Pulse of the Purchaser 2026
What North Carolina Employers Are Saying About Healthcare
The National Alliance of Healthcare Purchaser Coalitions conducts the annual Pulse of the Purchaser survey to understand employers’ healthcare priorities, challenges and strategies. The 2026 survey included 408 employers nationally, including employers responding through NCBCH.
The NCBCH-specific results offer a closer look at participating employers’ experiences and how their responses compare with national respondents. These insights support NCBCH’s work to bring North Carolina employers together with other healthcare stakeholders to improve healthcare quality, affordability and value.
Healthcare Affordability Is a Major Concern
Participating NCBCH employers identified high-cost claims, drug prices, and high-cost cell and gene therapies among the significant threats to the affordability of employer-provided coverage.
Share rating each issue a “Significant Threat.” NCBCH: 8 responses for each item shown. National responses vary by item; the full question had 297–305 responses per item. National figures include NCBCH respondents. Source: NCBCH coalition report, question 13, slide 15; companion workbook.
Rising Costs Affect More Than Benefits
Participating NCBCH employers connect healthcare affordability with employee costs, workforce priorities and business competitiveness.
In addition, 77.8% agree that healthcare cost increases often lead to trade-offs with salary or wage increases. Affordability has implications for employees’ pay as well as their benefits.
“Agree” and “Strongly Agree” combined; 9 NCBCH responses per statement. Source: NCBCH coalition report, question 9, slide 11; companion workbook.
Pharmacy Benefits Remain in Motion
About two-thirds of participating NCBCH employers answering the question were considering changing their pharmacy benefit manager (PBM) within the next 1–3 years.
Considering a PBM change
4 of 6 employers
273 responses
Reported PBM contract features
- 83.3% — access to claims-level pharmacy data
- 83.3% — disclosed administrative fee structure
- 66.7% — full audit rights, including rebate agreements and pharmacy claims
- 50% — 100% rebate pass-through to the plan sponsor
Contract features: 6 NCBCH respondents; multiple selections allowed. These are reported contract provisions, not an independent assessment of contract performance. Source: NCBCH coalition report, questions 23–24, slides 25–26; companion workbook.
Employers Are Looking for Ways to Manage High-Cost Claims
Concern is accompanied by action. Participating NCBCH employers responding to the high-cost-claims strategy question reported using navigator, advocacy or enhanced case management support, as well as stop-loss, captive reinsurance or other financial protection.
Other approaches already in use included disease-specific vendors or programs, such as cancer, diabetes, kidney disease or musculoskeletal care (66.7%); enhanced screening or early detection (50%); centers of excellence, bundled payments or other high-value provider arrangements (50%); and review of pharmacy claims billed through the medical benefit (50%).
These responses show employers combining support for people with complex care needs, earlier detection, provider arrangements and financial protection.
Share selecting “Currently Doing”; 6 NCBCH responses per strategy. Source: NCBCH coalition report, question 38, slide 40; companion workbook.
Data Can Help Turn Concern Into Action
One central national finding links claims data access with the purchasing strategies employers have put into practice.
Average number of hospital and high-cost-claim strategies in use among employers with full medical claims access versus those with limited, no or uncertain access.
Employers with full access reported using nearly four more strategies on average. Usable claims data can help employers evaluate networks, understand prices, manage vendors, audit claims and make more informed purchasing decisions.
National analysis: 166 employers with full medical claim-level access and 86 with limited, no or uncertain access, among those answering the access question and at least one of 26 strategy items. This is an association, not proof that data access causes greater adoption. Source: national report, page 14; findings release, page 2.
About the 2026 Survey
The National Alliance and its member coalitions fielded the online survey in May and June 2026. It included 408 employers nationally; 247 completed the entire questionnaire. Participation was voluntary, using a non-probability sample recruited through member coalitions.
Ten employers participated through NCBCH overall. Percentages use valid responses to each question, excluding blanks. The findings provide a snapshot of participating employers’ perspectives; they do not represent all North Carolina employers.
Sources: national report, page 39; findings release, page 3; NCBCH coalition report, slide 1; companion workbook, “Read Me.”
Explore the Full Results
Explore the detailed national findings to learn more about employers’ priorities, benefit strategies and healthcare purchasing decisions.
Contribute Your Perspective Through PPRI
The Pulse of the Purchaser Research Institute (PPRI) gives employer coalition members an opportunity to share their perspectives confidentially in research that informs employer-sponsored healthcare.
Employer leaders can learn about the expert panel and participation opportunities through the National Alliance. Sharing your experience helps national and local coalitions better understand the issues employers face.
To connect these findings with NCBCH’s work, explore our current initiatives and areas of focus.