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Bill Would Require Health Plans to Count Online Drug Purchases Toward Deductibles

by Inoventive Solutions
May 26, 2026

Workers are increasingly turning to direct-to-consumer online drug platforms like Amazon Pharmacy, Mark Cuban Cost Plus Drug Company and the government-backed TrumpRx to buy prescription medications at prices sometimes far lower than what they would pay through their employer-sponsored health plans. But in many cases, the money they spend on those drugs does not count toward their health plan deductible or annual out-of-pocket maximum.

A new bill in Congress aims to change that. The Every Dollar Counts Act, introduced by Rep. Greg Murphy (R-North Carolina), would require health insurers to apply out-of-pocket spending on covered prescription drugs toward a patient’s deductible and out-of-pocket maximum regardless of where the drugs were purchased. 

Murphy, a physician and longtime critic of insurers and pharmacy benefit managers, said the legislation is designed to remove barriers that discourage patients from using lower-cost prescription drug options.

Direct-to-consumer drug platforms have gained traction by bypassing some traditional distribution channels and offering discounted pricing, particularly for certain brand-name medications. The issue has drawn additional attention following the White House-backed launch of TrumpRx earlier this year, which seeks to negotiate lower drug prices directly with manufacturers. 

Supporters of the legislation argue that the current system can effectively force patients to “pay twice.” Even if a worker saves money by purchasing a medication through a low-cost online platform, those expenditures often do not help satisfy the plan deductible unless the drug is purchased through a plan-approved pharmacy or pharmacy benefit manager network. 

For employers, the proposal highlights a growing tension in prescription drug benefits. On one hand, allowing employees to use lower-cost purchasing options could reduce out-of-pocket expenses and improve medication adherence. Employees who can afford their medications are more likely to stay on treatment and avoid costlier health complications later.

On the other hand, some employers and health plans may worry that the bill could weaken cost-management strategies tied to network pharmacies, formularies and benefit design. Plans often use deductibles, copayments and preferred pharmacy arrangements to steer participants toward negotiated pricing and control overall drug spending.

The debate could shape how workers access lower-cost medications and how health plans balance affordability with efforts to manage overall drug spending.

"mental
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Employers See 500% ROI on Mental Health Programs: Study

by Inoventive Solutions
May 21, 2026

As demand grows for employer-sponsored behavioral health programs, new research suggests that well-designed mental health programs can generate measurable financial returns for businesses while improving employee well-being.

Behavioral health services can deliver a projected return on investment of more than 500%, with employers seeing about $6.07 returned for every $1 spent, according to an analysis by ComPsych, a company that specializes in organizational mental health and absence management services. The cost returns from behavioral health services are derived from reduced absenteeism and presenteeism, improved productivity and reduced medical spending.

While group health plans are required by law to cover mental health services just as they do physical health services, the shortage of therapists coupled with soaring demand has made it difficult for enrollees to access psychologists on a regular basis. Providing additional behavioral health services can help bridge that gap.

Where the savings come from

Besides the services offered through group health plans, employers have additional options such as:

Employee assistance programs — Typically provide a set number of free counseling sessions along with referrals for ongoing care.

Tele-counseling and virtual therapy — Access to licensed therapists via video, phone or messaging.

In-person therapy networks — Expanded provider networks or preferred access to local clinicians.

Mental health apps — Programs focused on stress, anxiety, sleep and mindfulness.

Caregiver support — Help managing elder care, childcare or family responsibilities.

Mental health days or expanded leave policies — Time off specifically for mental well-being.

The financial impact is driven by several factors that tie directly to workplace costs:

  • Lower medical spending — Early intervention can reduce emergency room visits, hospitalizations and prescription drug use (this accounts for about one-third of ROI).
  • Fewer disability claims — Treating mental health conditions before they escalate can prevent or shorten disability leaves (this accounts for about 15% of ROI).
  • Reduced absenteeism — Employees who receive care are less likely to miss work.
  • Improved productivity — Workers who are mentally well tend to be more focused and engaged on the job (this accounts for about half of ROI).

Even when employers exclude productivity, the return on investment remains strong based on health care and disability savings alone, according to ComPsych.

Clinical improvements translate to workplace gains

The same research found that employees who engage in counseling and related services see meaningful improvements in common conditions like depression and anxiety. Those clinical gains directly affect workplace outcomes.

Workers who feel better are more likely to stay on the job, avoid extended leaves and maintain consistent performance. That can lead to fewer disruptions for employers and lower overall benefit costs.

Access and engagement remain key

While many employers offer behavioral health benefits, utilization is often lower than expected. Stigma, lack of awareness and limited access can all stand in the way.

Expanding access has become easier in recent years, particularly with the growth of telehealth and digital tools. Many employees now prefer a mix of in-person and virtual care that allows them to fit treatment into busy schedules.

Employers that see the strongest results tend to focus on more than just offering benefits. They also actively promote them and work to normalize their use.

Strengthen behavioral health ROI

To get the most value from behavioral health investments, employers can:

  • Promote benefits regularly so employees know what is available.
  • Train managers to recognize signs of stress and guide employees to resources.
  • Offer a mix of in-person, virtual and self-guided care options.
  • Integrate mental health with broader well-being programs, including financial and caregiving support.
"Medicare"/
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Why Employers Must Help Older Employees Navigate Shift to Medicare

by Inoventive Solutions
May 12, 2026

For many workers, retirement marks the first time they must make complex health coverage decisions on their own. After years of relying on employer-sponsored insurance, the transition to Medicare can feel abrupt and confusing, often leaving employees unsure of what to do next.

Employers that step in to guide workers through this transition can improve retirement outcomes, reduce benefit costs and strengthen employee trust. When older employees understand their Medicare options, they are more likely to retire on time, avoid costly mistakes and feel supported by their employer.

The risks of not helping

Employees approaching retirement often receive little more than COBRA paperwork and general instructions. This lack of guidance can lead to employees making costly errors such as missing key enrollment deadlines.

Two of the most common and expensive mistakes involve late enrollment penalties that apply for the rest of an enrollee’s life:

  • Medicare Part B (medical insurance): If employees do not enroll when first eligible and lack qualifying coverage, they may face a lifetime premium penalty that increases their monthly cost permanently. The penalty is 10% of the standard premium for every full 12-month period the employee was eligible but didn’t enroll or have qualifying coverage.
  • Medicare Part D (prescription drug coverage): Delaying enrollment without creditable drug coverage can also trigger a permanent penalty added to premiums. The penalty is 1% of the baseline premium for each month the person didn’t have Part D coverage.

In addition, some employees remain on employer plans longer than necessary, increasing costs for themselves and the organization.

How Medicare works with employer coverage

Medicare decisions are not one-size-fits-all. Whether an employee should enroll at age 65 depends largely on their employment status and employer size.

Employees working for companies with 20 or more employees can often delay Part B without penalty if they remain covered under the employer’s plan.

Those at smaller firms may need to enroll in Medicare at 65, as Medicare typically becomes the primary payer.

Employees must also coordinate coverage if they have a spouse on the plan or contribute to a health savings account, which they must stop prior to Medicare enrollment.

How employers can support the transition

You don’t need to provide individualized advice to help your older workers. You can easily create an education strategy that will go a long way toward improving outcomes. Make sure to:

Start early. Introduce Medicare basics as early as age 60, with more detailed education between ages 62 and 64.

Offer workshops and webinars. Discuss enrollment deadlines, coverage options and how Medicare interacts with employer plans.

Provide decision-support tools. Help employees evaluate whether to stay on the employer plan or transition to Medicare.

Send timely reminders. Notify employees as they approach their initial enrollment window (three months before and after age 65).

Connect employees with experts. Offer access to third-party Medicare advisers for one-on-one guidance.

Integrate into offboarding. Include Medicare education in retirement planning materials and exit communications.

Benefits to your organization

Medicare is one of the most important financial and health decisions employees will make, and failing to support them during the transition can lead to unintended consequences. Employees may delay retirement due to uncertainty about health coverage, driving up employer health plan costs as well as their own costs for life. Others may make poor coverage decisions.

When older employees understand their Medicare options, they are more likely to retire on time, avoid costly mistakes and feel supported by their employer. With the right guidance, employers can turn a confusing and stressful process into a well-managed transition that benefits everyone involved.

"Health
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How Health Insurers Are Trying to Rein in Costs Without Cutting Value

by Inoventive Solutions
May 5, 2026

Employers are grappling with another year of steep increases in group health plan premiums due to medical cost inflation, higher utilization and rising drug prices.

At the same time, health insurers can no longer shift additional costs to employers and employees through higher deductibles or narrower networks.

Instead, many insurers are pursuing structural changes designed to control long-term costs while improving care quality and member experience.

Interviews with health plan executives and recent industry reporting point to a common theme: reducing avoidable care, simplifying administration and investing earlier in health to prevent expensive problems later.

Employers and their staff can benefit from these strategies, which are increasingly being built into plan design, provider networks and care management programs that influence both premiums and employees’ out-of-pocket costs.

Preventive and personalized care

A central focus for many insurers is expanding preventive care and making it easier for enrollees to engage with their providers before health issues worsen. Executives at plans such as Humana and Highmark Wholecare, in a recent roundtable with the news website Becker’s Payer Issues, emphasized coordinated care models that connect primary care, specialists and support services around the individual.

These models rely on data and digital tools to identify care gaps early, such as missed screenings or unmanaged chronic conditions. Members may receive targeted reminders, care manager outreach or digital coaching to stay on track. For employers, this approach can translate into:

  • Fewer high-cost claims tied to late-stage disease
  • Fewer avoidable hospitalizations
  • Fewer emergency department visits

Employees benefit from clearer guidance, easier navigation of benefits and more proactive outreach instead of reacting to health issues once they become serious and costly.

Cost containment through innovation and collaboration

Insurers are increasingly rethinking how care is paid for and delivered. Many are expanding value-based payment arrangements that reward providers for keeping patients healthy rather than paying for higher volumes of services.

Under these arrangements, insurers and providers share data and align financial incentives around outcomes and the total cost of care.

Plans are also using predictive analytics and artificial intelligence to identify members at higher risk of complications and intervene earlier through care coordination, remote monitoring or alternative sites of care.

For employers, this can help slow medical cost growth over time without eroding access to care for their employees.

Administrative efficiency and transparency

Health plans are investing in modernized claims systems, real-time eligibility and claim validation and more streamlined prior authorization for routine or evidence-based care.

Some plans are reducing or reforming prior authorization requirements where data shows little value, while using technology to make remaining reviews faster and more predictable. Insurers are also working to improve transparency around costs and benefits, helping members better understand service costs and coverage before care is delivered.

For employers, lower administrative costs can help moderate premium growth and reduce HR workload tied to billing disputes and employee questions. Employees may benefit from fewer delays, clearer explanations of benefits and less confusion when accessing care.

What this means for employers

While no single initiative will eliminate health care cost pressure, insurers argue that combining preventive care, value-based payment and administrative simplification offers a more durable path forward.

Employers evaluating plan options may want to work with us to assess how their carriers are implementing these or similar strategies and how they measure success.

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