What Employers Actually Care About in Pharmacy Benefits

Employers want pharmacy benefits that lower costs, explain the numbers clearly, and keep employees from feeling lost at the pharmacy counter

Table of Contents

1. What employers really want from pharmacy benefits
2. Cost control they can actually explain
3. Clear answers on specialty drugs and high-cost claims
4. Fewer employee complaints at the pharmacy counter
5. Less disruption during plan changes
6. Better visibility into rebates, discounts, and savings
7. Reporting that shows what is driving spend
8. Support for employees who cannot afford their medication
9. Lower-cost options for expensive prescriptions
10. What brokers should bring to the pharmacy benefits conversation
11. Key Takeaways

What employers really want from pharmacy benefits

When employers ask about pharmacy benefits, they are usually asking a very practical question:

What is this plan doing for the company and for the employees who need medication?

They may not ask it that directly. They may ask why pharmacy costs are rising, why a specific drug is so expensive, why an employee was charged more than expected, or why the renewal increase is hard to explain.

For brokers, those questions create an opportunity to keep the conversation focused on what employers actually care about: cost, clarity, access, disruption, and support.

Most employers need to understand what is driving spend, what can be done about it, how employees will be affected, and whether the plan has better options available.

That is the pharmacy benefits conversation that earns attention.

Cost control they can actually explain

Employers care about pharmacy costs because those costs show up in places they already watch closely: renewal conversations, budget planning, payroll deductions, and employee complaints.

A recent Mercer survey found that total health benefit costs are expected to increase 6.7% in 2026, pushing the average cost above $18,500 per employee. The same survey noted that prescription drug benefits are one of the fastest-growing expense categories, rising about 9% in 2026.¹

That matters because pharmacy spend can feel difficult to explain when the employer only sees totals. A higher pharmacy number becomes much easier to discuss when the broker can show what is behind it.

A helpful pharmacy cost conversation should answer questions such as:

• What percentage of total plan spend is tied to pharmacy?
• Which drugs are driving the highest costs?
• How much is tied to specialty medications?
• How much are employees paying out of pocket?
• Are lower cost options available for certain prescriptions when available?
• Is the current PBM identifying savings opportunities before renewal?

Employers want a clear explanation of what is happening, which claims deserve a closer look, and what options can be reviewed.

Clear answers on specialty drugs and high-cost claims

A few medications can shape a large part of the pharmacy conversation.

Specialty drugs, GLP-1 medications, chronic condition drugs, and certain high cost brand medications can change the plan’s pharmacy spend quickly. A recent specialty pharmacy report found that specialty drug trend remained high at 10.8% on a gross cost basis.²

For employers, that makes drug-level reporting easier to defend. They want to know which medications are driving costs, whether any specialty drugs are being billed through the medical benefit, and whether high cost claims are being reviewed early enough to identify possible savings opportunities.

That review should answer practical questions such as:

• Which specialty medications are running through the pharmacy benefit?
• Are any specialty medications being billed through the medical benefit?
• Are GLP-1 medications creating new cost pressure?
• Are there medications with lower cost sourcing opportunities?
• Are employees receiving support when a medication is hard to access?
• Is the plan catching high cost claims early enough to review options?

This is where brokers can help employers move from a broad pharmacy spend conversation to a more useful drug-level discussion.

Fewer employee complaints at the pharmacy counter

Employers often judge pharmacy benefits by what employees experience when they try to fill a prescription.

A plan can look strong in a proposal and still create frustration at the pharmacy counter. Employees may run into high copays, rejected claims, prior authorization confusion, delays, unclear pharmacy instructions, or a medication that suddenly costs more than expected.

When that happens, HR usually hears about it first.

The employer wants to know whether the pharmacy benefit has a clear process for helping members when something goes wrong. That includes questions such as:

• Who does the employee call?
• Can the member get help understanding the issue?
• Is there a process for expensive medications?
• Can someone explain next steps in plain language?
• Will HR have to manage the issue alone?

This is one of the areas where member support matters. A pharmacy benefit should not leave employees guessing when they are trying to access medication they already rely on.

Intercept Rx’s member support helps employees understand what is happening with their prescriptions, review available options, and get guidance when a medication is expensive, delayed, or difficult to access. For employers and brokers, that support can reduce confusion before it turns into repeated HR questions.

Less disruption during plan changes

When employers review pharmacy benefit options, disruption is usually one of their first concerns.

They want savings, but they also want to avoid confusion, medication interruptions, and a flood of employee questions. That concern is reasonable. Employees notice pharmacy changes quickly because prescriptions are personal and often time sensitive.

Before recommending a new pharmacy benefit solution, brokers can help employers understand what the change would look like in real life.

The right questions include:

• Will employees need to change pharmacies?
• Will prescriptions transfer correctly?
• Will high cost medications be reviewed before the plan starts?
• Will employees receive clear instructions?
• Will HR have support during the change?
• What happens if a member has an urgent medication issue?

Employers are usually more open to change when they understand the steps, the timing, and the member support process.

Better visibility into rebates, discounts, and savings

Employers want a clear explanation of how money moves through the pharmacy benefit.

This includes rebates, discounts, spread pricing, pass through arrangements, acquisition cost models, and savings guarantees. The details can get technical quickly, so the strongest broker conversations usually keep the focus on what the employer needs to know first.

Where does the money go?
What savings does the employer keep?
What fees apply?
How are rebates and discounts handled?
What can be shown in reporting?

For example, spread pricing means there can be a difference between what the plan is charged for a drug and what the pharmacy is paid. A pass through model is designed to give the employer clearer visibility into rebates, discounts, and fees.

Intercept Rx’s pharmacy benefit transparency guidance describes its model as including 100% pass through of rebates and discounts, which can help employers see how savings flow back to the plan.

This type of clarity helps brokers keep the conversation focused on facts instead of assumptions.

Reporting that shows what is driving spend

Employers want reporting that helps them make decisions.

A pharmacy report should help the broker and employer understand what is driving spend and what deserves attention before the next plan decision.

A useful report should show:

• Top cost drugs
• Specialty spend
• Member cost exposure
• Claims trends
• Savings opportunities
• Prior authorization activity
• Drugs with lower cost alternatives
• Medications that may need member support

The value is in what the employer can do with the information.

If a report shows that a few medications are driving a large share of spend, that gives the broker a place to start. If member costs are rising, that may point to affordability issues. If specialty claims are increasing, that may require a closer review of pharmacy and medical benefit billing.

Good reporting gives the conversation direction.

Support for employees who cannot afford their medication

Employers care about employee access because prescription costs can become a workplace issue quickly.

When employees skip medications, delay refills, or call HR because they cannot afford a prescription, the pharmacy benefit is no longer just a claims line. It becomes an employee experience problem.

Brokers can help employers ask whether the pharmacy benefit includes member support for expensive or confusing prescriptions.

That support may include help understanding coverage, finding lower cost access when available, arranging delivery, or speaking with someone who can guide the employee through the process.

Intercept Rx’s Rx Optimization Program includes $0 copay opportunities for eligible high cost prescriptions, free delivery, and direct contact with a member advocate.

For employers, that type of support can reduce confusion and give employees a clearer path when a medication is expensive or difficult to access.

Lower-cost options for expensive prescriptions

It is important for employers to know whether expensive prescriptions are being reviewed before the plan keeps paying more.

This does not mean every medication has an easy alternative. Some medications are expensive because they treat serious or ongoing conditions. The question is whether the plan has a process for identifying savings opportunities when they exist.

Brokers can help employers review:

• Alternative sourcing opportunities
• Lower cost access programs
• Plan paid savings opportunities
• Member savings opportunities
• High cost medications that need review before renewal
• Drugs that may qualify for a $0 copay program
• Medications that need extra member support

This section of the conversation should stay practical. Which medications need attention? Which ones have possible savings options? Which employees may need help accessing their prescriptions?

That is the information employers can use.

What brokers should bring to the pharmacy benefits conversation

The best pharmacy benefits conversations are clear, specific, and tied to employer concerns.

Brokers do not need to overcomplicate the discussion. Employers usually want answers they can bring back to leadership, finance, and HR without having to decode PBM language.

A strong pharmacy benefits conversation should cover:

• What is driving pharmacy spend
• Which medications need attention
• Where savings may exist
• How employees are supported
• What disruption may look like during plan changes
• How rebates, discounts, and fees are handled
• What reporting will be available after implementation
• How expensive prescriptions are reviewed throughout the year

This keeps the conversation centered on lower costs, fewer surprises, and a pharmacy benefit employees can actually use.

For brokers working with self funded or level funded employers, Intercept Rx can help review pharmacy spend, identify savings opportunities, and support eligible members through the Rx Optimization Program. The goal is simple: help employers understand what is happening inside the pharmacy benefit and what options may be available.

Key Takeaways

• Employers want pharmacy costs explained clearly.
• Specialty drugs and high cost claims need a closer review.
• Employee access matters when prescriptions are expensive or confusing.
• Reporting should show what is driving spend and where action may be needed.
• Brokers can lead a stronger pharmacy benefits conversation by focusing on cost, clarity, disruption, savings, and member support.
• Intercept Rx gives brokers a practical pharmacy benefit solutions partner for employers that want clearer reporting, lower cost opportunities, and support for eligible members.