How Organizations Can Address Rising Pharmacy Spend

Employer health costs are projected to rise 5.8% on average in 2025, driven largely by the high cost of prescriptions. In fact, prescriptions make up the fastest-growing component of employer health costs, increasing 7.2% per employee in 2024, according to a Mercer study. 

U.S. employees also take more prescriptions than most peer nations and pay 2.5 times more for their medications. It creates an untenable situation, forcing employers to rethink their partnerships with pharmacy benefit managers (PBM).

Advanced primary care (APC) puts patients first by making prescription drugs more affordable and accessible. It expands access to common medications and offers smart tools to help manage usage, ensuring better, more convenient care.

By partnering with an APC provider, employers can set up onsite pharmacies or give employees access to a network of health centers that can dispense certain medications at little to no cost. With easier access and lower costs, employees are more likely to take their medications as prescribed, leading to better health, fewer complications and cost savings for employers.

Here’s how advanced primary care helps employers reverse the trend of spiraling prescription drug costs.

Integrated Medication Management 

A Department of Health and Human Services report found employer-sponsored health plans are increasingly adopting coinsurance models, meaning employees pay a percentage of a drug's cost rather than a fixed copayment. 

For high-cost drugs, it can be a deal-breaker for many employees, especially for those who need cancer drugs or new therapies. One study found that 30% of respondents skipped taking a medication due to costs. 

Over 50% of U.S. adults live with at least one chronic condition like Type 2 diabetes or hypertension, requiring medication and ongoing management. Out-of-pocket costs are particularly high for employees with diabetes, who pay nearly $600 out of pocket on average each year in order to manage the condition. 

With a dedicated employer pharmacy and medication management solution, employees can access common medications to treat everything from the common cold and arthritis to Type 2 diabetes, hypertension, hypothyroidism, and asthma — all at little to no cost.

For employees managing chronic conditions, APC ensures they have continuous access to the right medications without worrying about cost. Employees can pick up prescriptions during their appointment and skip a trip to the pharmacy, or set up home delivery and automatic refills to ensure they never miss a dosage. APC eliminates long waits for medications by offering same-day or next-day appointments, as well as 24/7 virtual visits. 

If employees have questions or concerns about a prescription, they can book an online or in-person medication consultation. APC providers also monitor medication adherence, adjust dosages as needed and coordinate with specialists to prevent gaps in care.

Medication Compliance Enhances Outcomes

By focusing on convenience, affordability and proactive management, APC removes common obstacles to medication access. When employees can seamlessly obtain medications and take them as prescribed, they become healthier.

APC providers spend more time with patients than in the hospital system, allowing them to form stronger relationships and understand the root cause of health concerns. They consider factors like medical history, lifestyle and potential drug interactions, ensuring employees get the most effective and affordable medications.

APC also takes a proactive approach to chronic condition management, leveraging data to identify at-risk employees and tailor personalized treatment and provide ongoing support. 

When providers catch issues early and connect employees with medication, they’re less likely to need expensive emergency treatments or specialty drugs. Healthier employees also experience fewer sick days and higher productivity. 

Marathon Health data shows 67% of patients who engage with APC improve at least one biometric health measure, reducing downstream costs such as expensive interventions or trips to the emergency department. For example, workplaces that implement Marathon Health solutions see a 42% reduction in ER and inpatient costs. 

Employers who offer advanced primary care through a Marathon Health solution save $1,800 per employee per year by reducing ER and inpatient visits, decreasing specialty referrals and optimizing medication spending. In addition, employees see a 17% reduction in out-of-pocket healthcare expenses.

ACP: A Solution to Lower Medication Costs

Marathon Health’s independent advanced primary care model offers a cost-effective way to lower employer healthcare costs while improving employee health. Because our health centers operate independently of insurance carriers and hospital system partnerships,  we stay focused on what matters most—improving employee health. 

By investing in advanced primary care, employers ultimately create a healthier workforce while lowering prescription drug costs. More engaged patients, better disease management and easier access to care all contribute to fewer unnecessary prescriptions and lower overall healthcare spending.