency
One of the most significant advantages of the fiduciary PBM model is the level of transparency it offers based on ERISA defined terms. Traditional PBMs and many “transparent PBMs” often have hidden fees, kickbacks from drug manufacturers, dispensing profits, and opaque pricing structures that inflate the costs for employers and members. This can result in inflated drug prices, higher premiums, and a general lack of clarity around the true cost of medications. “Transparency” is not a legal term. “Fiduciary,” as defined by ERISA and embraced by US-Rx Care, is legally binding, which is why plan fiduciary status is not accepted by traditional and transparent PBMs. It can’t be without violating its core principles inherent in those conflicted PBM models.
On the other hand, Fiduciary PBMs—like US-Rx Care—offer full transparency in pricing and reimbursement, working directly with employers to ensure the lowest possible costs for prescription drugs while maintaining high-quality care. By eliminating conflicts of interest, fiduciary PBMs also pass 100% of savings directly onto employers and members. This means that employers can expect better value from their pharmacy benefits program, and employees will benefit from lower out-of-pocket costs and better access to the medications they need.
Impacts on Future Growth
The fiduciary PBM model isn’t just about saving money in the short term—it also sets the stage for sustainable, long-term growth for both employers and their members. By maintaining transparency and focusing on cost-effective solutions, employers are able to reinvest the savings into other areas of their business, whether it’s improving employee benefits or income, enhancing health programs, or even offering more comprehensive care options.
It’s truly a win-win!
By prioritizing the long-term needs of their clients and members, fiduciary PBMs are also better equipped to navigate the evolving healthcare landscape and provide solutions that can scale with the growth of the organization. This unique future-proof approach helps employers plan for tomorrow while addressing the needs of today.
The US-Rx Care Solution
Since our founding in 2007, US-Rx Care has built our fiduciary model around the core principles of ERISA-defined transparency and conflict-free accountability in the best interest of the plan and enrollees always. With no conflicts of interest, no misaligned profit incentives, no benefit constraints, and no waste, employer groups can trust that they’re getting the best deal and best outcomes possible.
If you’re ready to make the shift toward a fiduciary PBM solution that effectively mitigates risk while offering substantial savings and better long-term outcomes, let’s talk about what US-Rx Care can deliver for you.
In the meantime, click below to see how our model helped a multi-state hospital group save more than $10 million in annual drug costs!
For years, high-deductible health plans have been the most common type of health insurance that employers offer.
HDHPs surged in popularity between 2013 and 2021, peaking at 55.7% enrollment. But in a sharp reversal, enrollment in these plans has now fallen for two consecutive years, dipping to 49.7% in 2023, according to the latest data from ValuePenguin.
The drop in enrollment could reflect a turning point for employees who are increasingly concerned about rising out-of-pocket health care costs and the prospect of not being able to afford a medical emergency.
How HDHPs work — and their drawbacks
An HDHP typically features lower monthly premiums in exchange for a higher annual deductible. These plans are often paired with HSAs, which let workers save pretax dollars to use for qualified medical expenses.
While appealing due to their low premiums, HDHPs can become a financial burden for employees who need more than routine care. A medical emergency, unexpected illness or ongoing treatment for chronic conditions can lead to steep out-of-pocket costs.
In fact, surveys show that nearly three-fourths of Americans worry about affording unplanned medical expenses. As a result, employees are now scrutinizing their options more closely and looking for plans that balance cost, predictability and comprehensive coverage.
Why enrollment is falling
Several factors are contributing to the recent decline in HDHP popularity, according to ValuePenguin:
Rising deductibles: Even as premiums stay relatively low, the cost burden has shifted to higher deductibles. This trade-off is less tolerable for employees who feel they might need care.
More plan choices: Around 61% of workers now have access to multiple health plan options. With more choices, many are opting for plans with lower out-of-pocket costs, like PPOs, HMOs or point-of-service plans.
Shift away from HDHP-only offerings: The number of employers offering only HDHPs has dropped by 33% since its peak in 2020. That shift is reflected in the enrollment decline.
The rise of POS plans
As HDHP enrollment falls, POS plans are quietly gaining ground — especially among small businesses. These plans combine elements of HMOs and PPOs, offering moderate flexibility at a midrange cost.
Employees typically choose a primary-care doctor and need referrals for specialists, similar to an HMO. However, they also retain some out-of-network coverage like a PPO, although usually at a higher cost.
From 2018 to 2023, POS plan enrollment grew from 6% to 10%, reflecting growing interest in plans that offer a balance between cost and flexibility.
For small employers, POS plans can be a strategic middle ground — less expensive than PPOs but more comprehensive than HDHPs. As more employees seek plans that reduce uncertainty without ballooning premiums, POS offerings may continue their steady rise.
When HDHPs still make sense
Despite the downturn, HDHPs aren’t vanishing, and they are still a good choice for certain groups:
Young and healthy workers: People who rarely use medical services can benefit from the low premiums and use HSAs to build tax-free savings.
High earners with savings: Employees who can pay upfront costs without financial strain may find HDHPs cost-effective, especially when negotiating reduced provider rates.
Those committed to using HSAs: For individuals actively contributing to and spending from HSAs, HDHPs can offer both immediate tax benefits and long-term savings growth.
In some states — notably South Dakota, South Carolina and Utah — HDHP enrollment remains high, even increasing sharply in 2023.
Key takeaways
As the health benefits landscape shifts, here’s what employers should keep in mind:
Diversify plan offerings. Employees want options. Offering more than just HDHPs helps meet a wider range of needs and mitigates risk for workers with varying financial situations.
Educate your workforce. Most employees, especially younger generations, report confusion about health benefits. Provide ongoing education to help workers make smarter decisions about coverage.
Monitor enrollment trends. While HDHPs are declining overall, regional and demographic factors still matter. Tailor offerings to the specific needs of your workforce and location.
The Equal Employment Opportunity Commission, together with the Department of Justice, recently issued new guidance that significantly reshapes the legal landscape for workplace diversity, equity and inclusion programs.
This comes on the heels of a series of executive orders issued by President Trump that direct federal agencies to eliminate what the administration characterizes as “illegal DEI” practices.
For employers — especially those with formal DEI programs — this development creates new legal exposure, murky compliance territory and growing uncertainty around what is now permissible. Below is a practical breakdown of what’s changed, what remains unclear and what senior leadership should consider doing now.
On March 19, 2025, the EEOC and DOJ issued two technical assistance documents meant to clarify how Title VII of the Civil Rights Act applies to DEI programs. While the documents reflect long-standing principles of anti-discrimination law, they also take a narrower view of what DEI initiatives are legally permissible.
Importantly, these documents are informal guidance and not legally binding, but they reflect how the agencies intend to interpret and enforce the law under the current administration.
The guidance
The EEOC’s guidance reaffirms that Title VII prohibits employment decisions based — in whole or in part — on protected characteristics such as race, sex, religion or national origin. The guidance also emphasizes that protections apply equally to majority and minority groups.
The agency said DEI policies, programs or practices may be unlawful under Title VII if they involve “an employment action motivated — in whole or in part — by an employee’s race, sex, or another protected characteristic.”
Based on various legal interpretations of the guidance, some of the most significant changes include:
No exceptions for diversity goals — The EEOC states in its guidance that there is no “diversity interest” exception under Title VII. Even if a DEI program is aimed at increasing representation or equity, it cannot involve employment actions motivated by race, sex or other protected characteristics.
Affinity and resource group access must be open to all — Employers cannot restrict participation in affinity groups based on race, sex or similar traits. Limiting access — even with the goal of creating safe spaces or support systems — may now violate Title VII.
Segregation in training and development is risky — Organizing DEI training or programs that separate participants by race, gender or other protected categories is likely unlawful.
Quotas and workforce balancing remain unlawful — The EEOC reiterated that hiring or promotion quotas, or any form of “balancing” the workforce based on demographic traits, is discriminatory under Title VII.
No such thing as “reverse discrimination” — The EEOC emphasized that Title VII protects all employees, regardless of group status. It does not require a higher burden of proof for claims from majority-group employees.
Hostile work environment claims from DEI training — DEI training that is viewed as offensive or discriminatory by employees could give rise to hostile work environment claims. This includes situations where training materials stereotype or marginalize employees based on race or gender.
Retaliation protections apply — Employees who object to perceived unlawful DEI practices, participate in investigations or file EEOC charges are protected from retaliation under Title VII.
While the guidance outlines several potentially unlawful DEI practices, it does not provide a definitive list of what is permissible. This ambiguity puts employers in a difficult position because the line between compliant and noncompliant practices is often hard to draw.
Steps to take
Given the legal uncertainty and heightened scrutiny, the law firm of Fisher Phillips recommends that companies consider the following actions:
Engage legal counsel to review DEI-related policies, training materials and communications. Focus on areas such as hiring, promotion, compensation, training, mentorship, internships and affinity group policies.
Shift from targeted DEI initiatives based on protected characteristics to programs that promote skill-building, access and inclusion for all employees. Emphasize transparent, merit-based advancement and development opportunities.
Where possible, position DEI efforts to emphasize workplace culture, professional development and inclusive merit-based access to opportunities.
Update your training to reflect the latest EEOC guidance. Ensure that decision-makers understand that DEI efforts cannot involve preferences or separate treatment based on protected traits.
Bottom line
The new guidance is a major shift in how the EEOC will approach regulating workplace discrimination. For employers, this means a narrower path for legally compliant programs and greater exposure to discrimination claims from any employee group.
If you have a workplace DEI program, it’s imperative that you revisit it and adjust it accordingly.
Many employers are facing challenges in incorporating high-cost GLP-1 medications, such as Mounjaro, Ozempic, Rybelsus, Trulicity and Wegovy, into their group health plans, as they must balance the cost of the group health plan against the interests of participants and beneficiaries in the treatment.
With prescriptions for these drugs cost around $1,000 a month, outlays for these drugs could eat up all the premiums paid for health insurance for an individual. While most health plans will cover these drugs for individuals who have diabetes and obesity, employers have been loath to cover them for employees who just want to lose weight due to the immense costs.
Despite that, employer spending on GLP-1s solely for obesity jumped nearly 300% between 2021 and 2023. And with demand continuing to increase, many employers are looking for ways to accommodate coverage for weight loss without breaking the bank. Here’s what some of them are doing:
Taking a holistic approach — One of the major drawbacks when taking a GLP-1 to lose weight is that once a patient stops taking injections, they often gain the weight back and any improvements in their blood pressure, blood sugar levels and cholesterol may disappear.
This is why more employers who are covering GLP-1s for weight loss are also requiring the employees to take part in holistic weight-management or lifestyle programs, like a dedicated exercise regimen and adopting a healthy and sensible diet. These lifestyle choices not only enhance the medication’s efficacy, but also support weight management, nutrient absorption, muscle preservation and overall health.
With this approach, patients have a better chance of maintaining their weight loss if they stop taking the drug.
Set conditions — Experts recommend setting certain conditions to qualify for a GLP-1 prescription solely for weight loss. This may include requiring that they have a body mass index of 33 or higher (anything over 30 is considered obese) along with one comorbidity like:
High blood pressure,
Chronic obstructive pulmonary disease,
Diabetes,
Heart disease, or
Respiratory disease.
Setting a lifetime limit — Some employers and health plans cap the amount that they spend on a GLP-1 for patients who want to lose weight. Some set an expense limit like $10,000 or $20,000, while others have a time limit, such as two years.
Higher copays and deductibles — Another strategy is setting a higher copay for GLP-1s. Also, since these drugs are not included on the ACA preventive service list, plans may introduce a deductible for this category of prescription drugs, provided that GLP-1 coverage is not required for preventive diabetes services.
Remove Ozempic from formulary — Ozempic is by far the most popular of the GLP-1s thanks to media hype and word-of-mouth recommendations. This brand-name recognition has helped drive utilization up 75% between 2022 and 2023, according to the “IQVIA 2023 National Sales Perspectives” report.
Employers can ask their health plans to have their pharmacy benefit manager remove Ozempic from their list of covered drugs and opt for another GLP-1 like the lesser-known Trulicity, the utilization of which grew just 25% between 2022 and 2023.
Making a coverage change to a less utilized GLP-1 can reduce utilization, while preserving options for members with diabetes who need GLP-1s to remain healthy.
Have an alternate solution — Another option is to cover bariatric surgery, which yields better results. It typically costs between $10,000 to $15,000 — about the same as one year of most GLP-1 prescriptions. Most people who undergo this type of surgery have a much higher success rate of keeping weight off.
For example, the success rate of keeping weight off after bariatric surgery is 90%, according to the Cleveland Clinic. After this surgery, many patients steadily lose weight during the first two years after the surgery, after which the typical patient regains less than 25% of their weight. Most people who stop taking GLP-1s after losing weight cannot expect similar success in keeping their lost weight off.
Step therapy — Step therapy or fail-first programs are a medical management technique that requires the use of generally less expensive treatments before allowing coverage of higher-risk, higher-cost treatment options.
The takeaway
Currently, self-funded and fully insured group health plans are not required to cover GLP-1s for any purpose. However, because GLP-1s are a common form of treatment for diabetes, it may be difficult to exclude all GLP-1 coverage.
If a plan sponsor intends to provide GLP-1 coverage for weight loss, it may want to consider implementing medical management techniques to reduce claims exposure associated with GLP-1 coverage.
Health savings accounts have become a prime target for cyber criminals, who are using advanced tactics to steal funds from them, putting your employees’ medical expense savings at risk.
The risk is even greater considering that employees can keep HSAs for life and many of them are building wealth in these accounts to save for future medical costs in their retirement years.
As the popularity and value of HSAs grows, employers are in a unique position to train their workers on how to best protect their accounts from cyberattacks that can drain their hard-earned medical expense savings.
Criminals see HSAs as ripe for plundering
HSAs have surged in popularity in recent years, with assets growing by 18% between mid-2023 and mid-2024 alone. There are an estimated 38 million HSA accounts in the U.S. with a combined $137 billion in funds, according to investment research firm Devenir.
Thanks to the portability of these accounts and the ability to invest them in investment funds — much like 401(k) plans — some HSAs hold large balances. That makes them especially appealing to cyber criminals.
While HSA providers have invested heavily in cyber security, threats continue to evolve because cyber attackers aren’t always breaching the providers directly. Sometimes, they gain access through third party vendors or by leveraging personal information leaked in unrelated breaches.
For example, HSA provider HealthEquity reported that attackers gained access to one of its business partner’s accounts in 2024, potentially compromising the personal data of more than 4 million account holders.
Criminals may also send scam e-mails which direct account holders to bogus sites that steal their account username and password.
Once attackers have access to personal information, they may bypass security measures through phishing e-mails, social engineering tactics or brute-force password attacks. In some cases, they exploit weak or reused passwords and intercept sensitive communications.
Employers can help
Given how deeply integrated HSAs are into employee benefits, employers can help by providing training that teaches their staff how to protect their HSA accounts and recognize phishing attempts or social engineering scams.
Cyber-security education doesn’t have to be complex. Even short, focused sessions on topics like password hygiene, spotting suspicious e-mails and using multi-factor authentication can make a significant difference.
Here are some steps every HSA holder should take:
Monitor account alerts and e-mails: Always check for e-mails or notifications about changes to your account, like updated contact info or security settings. If something looks unfamiliar, report it to your HSA provider immediately.
Review account transactions regularly: Just like with a bank or credit card statement, it’s important to review your HSA transactions to ensure all activity is legitimate. Most providers allow users to freeze their benefits card if they suspect fraud.
Use strong, unique passwords: Never reuse passwords across accounts, and consider using a password manager to create and store complex, randomized passwords. The longer and more unique the password, the better.
Enable multi-factor authentication: Many providers are expanding MFA options to add an extra layer of security. This can include verification codes sent via text or e-mail, or biometric verification.
You have a great group of employees working with you and your business is thriving. For many small-to-mid-sized businesses that success is due to key employee with both skills, experience and connections that would be difficult to replace.
But what if one of your personnel were injured and out of work for a while, or even worse, suppose they died unexpectedly? Would your business survive without this key person’s involvement in your operations?
If this were to happen, you’d likely immediately have to find and train a replacement, but getting the right person for the job would require a substantial amount of training and building on-the-job knowledge. During this transitional time, you could face losing business if you are unable to fulfill all of your orders or contractual obligations or if delivery time starts slowing.
Fortunately, there are two products that would provide your organization with additional funds to weather this uncertain time: key person life insurance and key person disability insurance.
Key person life insurance
Generally, your business purchases a life insurance policy on a key employee, pays the premiums and is the beneficiary in the event of the employee’s death. As the owner of the policy, the business may surrender it, borrow against it and use either the cash value or death benefits as the business sees fit.
However, coming up with a dollar value on a key employee’s economic worth can be challenging.
There are no specific rules or formulas to follow, but there are several guidelines that can help.
The appropriate level of coverage might be the cost of recruiting and training an adequate replacement.
Or, the insurance amount might be the key employee’s annual salary times the number of years a newly hired replacement might take to reach a similar skill level.
Finally, you might consider the key employee’s value in terms of company profits. The level of insurance coverage might then be tied to any anticipated profit or loss.
Premiums for key employee life insurance are not a tax-deductible business expense for federal income tax purposes, since your business is the recipient of the benefits. For the most part, the death benefits your company receives as the beneficiary of the policy are not considered taxable income.
However, if your business is a C corporation, the death benefits may increase the corporation’s liability for the alternative minimum tax. You should consult a tax professional for information on your specific circumstances.
Key employee disability insurance
The death of a key employee isn’t the only threat to your business. What if a key employee is injured or becomes ill and is out of work for an extended period of time? Disability insurance on such a key employee is another way you can protect your business against any resultant financial loss.
A crucial part of key employee disability insurance policies is the definition of disability.
Typically, these policies define disability as the inability of the employee to perform his or her normal job duties due to injury or illness. As with life insurance, your business buys a disability insurance policy on the employee, pays the premiums, and is named as the beneficiary.
If the employee becomes disabled, the insurance coverage pays monthly disability benefits to your business. These benefits can equal a certain percentage of the key employee’s monthly salary, up to either a maximum monthly limit or 100% of their salary.
The benefits may be used to pay the operating expenses of the business and to cover the expense of finding a temporary or permanent replacement for the key employee.
The disability policies typically offer elimination periods (i.e. the waiting period between the disability and when the benefits begin) ranging from 30 to 365 days.
Depending on the policy, your business may receive benefits for 6 to 18 months, which would be long enough to allow the key employee to return to work or for the company to replace the key employee.
Depending on the type of coverage purchased, the premiums you pay for the key employee disability policy may or may not be a tax-deductible business expense. If the policy is considered business overhead expense insurance, then the premiums are a deductible expense.
While the business would be responsible for paying taxes on any disability benefits received, the business expenses the policy indirectly pays for would result in an offsetting deduction.
The takeaway
Planning ahead can help secure your company’s financial future. Key employee insurance can help assure families, employees, creditors, suppliers and customers that the future of the business is secure.
By purchasing life and disability insurance on the owner(s) and/or key employees, you can are ensuring peace of mind in the event that a tragedy should befall one of your most important personnel.
