The EOB Podcast Live! with Shawn Gremminger at Elevated Insights Summit 2026

Employers Are Finally Fighting Back: Shawn Gremminger on Healthcare Transparency, PBMs & Data Access

The first-ever LIVE episode of The EOB Podcast was a little different.

There were skits.

There was audience participation.

There was a fake Kohl’s Cash program.

And somewhere between the jokes and the sarcasm, there was a serious conversation about one of the biggest challenges facing employers today:

Why is it still so difficult to access information about your own healthcare plan?

Joining Justin and Julie was Shawn Gremminger, whose organization represents employer coalitions covering more than 90 million Americans and over $850 billion in healthcare spending annually.

And his message was clear:

Something is changing.

Employers are no longer willing to blindly trust the system.

A Turning Point for Employer Healthcare

According to Shawn, employers today are more informed, more aggressive, and more willing to challenge traditional healthcare arrangements than ever before.

Some organizations are already:

• Moving to direct contracting models
• Replacing legacy PBM arrangements
• Negotiating stronger data rights
• Eliminating restrictive contract provisions
• Demanding transparency from brokers and consultants

Others are still learning.

And many are just beginning to realize how much control they’ve historically given away.

But the momentum is undeniable.

After years of frustration, employers are finally saying:

We’ve had enough.

The Big Three PBMs Are Feeling the Pressure

One of the biggest shifts Shawn discussed involves the changing landscape of pharmacy benefit management.

The dominance of the “Big Three” PBMs—CVS Caremark, Express Scripts, and Optum—has long defined the market. Yet employers are increasingly exploring alternative models that prioritize transparency and pass-through pricing.

Even more interesting?

Major PBMs are now publicly talking about transparency, pass-through arrangements, and access to data—topics that weren’t part of the conversation just a few years ago.

Whether those changes are genuine or simply a response to competitive pressure remains an open question.

But one thing is certain:

The market is forcing the conversation.

Hospital Prices Should Be Employers’ Biggest Concern

While PBMs dominate headlines, Shawn offered an important reminder:

Hospital pricing may be an even bigger problem.

According to employer surveys conducted by the National Alliance, hospital costs remain one of the largest concerns among employers—and arguably deserve even more attention than pharmacy spending because that’s where much of the money actually goes.

Yet many employers still struggle to answer basic questions:

• What are we actually paying?
• How do our prices compare?
• Are we getting competitive rates?
• Why do contracts differ so dramatically across providers?

Without access to meaningful data, those questions remain difficult to answer.

Data Access Is About More Than Compliance

Throughout the discussion, one theme kept resurfacing:

Employers deserve access to their own information.

Not summaries.

Not curated reports.

Not high-level trend dashboards.

The actual data.

Shawn argued that if employers cannot see prescription drug claims at the claim level, something is fundamentally wrong with the arrangement—and future regulations will make that increasingly difficult to justify.

Because without data, employers cannot:

• Verify costs
• Evaluate vendors
• Explore direct contracting opportunities
• Identify waste
• Improve plan design
• Fulfill fiduciary obligations

Access to data isn’t just helpful.

It’s essential.

Contract Transparency Is the Next Frontier

Price transparency was only the beginning.

The next battle?

Contract transparency.

Employers may understand their agreements with TPAs or PBMs, but they rarely see the contracts those organizations maintain with hospitals, manufacturers, and other entities.

And that’s where many of the most important provisions live.

Special arrangements.

Revenue guarantees.

Unique pricing structures.

Exceptions that completely change what employers thought they negotiated.

As Shawn explained, employers often believe they’ve secured one thing, only to discover that downstream contracts effectively override those expectations.

That’s a problem.

The Best Time to Negotiate Is Before You Sign

One of the strongest messages from this live discussion centered on leverage.

The best opportunity to demand transparency is during the RFP and contracting process—not after the agreement has already been signed.

At that stage, employers can negotiate for:

• Claims data access
• Contract review rights
• Stronger audit provisions
• Transparency requirements
• Fiduciary protections
• Clear dispute processes

Once the contract is finalized, leverage disappears quickly.

Which makes preparation incredibly important.

Fiduciary Responsibility Means Asking Questions

New PBM disclosure requirements and evolving regulations continue to raise the bar for employer fiduciaries.

But Shawn and Julie emphasized something important:

Employers aren’t expected to be perfect.

They’re expected to have a process.

That means:

• Asking questions
• Reviewing contracts
• Requesting data
• Evaluating compensation arrangements
• Monitoring vendors
• Identifying conflicts of interest

The more employers normalize these conversations, the easier they become.

And over time, vendors adapt.

Direct Contracting Creates New Opportunities

Data access doesn’t simply help employers understand the past.

It helps them build better solutions for the future.

For example, understanding prescription spend could reveal opportunities to:

• Contract directly with manufacturers
• Explore alternative pharmacy arrangements
• Improve care navigation
• Reduce unnecessary costs
• Customize benefits for employees

The traditional healthcare ecosystem is no longer the only option.

And many employers are discovering they have far more choices than they once realized.

The Role of ERISA Preemption

The conversation also explored the complicated relationship between state healthcare reforms and ERISA preemption.

For self-funded employers operating across multiple states, ERISA creates consistency and helps avoid navigating dozens of conflicting regulatory frameworks.

At the same time, states continue experimenting with innovative approaches to PBM regulation, transparency requirements, and employer protections.

The challenge moving forward is finding solutions that preserve employer flexibility without creating unnecessary barriers or legal conflicts.

It’s a balancing act—but one that policymakers are increasingly willing to address.

Why Shawn Is Optimistic About the Future

Perhaps the most encouraging part of the conversation came at the very end.

After decades of policymakers largely overlooking the commercial healthcare market, Shawn believes that’s beginning to change.

Healthcare affordability has become impossible to ignore.

And both Republicans and Democrats are starting to recognize that the 185 million Americans covered through employer-sponsored insurance deserve greater attention and better solutions.

The path forward won’t be easy.

But for the first time in years, meaningful progress feels possible.

Final Thoughts: Employers Have More Power Than They Think

The biggest lesson from this live discussion wasn’t about legislation.

Or lawsuits.

Or even PBMs.

It was about agency.

Employers have more leverage, more options, and more influence than they’ve historically been led to believe.

The challenge is using that power.

Start with the contracts.

Ask for the data.

Question the assumptions.

Build better processes.

Because transparency isn’t a luxury anymore.

It’s a requirement.

And the employers who embrace that reality today will be in a much stronger position tomorrow.

FAQ: Healthcare Transparency and Employer Data Rights

Why do employers struggle to access their own healthcare data?

Many contracts limit how data is shared or require employers to purchase additional reporting services instead of receiving raw claims information directly.

Why is hospital pricing such a major concern?

Hospital costs represent one of the largest portions of healthcare spending, often exceeding pharmacy costs for employer-sponsored plans.

What is contract transparency?

Contract transparency involves understanding not only your own agreements with vendors but also the downstream contracts that impact pricing, reimbursements, and plan administration.

What should employers do before signing healthcare contracts?

Employers should negotiate data rights, audit provisions, transparency requirements, and fiduciary protections during the RFP process when leverage is strongest.

Why is access to claims data important?

Claims data helps employers evaluate spending, improve plan design, explore direct contracting opportunities, and fulfill their fiduciary responsibilities.

Listen to the Full Episode

The first-ever live episode of The EOB Podcast combined humor, audience participation, and serious policy discussions to tackle some of healthcare’s biggest challenges.

And yes…

There was a fake Kohl’s Cash rebate program involved.

If you’re an employer, benefits professional, advisor, or simply someone who wants a better understanding of healthcare transparency, this is an episode you won’t want to miss.