Health & Preformance
Specialty drugs account for roughly 2% of prescriptions but half of pharmacy spending in employer-sponsored plans, and the top 4 Pharmacy Benefit Managers (PBMs) control 67% of the market. HUB's pharmacy benefits management brings integrated clinical, pharmacy and actuarial expertise to negotiate real leverage and design coverage that lasts.
Stay Ahead of Business Challenges
Three gaps driving your fastest-growing benefits cost category
Limited leverage against concentrated Pharmacy Benefits Manager (PBM) markets, coverage decisions made ad hoc for emerging treatments and wellbeing programs designed without looking at claims data all quietly drive up costs and erode outcomes. HUB addresses all three as one connected discipline.
The top 4 PBMs control 67% of the market, and specialty drugs alone account for half of pharmacy spending despite being roughly 2% of prescriptions. An employer negotiating alone has little real leverage against that concentration.
A small number of PBMs control most of the specialty pharmacy market, so an individual employer negotiating alone has limited leverage over pricing, rebates or funding structures for the drug categories (GLP-1s, gene therapies) driving the fastest-growing share of benefit costs.
A broker with aggregated market relationships and specialty pharmacy expertise can negotiate PBM terms, formulary strategy and alternative funding arrangements that an individual employer can't access on its own, no matter how it approaches the conversation.
An employer negotiating alone against a PBM that controls a quarter of the national market is not really negotiating. Aggregated leverage is the only real lever available.
Employers gain PBM terms and specialty pharmacy strategies that reflect aggregated market leverage, rather than what they could ever negotiate entirely on their own, at any renewal.
The question employers face is no longer whether to cover fast-growing treatment categories like GLP-1s and gene therapies. It's how to cover them, with clinical criteria and prior authorization rules decided in advance rather than case by case.
Without a deliberate coverage policy for emerging, high-cost treatment categories, employers end up making case-by-case coverage decisions under pressure, after a claim has already been filed or an employee has already asked, rather than a designed, defensible policy set in advance.
A structured clinical review process — establishing coverage rules, prior authorization criteria and utilization monitoring before the treatment category becomes a live claims issue — replaces reactive, ad hoc coverage decisions with a designed policy.
The employers who handle GLP-1 or specialty drug coverage well aren't the ones who said yes or no fastest. They're the ones who decided the rules before the first employee asked.
Employers have a deliberate, defensible coverage policy for emerging treatment categories in place before claims pressure forces a reactive decision under time pressure at renewal.
population health and culture initiatives often get designed and measured on their own, disconnected from what claims and pharmacy data show about a workforce's health. Absence management, population health and voluntary benefits end up split across separate owners too.
When population health and culture initiatives are designed without reference to what clinical and pharmacy data show about the workforce's health needs, and when absence management, population health and voluntary benefits each sit with a different owner, the resulting programs don't target real cost and health drivers and can feel disconnected to employees.
A clinical informatics approach that analyzes claims, pharmacy and population health data together — rather than as separate reporting streams — connects program design to what's driving cost and poor outcomes in a specific workforce, and gives absence management, population health and voluntary benefits one coordinated strategy instead of three disconnected ones.
Claims data is what transforms a population health program from a guess into a strategy.
Employers design population health, absence management and voluntary benefits programs informed by what claims and pharmacy data show, rather than by generic best practice, and employees experience one coordinated program rather than several disconnected ones.
Our Areas of Expertise
One team analyzing claims, pharmacy and wellbeing data together
Standard population health programs and pharmacy cost management get designed separately, without ever comparing notes. HUB structures Health & Productivity around one clinical informatics team, so claims, pharmacy and population health data inform program design and coverage decisions together instead of in isolation.
Claims data, pharmacy data and wellbeing program data usually live in three separate reports that nobody compares side-by-side. HUB's clinical informatics team analyzes all three together, identifying trends, risk factors and care gaps that would stay invisible if each data set were reviewed on its own. That integrated view directly shapes how absence management, population health and voluntary benefits programs get designed, so they target what is driving cost and poor outcomes in a specific workforce rather than following a generic template. For employers whose wellbeing programs were built from a best-practice checklist rather than their own claims data, this is where program design starts reflecting the workforce it's built for.
HUB's pharmacy benefits management brings aggregated market relationships and named clinical pharmacy expertise to the table, negotiating PBM terms, formulary strategy and alternative funding arrangements that reflect more leverage than what one employer could get on its own. That expertise extends to GLP-1s and gene therapies specifically, categories where per-patient costs can run $9,000 to $10,000 annually, or up to $4.25 million for a single gene therapy treatment. For employers facing renewal conversations dominated by specialty pharmacy trends, this is where a broker's aggregated leverage starts showing up in the actual terms offered.
Voluntary benefits, absence management and population health programs often get built and measured by three different teams, each with its own view of what the workforce needs. HUB brings these together as part of one coordinated strategy, informed by the same clinical informatics view used across the rest of this sub-segment rather than three separate best-practice templates. Voluntary benefits fill specific coverage gaps employees choose into individually, absence management supports the practical realities of leave and return to work and population health programs are built through a structured process, including a workforce needs assessment and participation-barrier review, rather than an off-the-shelf wellbeing template. For employers running these three programs through separate internal owners today, this is where they start operating as one connected employee experience instead of three unrelated benefits.
HUB's Impact
What integrated clinical, pharmacy and actuarial expertise changes
Mental health costs now exceed $300 billion annually, and specialty drugs now account for half of pharmacy spending. HUB's integrated clinical, pharmacy and actuarial approach has helped employers manage exactly these pressures without simply cutting coverage.
Case studies
Cost Contained
Joaquin Garbiso, Senior Benefits Manager, City of Fort Collins
Insights for Your Business
Health & productivity insights and research
