Employer costs for health benefits in the private sector rose six percent in the 12 months to June 2026, more than double the 3.1 percent growth in wages and salaries over the same period, according to the Bureau of Labor Statistics (BLS) Employment Cost Index.
But Paul Pruitt, founder of SHARx, a procurement management solution for high-cost prescription drugs based in St. Louis, Missouri, who is a former benefits broker with more than a decade of experience placing group coverage for employers, argues that most of the strategies brokers are offering are solving the wrong problem.
"If we focus on the cost of insurance, we're looking at the wrong problem," Pruitt told Insurance Business Benefits. "The insurance price and what it costs is a function of how it's used, how your members access care. Those are the areas where brokers can actually make a meaningful impact."
It has become easy to treat GLP-1 medications as the source of the employer cost crisis. Pruitt insists they are not.
Having worked in pharmacy benefit strategy since 2017, he was watching specialty drug costs disrupt employer plans long before semaglutide became a household name.
"GLP-1s are exacerbating an existing problem, not creating a new one," he said. "Medication cost pressure has been building since the mid-2010s. The demand surge was predictable once GLP-1s were repurposed for weight loss."
The instinct among many employers to simply carve GLP-1s out of the health plan or move them into a health reimbursement arrangement, is understandable, but Pruitt cautions it is a temporary fix with unintended consequences.
He says that employers who cover GLP-1s without a structured program are compounding the problem rather than managing it and says the deeper issue is that obesity and type 2 diabetes share the same root causes in lifestyle, but the healthcare system addresses both primarily by masking symptoms rather than changing behavior.
And GLP-1s will not be the last high-cost drug class employers are forced to reckon with, with sleep medications among the next wave already building according to Morgan Stanley, which projects orexin-based therapies could mirror GLP-1s' market trajectory and reach $16 billion by 2035.
"You can play whack-a-mole with GLP-1s, or the sleep thing, or whatever comes next," Pruitt said. "Or you can plan for it and address all of it more holistically. There's always going to be that next new thing we're freaked out about. We can either respond to it or we can plan for it."
Pruitt is direct about where he believes broker conversations need to shift given that healthcare costs are a function of two variables: utilization and unit cost.
"Changing member behavior is slow and difficult," he said. "Pricing and sourcing of medications can be restructured more immediately. Unit cost is the more actionable lever."
That reframing has practical implications for how brokers engage employer clients. Rather than leading with insurance premium negotiations or pharmacy benefit manager (PBM) rebate terms, Pruitt argues brokers should begin by asking whether an employer's current partners such as their third-party administrator and pharmacy benefit manager, actually have aligned incentives.
"A lot of the time they've got partners that are happy with the high claims," he said. "They profit when you don't win. That's a misaligned incentive. Step one is: do you have partners that want you to win?"
For brokers navigating these conversations, IBB's recent coverage of how pharmacy benefit transparency rules are reshaping employer plan design and what self-funded employers need to know about stop-loss market trends provides useful context on the regulatory and market forces driving this pressure.
One of the most consistent patterns Pruitt encounters is a disconnect between the HR teams responsible for benefits and the finance executives whose decisions ultimately determine whether meaningful change happens. He describes it bluntly.
"HR teams will say they want to save money. I ask, 'How much?' They say, 'I don't know.' Well, if you don't know what you're looking for, how do you know when you've found it?"
The problem, as he sees it, is structural. HR departments lack both a defined savings target and explicit direction from leadership, which means even a well-designed broker strategy has no framework within which to demonstrate success.
"CFOs and C-suites, until they care enough to have expectation and accountability, you don't see change in a meaningful way," he said. "And many organizations treat high healthcare costs and their downstream consequences - layoffs, hiring freezes, wage stagnation - as unrelated events. They haven't connected the dot that healthcare is the reason those things are happening."
That message is landing differently now that even the largest employers are feeling the pressure.
"The only reason the biggest companies haven't had to solve this is because they had more cushion," he said. "But if they're now saying uncle - well, size never mattered. The game isn't winnable, and there has to be a different way to approach it."
For benefits brokers approaching the next renewal season, Pruitt's framework comes down to a short set of diagnostic questions that, he argues, most advisors are not yet asking consistently.
Does this employer have partners with aligned incentives? Does the C-suite have a defined healthcare cost target? Is the benefit plan performing its core purpose - attracting and retaining talent - or is it simply being preserved out of inertia?
Brokers looking for additional frameworks on structuring these conversations can draw on guidance from the Employee Benefit Research Institute (EBRI) and the Kaiser Family Foundation's annual Employer Health Benefits Survey, which tracks employer cost trends and benefit design decisions across the US market. The Society for Human Resource Management (SHRM) also publishes regular employer benchmarking data on healthcare cost-management strategiesthat can help brokers contextualize their client conversations with independently sourced data.
The urgency, Pruitt argues, is not hypothetical. Specialty medications accounted for approximately 35 percent of total Rx spend in 2017 while representing just one to two percent of prescription volume.
Today, specialty drugs still represent roughly one to two percent of pharmacy volume but account for approximately 60 percent of pharmacy spending, according to a UnitedHealthcare analysis cited in Marsh McLennan Agency's 2026 pharmacy trends report.
"How much of the Rx dollar can specialty take until everyone has to say uncle?" he said. "The mid-market, the smaller employers, they've been saying it for a while. Now we're seeing it from the biggest companies too."
