DALLAS and HOUSTON – October 20, 2025 – For the fifth year in a row 100% of employers say hospital prices along with drug prices are significant threats to health care affordability for both the employer and its employees. Increasing health care costs will lead to shifting even more expenses to employees and cause trade-offs for salary or wage increases. These are among the findings from the latest employer survey conducted by the non-profit Dallas-Fort Worth Business Group on Health (DFWBGH) and Houston Business Coalition on Health (HBCH).
The study conducted with employer coalitions across the country and the National Alliance of Healthcare Purchaser Coalitions gauged concerns and approaches of employers to address the workforce environment, high-cost claims, pharmaceutical drug and hospital prices, fiduciary strategies, obesity management, mental health, women’s health, equity, and potential health reforms.
“The results of this annual survey continue to demonstrate that employers are in dire straits in their ability to continue to provide health care benefits to their employees and their families,” said Chris Skisak, PhD, executive director for HBCH. “Employers have been refused a direct seat at the table in negotiations that determine what they must pay for health care and that will only change if Texas employers ban together market by market.”
Additional findings include:
· Most employers strongly agree/agree (90%) that rising health care costs impact their organizations’ competitiveness, due to steady, multi-year increases.
· All employers (100%) view drug prices, high-cost claims and hospital prices as the biggest threats to affordability.
· One-third of employers still can’t get complete health care data; four in 10 say health care services vendors refused to provide data.
· Six out of 10 employers doubt there has been improved hospital efficiency and pricing as a benefit of hospital consolidation.
· Purchasers with complete access to their health care claims are substantially more confident in fiduciary safeguards across hospital billing and pricing and pharmacy benefit management practices than those without full access.
· Employers are taking action to address drug spending concerns. Nearly two-thirds (61%) of purchasers are in motion on PBMs—either changing vendors in the past year or considering a change within the next 1–3 years.
· The number of employers moving away from the Big 3 PBMs – CVS (Aetna), Optum (United Healthcare) and Express Scripts (Cigna) – has more than doubled (31%) since last year as employers look to achieve better pricing, more transparency, formulary control, and greater fiduciary responsibility.
· Employers overwhelmingly (>90%) say PBM reform and drug price regulation would be helpful to their benefits plan.
“The results of this year’s survey show encouraging signs that employers are ready to take action,” said Marianne Fazen, PhD, executive director for DFWBGH. “Taking ownership of health plan relationships and applying more assertive, sophisticated, value-driven approaches are key to lowering costs. As examples, employers are demanding full access to claims data, transitioning to transparent PBM arrangements, and reevaluating hospital price variations using available transparency tools.”
The online survey was conducted in July and August with 24 Texas employers responding from industries including manufacturing, health care and government.
About DFWBGH
The Dallas-Fort Worth Business Group on Health (DFWBGH) is an employer-led coalition of Dallas and Fort Worth area employers and health services organizations committed to educating and empowering employers and their employees to make informed, value driven healthcare decisions and to promoting healthcare quality, cost-effectiveness, transparency and accountability in our community. For additional information visit our website dfwbgh.org and follow on LinkedIn.
About HBCH
The non-profit Houston Business Coalition on Health is the leading resource for Houston employers and their health services providers dedicated to providing health benefits at a sustainable cost while improving the quality and employee experience of their delivery through effective benefits design. With 60 members, HBCH represents 250,000 Houston employer-sponsored lives, 500,000 in Texas, and more than 1 million nationwide. For additional information visit our website houstonbch.org and follow on LinkedIn.
DFWBGH and HBCH are members of the National Alliance of Healthcare Purchaser Coalitions.
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