Hot Takes from MBGH’s 2025 Employer Forum on Pharmacy Benefits, Specialty & Biopharma Therapies

Scripta
Jul 1
3 min read

We were on the ground at this year’s MBGH pharmacy benefits conference that explores how employers can better navigate the financial and coverage challenges of ultra-high-cost therapies for members and their families.

Whether you’re grappling with high-cost cell and gene therapies (CGTs), frustrated by the lack of pricing transparency, or navigating your fiduciary responsibilities as a plan sponsor, the stakes have never been higher.

Here are the biggest takeaways HR and benefits leaders should know now—and how some employers are already taking action.

Complex Rx Modalities are Here to Stay

Complex Rx modalities—especially cell and gene therapies (CGTs)—are growing rapidly. They're a fast-growing segment in the market that’s becoming increasingly complex and expensive.

In 2021, complex modalities made up 40% of new drug launches (6% were CGTs).
By 2028, complex modalities could make up 54% of all new Rx launches (20% being CGTs).

Employers are taking notice, but there’s no one-size-fits-all solution. The most forward-thinking strategies include:

Educating plan sponsors and members alike
Assessing coverage decisions for CGTs
Implementing robust prior authorization (PA) protocols
Exploring alternative financial models

Transparency is Still a Major Employer Concern

The latest MBGH employer survey underscored a stark reality: drug prices are the number-one affordability concern for 98% of employers. Rounding out the top three were high-cost claims (82%) and hospital prices (74%).

But it's not just sticker shock. Employers remain deeply concerned about the lack of transparency in how drugs are priced, reimbursed, and managed—particularly given the conflicts of interest embedded in today’s healthcare system.

Here’s how employers are starting to address these concerns:

67% are promoting biosimilars on their formularies
56% are demanding full and independent audit rights from their PBMs
56% are securing ownership of all health data
45% are requiring that advisors receive no compensation from PBMs

Fiduciary Responsibility is No Longer Optional

It’s not enough to offer a pharmacy benefit—you’re now expected to prove that it’s being managed responsibly. With mounting legal and regulatory scrutiny around prescription drug pricing, plan sponsors must demonstrate that they’re acting in the best interest of their members.

So what should employers consider doing to stay compliant?

Rethink their PBM selection process
Negotiate (or renegotiate) their PBM contract to reflect transparency
Evaluate the “reasonableness” of drug prices
Conduct regular and independent PBM audits
Demand transparent rebate and pricing structures

Proof in Practice: How The CATO Corporation Transformed its Pharmacy Benefits

One of the most interesting discussions came from Alisa McCowen, Benefits Manager at The CATO Corporation. Facing rising Rx costs and growing complexity, she set out to reinvent how it approached pharmacy benefits—without compromising member experience.

CATO was on a mission to:

Lower Rx spend
Create awareness of medication options and transparent pricing
Offer competitive benefits
Reduce overall plan expenses

CATO partnered with Scripta for its:

Deep clinical expertise and data-driven guidance
Clear explanation of drug pricing to members
Robust member support
Turnkey communications and onboarding
Flexibility and proven ROI

The early results speak for themselves:

“Flawless” implementation—the easiest process she had ever been a part of
Successful awareness of the benefit through a multichannel approach
Strong initial member engagement, including:
- 400+ personal savings reports sent
- 15 high-impact prescription switches
- 5-star member support rating

Final Thought: There’s No Single Fix—But There Are Smart Moves

The complexity of pharmacy benefits is growing, but so is the opportunity for employers to make meaningful, cost-saving decisions. By staying informed, demanding transparency, and using the right tools, HR and benefits leaders can navigate this complex landscape to protect themselves, their organization and their members.