The Cutting Edge Benefits Podcast this week
Prescription drug spending has become one of the fastest-growing healthcare expenses facing employers today. While many business owners focus on premiums, deductibles, and provider networks, few realize that how prescription drugs are processed can significantly affect both current costs and future renewals. On the latest episode of The Cutting Edge Benefits Podcast, Anthony McMahon of ClaimLinx joins Neil Haley to unpack an often-overlooked strategy for controlling prescription drug expenses while helping employers reduce long-term healthcare costs.
Anthony begins by explaining the role of a Medical Expense Reimbursement Plan, or MERP, a type of health reimbursement arrangement authorized under Section 105 of the tax code. He outlines how these plans can deliver tax advantages for employers while offering valuable benefits to employees, and notes that many businesses simply aren’t aware these options exist, leaving substantial savings on the table.
The discussion then turns to prescription drug spending and the traditional approach most employees follow when filling medications. In a standard plan, employees present their primary insurance card for all medical services and prescription purchases. While that seems straightforward, Anthony explains that this process can create unintended consequences when prescription claims become part of the insurance carrier’s renewal calculations.
That insight anchors much of the episode. When carriers see ongoing prescription claims for chronic conditions, specialty medications, or high-cost therapies, those claims may feed directly into renewal assessments, quietly driving up future costs. Anthony discusses how businesses can benefit from alternative prescription management strategies that focus on controlling costs while still helping employees access affordable medications.
A major focus of the conversation is pharmacy benefit management. Anthony explains how third-party pharmacy benefit managers, or PBMs, can help identify lower-cost alternatives, generic substitutions, manufacturer coupon programs, and other discount opportunities. Tools like GoodRx, manufacturer assistance plans, and similar prescription savings solutions are becoming increasingly important weapons in the fight against rising healthcare costs. Rather than accepting medication prices at face value, Anthony encourages both employers and employees to actively explore the resources available to lower out-of-pocket expenses and improve overall plan performance.
One of the most important takeaways is that healthcare strategy extends far beyond premiums. Employers often pour their energy into negotiating insurance rates while overlooking prescription utilization patterns that can dramatically influence future costs. By addressing prescription spending proactively, organizations can improve both immediate affordability and long-term financial stability. Anthony shares examples of recent client outcomes where lower prescription spending contributed to improved claims experience and more favorable renewal results, reinforcing the broader message that real cost management requires a comprehensive approach rather than a focus on any single piece of the plan. As he puts it, it’s two birds with one stone, helping employees save on prescriptions today while helping employers control healthcare costs tomorrow.
Watch This Weeks Episodes Below
The Hidden Prescription Drug Strategy That Can Lower Renewals and Save Employers Thousands
Also this week:
Healthcare costs continue to rise at an alarming pace, and both employers and employees are feeling the pressure. On the latest episode of The Cutting Edge Benefits Podcast, Tom Quigley of ClaimLinx joins Neil Haley to discuss new survey data showing that two-thirds of large employers expect to increase employee healthcare contributions through payroll deductions by 2027. The conversation explores why costs keep climbing, what it means for workers, and why so many businesses are approaching benefits planning the wrong way.
Neil opens by highlighting recent industry research showing that employer-sponsored health insurance costs reached nearly $17,500 per employee in 2025 and are projected to exceed $18,500 in 2026. In response, many employers are shifting more of that burden onto employees through higher premiums, deductibles, copays, and payroll deductions.
Tom explains that rising healthcare costs are not simply the result of inflation. The problem, he argues, is baked into the structure of the system itself, where insurance carriers, prescription drug spending, and benefit financing methods all contribute to escalating costs. Too many organizations continue relying on outdated benefit strategies while expecting different results.
A major theme throughout the episode is cost shifting. Rather than solving the underlying problem, many employers simply pass rising expenses directly to their workers. Tom warns that increasing employee contributions creates a new set of challenges, including lower morale, financial stress, reduced productivity, and greater difficulty attracting and retaining talent. The conversation also examines the deepening affordability crisis facing American workers, citing research that nearly one-third of households at or below median income are uncertain whether they can afford necessary healthcare. As medical expenses consume a larger share of household budgets, families are forced into difficult tradeoffs involving housing, transportation, savings, and care.
From there, Tom shares his perspective on how business owners can take back control of healthcare spending by rethinking how benefits are structured. Instead of choosing between absorbing higher costs or passing them to employees, he advocates for a smarter approach centered on better benefit design and tax strategies that have existed for decades. The discussion digs into one of the biggest drivers of current healthcare inflation: prescription drug costs, fueled in part by the surging popularity of GLP-1 weight-loss medications. Tom explains how employers can evaluate alternative purchasing strategies, manufacturer assistance programs, and prescription savings resources to help rein in these expenses while still supporting employee health.
Another key takeaway is the role leadership plays in healthcare decisions. Tom suggests that healthcare planning should be treated as a financial and strategic business decision rather than simply an HR function. Business owners who grasp the long-term impact of healthcare expenses are far better positioned to protect profitability while strengthening their benefits. Looking ahead, Tom believes costs will keep climbing unless employers begin adopting different strategies. The real question, he says, isn’t whether change is necessary, but how much financial pain businesses and employees will endure before they decide to make it. As he puts it, the question isn’t whether employers need to change their healthcare strategy, it’s how much pain they’ll endure before they decide to do it.
Why Your 2027 Paycheck Could Take Another Hit: The Healthcare Cost Crisis
Stay in the Know
Visit ClaimLinx.com Schedule a free consultation with Tom, or a member of the ClaimLinx team. Discover how to reduce your premiums, improve your benefits, and finally take control Subscribe to the Cutting Edge Benefits Podcast on Apple Podcasts, Spotify, and YouTube for more no-nonsense conversations on how to fix your health benefits and save your company money—fast.
If you’re a business owner, HR leader, or employee frustrated with rising premiums and watered-down coverage, this conversation will completely change how you look at group health insurance.
