News|Articles|August 12, 2026

Employers With Claims Data Access Take More Cost Action, Survey Finds

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Key Takeaways

Employers with complete medical claims access implemented ~4 additional high-cost strategies on average, particularly those requiring price comparison, provider performance assessment, and contract negotiation.
Forecasted cost growth was highest in fully insured arrangements, consistent with constrained data rights; only about 60% felt able to audit full claims files.
Smaller firms drove a sharp shift away from Big 3 PBMs, while alternative PBMs more often offered no spread pricing, affiliate disclosure, and lowest-net-cost formularies.
Policy appetite intensified, led by PBM reform (87.6% supportive) and hospital price transparency/regulation; coalition-based engagement rose to 51.3%, but staff capacity remained the key constraint.

Employers with complete claims data access deploy more cost-containment strategies as health care costs rise and employers seek greater PBM transparency.

Employers with complete access to their medical claims data are deploying nearly 4 more cost-containment strategies on average than those without it, according to the 2026 Pulse of the Purchaser survey from the National Alliance of Healthcare Purchaser Coalitions, suggesting that greater claims data visibility may help employers move from considering options to taking action.¹

Employers Expect Health Care Costs to Rise 7.7%

Pulse of the Purchaser is an employer survey conducted annually by the National Alliance and its coalition members.² The 2026 survey was conducted online in May and June 2026 among 408 employers spanning manufacturing, public administration, educational services, finance and insurance, and health care and social assistance.¹ Among respondents, 24.4% had 10,000 or more employees, 37.5% had 1000 to 9999, and 38.1% had fewer than 1000.

The surveyed employers projected an average 7.7% increase in health care costs for the coming plan year before any plan design changes, and 33% of those who gave an estimate expect increases of 9% or more. Fully insured employers reported the steepest expectations, as 45% anticipate a 9% or greater increase, compared with 23% of employers using both fully insured and self-funded arrangements. The report linked this 22-percentage-point gap to the comparatively limited claims data access typical of fully insured plans.

For the first time, the survey asked employers to estimate where their health care dollars go. Hospital and facility costs account for the largest share, at 30.5% of total spend, followed by prescription drugs (21.1%) and professional fees (19.1%).

Claims Data Access is Linked to Greater Employer Action

Across 26 hospital and high-cost claim strategies tracked in the survey, employers with full claim-level access were more likely to be taking action, with the widest gaps appearing in strategies that require price comparison, provider evaluation, or contract negotiation. Specifically, employers with complete access reported using an average of 11.9 of the 26 strategies, compared with 7.9 among those with limited, no, or uncertain access. This 4-strategy gap persisted regardless of employers’ expected cost increases or premiums, according to the report.

Despite widespread reporting of data rights, access and audit capabilities remain inconsistent. Approximately one-third of employers said they lack complete claim-level access, and only about 3 in 5 said they are confident they could audit their complete files. Among respondents, 75% store their claims data with a health plan or third-party administrator, the arrangement associated with the lowest rate of complete access (59.2%), whereas about 1 in 4 who use an independent data warehouse reported the highest access rates.

“Employers have the concern and the will to act but too often lack the usable data, contractual rights, and staff capacity to do so,” Shawn Gremminger, National Alliance president and CEO, said in a news release.² “When those barriers are removed, employers are better able to move from concern to action.”

Employers Increasingly Consider Alternatives to the Big 3

While CVS Caremark, Express Scripts/Evernorth, and OptumRx, or the “Big 3” pharmacy benefit managers (PBMs), still lead the market, their share among employers fell from 63.4% in 2025 to 54.3% in 2026¹; respondents reported they are continuing to test alternatives that provide them greater control, value, and transparency.

The shift was concentrated almost entirely among employers with fewer than 1000 employees, whose use of a Big 3 PBM dropped 26 percentage points year over year. By contrast, midsize and large employer segments were comparatively stable. Among employers still using a Big 3 PBM, 55.7% said they are considering a change in the next 1 to 3 years, compared with 31.1% of employers already using an alternative PBM; the gap widened with employer size.

Contract transparency also diverged by PBM type. Besides rebate pass-through, employers using non–Big 3 PBMs reported stronger contract protections across the board, including no spread pricing, disclosure of affiliated entities, and lowest-net-cost formulary design, with gaps of 16 to 18 percentage points. Nearly 1 in 4 Big 3 clients said they were unsure what their PBM contract actually contained, roughly twice the rate among employers using other PBMs. This pattern echoes the shift reported in the National Alliance's 2025 Pulse survey, when transparent PBM adoption climbed from 12% to 31% in a single year and was linked to lower reported premiums.³

Employers Express Strong Support for Health Care Policy Reform

Employer support for regulatory intervention has grown substantially since 2023.¹ PBM reform was the most widely supported policy tested, with 87.6% of employers calling it very or somewhat helpful, up nearly 20 percentage points since 2023. Hospital price transparency (84.6%) and hospital rate regulation (82.6%) followed closely behind. Support for Health Savings Account reform increased more than for any other measure tested, up 23.8 points since 2023.

Engagement in federal or state health policy also increased, from 42.5% in 2025 to 51.3% in 2026, with employers holding full pharmacy claims access nearly 22 percentage points more likely to engage than those without it. Limited staff capacity, not disagreement over the issues, was the most commonly cited barrier to greater policy involvement, reported by nearly half of employers who had not yet engaged.

5 Actions for Employers to Address Health Care Costs

The National Alliance outlined 5 actions for employers looking to translate the results into practice. The first is to treat data access as a strategic imperative since those with full claims data access consistently reported greater implementation of purchasing and cost-management strategies than those without it. Similarly, the authors emphasized the need to focus on high-value purchasing rather than cost shifting; employers with higher expected cost increases did not necessarily report using more strategies, whereas those reporting results relied on targeted approaches such as site-of-care management, centers of excellence, navigation support, direct contracting, and claims audits.

The National Alliance also recommended strengthening PBM oversight. Recent developments in the PBM marketplace point to employer demand for greater transparency and accountability. Consequently, the authors advised employers to regularly evaluate contract provisions, compensation disclosures, formulary management practices, and access to pharmacy claims data to ensure alignment with their responsibilities and organizational goals.

A fourth recommendation is using policy engagement as a business strategy. As support for health care pricing and transparency reforms continues to rise, employer participation in policy discussions has increased substantially. The National Alliance encouraged employers to work through coalitions and industry partners to advocate for transparency, fair pricing, and stronger market accountability, noting that collective purchaser voices can address affordability challenges employers cannot solve independently.

Lastly, the report called for investing in long-term workforce health and affordability. The National Alliance framed investments in women’s health, mental health, obesity management, and protection against high-cost claims as part of a broader strategy that balances affordability, employee well-being, and workforce productivity. The authors concluded by arguing that sustainable health care value comes from addressing both the drivers of cost and the health needs of employees and their families.

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