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• Drug savings of $120K a year cited from using Mark Cuban pharmacy
• Democrat calls out association health plans for favoring healthy

Employers that sponsor health plans told a congressional panel Thursday they need better access to their claims data from health insurers and policy administrators so they can design lower-cost, high quality coverage for their workers.

Both Republicans and Democrats agreed at a hearing held by the House Education and the Workforce Committee’s Subcommittee on Health, Employment, Labor, and Pensions that better guarantees for employers to access their health-care data is critical to their ability to control costs. “Employers often struggle to access their own health plan and spending data from their third-party-administrator,” subcommittee Chairman Bob Good (R-Va.) said.

“Without this information, employers and providers are unable to adequately design innovative payment models and assess quality and savings,” he said.

Employers are pushing for better legal guarantees to access their data, which they say is necessary to fulfill their fiduciary responsibility to administer plans in the best interest of members. Despite transparency regulations in place requiring hospitals and health insurers to make the data public, employers say large insurers, which typically administer their plans, often argue the data constitute trade secrets to deny them access.

In December, the House passed legislation (H.R. 5378) that includes provisions bolstering legal requirements that health-care providers and insurers disclose information about health-care costs. Similar bipartisan legislation (S. 3548) has been introduced in the Senate, but no action has yet been taken.

Owning Claims Data

“We believe we should own our claims data, and we can make the best and informed decisions to meet our fiduciary responsibility to our employees and their families,” said Michele Beehler, senior director of health and wellbeing with Schweitzer Engineering Laboratories Inc., which manufacturers electric power system products. The Pullman, Wash.-based company covers nearly 10,000 people in 37 states.

Beehler cited as one example a reduction in costs for an employee whose medication cost $10,000 a month with out-of-pocket costs of nearly $3,000 a month. SEL identified a generic equivalent sold through Mark Cuban Cost Plus Drugs for $12.80 a month, saving the employee nearly $36,000 a year and saving SEL an additional $84,000 for a total savings of $120,000.

“That’s the power of transparency,” she said.

SEL uses its claims data to review contracts with its plan administrator and other providers to avoid hidden fees, identify large price discrepancies, manage its prescription drug program, and contract directly with “high-quality hospitals” like Pullman Regional, which helped it save nearly $2 million in 2023, Beehler said.

However, “at SEL we went through an arduous process that lasted over 18 months while we tried to get our claims data, both in discussions with our third party administrator as well as back and forth with data submissions that weren’t complete in nature. This shouldn’t be the norm,” she said.

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