Employers Pivot From Cost Cutting to Comprehensive Employee Support as Benefits Landscape Evolves

Gallagher's 2025 benefits management survey reveals shift toward holistic wellbeing strategies and innovative plan designs as organizations compete for talent.
By: | June 30, 2025
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Employers are fundamentally reshaping their benefits strategies, moving beyond traditional cost-containment approaches to embrace comprehensive employee support systems that address physical, emotional, career and financial wellbeing, according to Gallagher’s 2025 U.S. Workforce Trends Report focused on benefits management issues.

This shift in strategy, based on Gallagher’s survey of 4,035 U.S. organizations, is occurring even as 74% anticipate health care expenses will increase in 2025, according to the report.

Emerging Trends Reshape Employee Benefits Landscape

The survey shows a fundamental shift in employer priorities, with 70% now offering voluntary benefits specifically to ensure comprehensive packages—up from 64% in 2023. This evolution reflects growing recognition that diverse, multigenerational workforces require tailored support beyond traditional medical coverage, according to Gallagher.

Medical benefits remain nearly universal, with 98% of employers providing coverage, yet the approach to plan design is transforming. The percentage of employers offering consumer-directed health plans with health savings accounts declined by one point to 55%, signaling retreat from the high-deductible strategy that dominated the previous decade. Only 24% of employers now report these plans as having the highest enrollment, down from previous years.

“Many employers are starting to see that even though an HSA might be the cheapest option, it might not be the best fit for their lowest-paid employees if they can’t afford to use it,” said Ryan Lane, area vice president, U.S. Business Intelligence Lead, for Gallagher. “There’s a growing trend of employers looking into new benefit plans that incentivize employees to choose high-quality providers and help them navigate the health care system.”

Specialty medical coverage is expanding rapidly, with 48% of employers now covering infertility treatments and fertility services, the survey shows. Gender-affirming surgery coverage reaches 26% of employers, while 23% provide other transgender-inclusive benefits. These additions reflect both legal requirements and organizational commitments to inclusion and diversity, the report noted.

Voluntary benefits are evolving beyond traditional supplemental insurance. Accident insurance leads at 75% adoption, while quality-of-life products gain traction—employee perks discount programs jumped to 51% from 44%, and pet insurance coverage increased to 33% from 23% between 2023 and 2025, according to the survey.

The wellbeing landscape shows similar expansion, with 54% of employers implementing formal strategies. Emotional wellbeing remains the fastest-growing priority, cited by 56% of employers, while financial wellbeing support increased 14 points to 48% as organizations recognize the interconnection between various health dimensions.

Cost Pressures and Compliance Challenges Intensify

Health care cost management represents employers’ primary challenge, with 69% identifying high medical service costs as their top concern. Medical care prices surged 121.3% from 2000 to 2024, compared to 86.1% for all consumer goods, creating sustained pressure on benefit budgets, according to the report.

Specialty prescription drugs compound these challenges, affecting 46% of employers overall and 63% of large organizations (with 1,000 or more employees). Despite reluctance to increase direct cost-sharing—only 4% raised specialty drug copays in 2025—employers face mounting pressure from pharmaceutical innovations. Gene therapy coverage, while limited to 19% overall, reaches 27% among large employers better equipped to handle substantial claims.

Pharmacy benefit management grows increasingly complex, with rising costs driving strategic contract reviews, according to Gallagher. The concentration of purchasing power among three major PBMs, controlling about 80% of commercial covered lives, creates negotiation challenges for employers seeking transparency and flexibility.

GLP-1 medications for obesity present particular dilemmas for employers, the report noted. While 96% of employers cover these drugs for diabetes, 67% extended coverage to obesity treatment in 2024. The medications’ high costs and questions about long-term effectiveness force careful utilization management, with 87% requiring prior authorization and 51% setting criteria exceeding FDA label requirements.

Absence management compliance represents another mounting challenge, with 55% of employers struggling to navigate federal, state and municipal regulations, the report found. Recent legislative changes in Delaware, Maine, Maryland, Minnesota and other states introduce new paid family and medical leave requirements, while ballot measures in Alaska, Missouri and Nebraska mandate sick leave accruals.

Manager understanding of leave policies concerns 44% of employers, rising to 52% among large organizations, the survey found. The complexity increases as states like New York require 20 hours of paid prenatal leave starting January 2025, while California expands pregnancy disability leave options.

Strategic Solutions Emerge Across Benefit Categories

Employers are implementing sophisticated cost-control strategies beyond traditional cost-sharing increases, Gallagher’s survey finds. Value-based tactics, adopted by 27% overall and 53% of large employers, focus on improving care quality while managing expenses. The most common approach—reducing prescription costs for chronic conditions like diabetes—aims to boost medication adherence and prevent costly downstream care.

Centers of excellence for specific procedures, utilized by 13% of employers, offer targeted cost management through designated high-quality providers. These programs often include travel accommodations and reduced out-of-pocket costs to incentivize participation.

PBM contract management shows significant evolution, with 32% of employers implementing pharmacy carve-outs—up 13 points from 2024. Large employers lead this trend at 54%, seeking greater transparency and control over prescription drug benefits. Additionally, 21% overall and 52% of large employers conduct regular pharmacy contract reviews and negotiations.

Biosimilars emerge as promising cost-control tools, offering 15-35% savings compared to branded biologics that can cost $10,000-$30,000 annually, per the report. As competition intensifies for blockbuster medications, these alternatives provide PBMs with enhanced negotiating power and employers with meaningful savings opportunities.

Wellbeing programs adopt more strategic measurement approaches, moving beyond participation rates to include employee engagement surveys (44%) and health outcome tracking through claims data (31%). Investment varies widely, with spending distributed across ranges of less than $100 (23%), $100-$249 (19%), and $250 or more (22%) per employee annually.

Family-friendly policies expand to meet competitive labor market demands. Paid parental leave reaches 38% of employers, while 19% offer prenatal leave beyond legal requirements. Most employers (92%) provide equal time off for birth and adoption, and 62% offer equal leave to primary and secondary caregivers, reflecting evolving workplace equity standards.

View the full survey here. &

The R&I Editorial Team can be reached at [email protected].

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