As we head into the final months of 2023, large employers have been grappling with historically high increases to their 2024 healthcare budgets. The residual impact from the pandemic and broad macroeconomic forces have combined to push cost estimates above historic annual trends.

Employers expect their healthcare costs to increase an average of 5.5% for 2024 after accounting for changes to their plan offerings (including plan design changes and types of plans being offered), according to results from a recent Brown & Brown analysis of large employers. If no changes were made to plan offerings, employers would have expected an increase of 6.8%.

Other industry sources are projecting similar increases for 2024:

• The Centers for Medicare and Medicaid Services (CMS)¹ have projected annual cost increases per enrollee of 6.8% in 2023 and 2024 before stabilizing to 5.1% for 2025 through 2031.
• Business Group on Health² members are expecting a 6.0% increase in costs for 2024 after plan changes (6.9% before plan changes).

As employers have seen their spending on claims return to or even exceed pre-pandemic levels, they will need to look beyond the ‘usual suspects’ (e.g., stable increases for unit costs/utilization and population aging) and focus on new and evolving cost drivers. These include more acute price inflation brought on by provider losses sustained during the pandemic, a robust drug pipeline, emerging therapies for cancers and other complex diseases and the increasing number of large claimants.

A Closer Look at Four Key Cost Drivers for Employers

1. Broader Economic Environment (Inflation & Labor Market)
   Healthcare providers continue to experience significant financial challenges driven by decreases in revenue, intense staffing shortages and rising expenses for supplies, equipment and drugs.^3,4
   Providers will look to offset losses through additional federal funding, as well as by negotiating new contracts with insurers. While broader inflation markers have been trending downward over the past several months, medical inflation tends to lag by as much as 12 months. Because many provider contracts renew on three-year cycles, provider reimbursements have not kept pace with elevated operating expenses, such as increased costs for labor and supplies. We began to see the initial impact of these contract renewals in 2023 and expect it to continue into 2024 and 2025. Elevated costs for services will likely drive increases in costs for employers as a result of these renegotiated contracts.

   Employer Actions to Consider:

   1. Continue to review cost management strategies
      Reevaluate how well current health benefit programs are working today and what changes (if any) are necessary – including plan design, network strategy and clinical programs.
   2. Proactively establish a realistic budget
      Be proactive when planning for higher-than-expected future costs and engage financial colleagues early in the process to manage expectations and set pricing assumptions accordingly.
   3. Manage Request For Proposal activity closely
      Have conversations with prospective bidders on their network and contracting efforts and negotiate meaningful performance guarantees around their management of claims spend― including a trend guarantee, where carriers commit to managing claims within a certain threshold on a per-member basis.
2. Prescription Drugs – GLP-1 and Biosimilars
   While drugs for treating diabetes and obesity have existed for years, recent advances have brought on new classes of drugs with greater efficacy and reduced side effects. As a result, adoption has grown significantly in 2023 – partially driven by social media influencers and direct-to-consumer marketing.
   
   • GLP-1 drugs like Ozempic® and Wegovy® can cost more than $11,000 annually per patient.⁵
   • Quarterly prescriptions for those drugs increased 300% between early 2020 and the end of 2022.⁶
   • Roughly 1.7% of Americans have been prescribed a weight loss medication in 2023, up forty times the amount in 2018.⁷
   • Recent studies have suggested that GLP-1 drugs can also improve other cardiovascular risk factors, which could lead to the ongoing expansion of treatment indications for these drugs. As a result, financial analysts have doubled their market projection for GLP-1 drugs over the next ten years.

¹ Centers for Medicare & Medicaid Services, Office of the Actuary
² Business Group on Health, “2024 Large Employer Health Care Strategy Survey”
³ Wall Street Journal
⁴ Advisory Group
⁵ Peterson-KFF Health System Tracker
⁶ Trilliant Health
⁷ Epic Research

Kevin Baker, FSA, MAAA, FCA

Principal