There’s no question that health care is becoming more expensive, not just for individuals, but for employers, too. HDHPs are widely accessible in the United States, and they provide the benefit of lower premiums compared to lower-deductible PPO or EPO plans. But HDHPs do have some interesting caveats that employers and employees need to consider, and the cost of care is one of them.

Many Americans are “underinsured” 

With half of workers enrolled in HDHPs, HR and benefits leaders must understand the implications of these plans on their populations. A 2024 survey reveals that nearly 1 in 4 working-age adults remained “underinsured,” grappling with high out-of-pocket costs and deductibles that make timely care unaffordable.

Findings from The Commonwealth Fund reveal another alarming trend: 57% of these underinsured adults report avoiding necessary medical care due to cost. Many people don’t have enough savings to cover their deductible, which results in them delaying care until it becomes an emergency.

Ultimately, this delayed care can lead to high-cost claims for employers and medical debt for employees. In fact, 2 in 5 respondents reported worsened health as a result, and nearly 30% are burdened with medical debt, half of them owing $2,000 or more.

The connection between prescription non-adherence and HDHPs 

There’s a unique and unfortunate connection between those who participate in HDHPs and non-adherence to medications. A study of over 106,000 patients revealed that for individuals on an HDHP, 10% less adhere to their medications due to the high deductible after the first year. 

The study also revealed that the higher the deductible, the less likely a patient was to adhere to their prescribed medication; meanwhile, the lower the deductible, the more likely they were to adhere.

What’s even more unfortunate is that there is an outsized impact on those who take medications to manage chronic conditions like hypertension or heart disease. The CDC reports that drug non-adherence causes up to 125,000 deaths each year.

This is the stark reality of the health care system today. Cardiovascular medications are not cheap, and some patients must sadly choose between filling their potentially life-saving prescription or making ends meet.

Employees are gambling with their health

Ultimately, employees are placing bets with their health. If an individual needs medical care or a prescription, for example, and they are enrolled in an HDHP, they are tasked with making a difficult decision.

They can go through insurance and pay a steep co-pay, or bypass it and pay less upfront with options like Amazon Pharmacy, Mark Cuban Cost Plus Drug Company or GoodRx. The second option means they would avoid using their employer-sponsored health plan altogether.

As HDHPs continue to see wider adoption, a critical tension has emerged: While employers want members to use the plan’s built-in pharmacy benefit, employees, especially those unlikely to hit their deductible, are incentivized to shop around.

When faced with $100 out-of-pocket through their plan or $30 through a direct-to-consumer option, most consumers will choose the lower price.

An important challenge for HR and benefits leaders

This raises a critical question. If you’re asking employees to act like consumers, do you have a responsibility to equip them like consumers?

For those who answer “yes,” that could mean exposing all available options including those outside your PBM contract. It may also require giving employees the tools to compare prices before filling a prescription.

A meaningful way HR and benefits leaders can do this is by evaluating care navigation tools that prioritize transparency, rather than simply assuming the built-in plan is always the best option for your population.

Employers must empower employees to take advantage of alternative pharmacy options

Approximately 50% of Americans take prescription medications, and 25% use three or more concurrently. In January 2025, pharmaceutical companies raised the list prices of over 800 prescription drugs by a median of 4%, increasing the financial burden on employees.

These rising costs, combined with the removal of GLP-1 coverage from many employer plans, mean employees will be paying more out-of-pocket for high-demand medications. As GLP-1 drugs become more commonly prescribed for weight management, employers must explore innovative ways to support affordability such as manufacturer assistance, discount programs, or steerage to lower-cost channels.

Accountability may soon be on the horizon for big pharmaceutical companies. A recent executive order signed by President Donald Trump aims to pressure drugmakers to lower prices. How pharmaceutical companies respond could significantly impact the broader pharmacy landscape.

In the meantime, employers must act. In a world where HDHPs shift more of the cost burden to employees, withholding information about lower-priced alternatives doesn’t just hurt wallets, it erodes trust. Forward-thinking benefits strategies will embrace transparency and empower employees to make smarter pharmacy decisions, regardless of where the medication is purchased.

Employees shouldn’t have to place bets on their health care

Sports betting is growing in popularity, but people shouldn't have to place bets on their health care. But for those on HDHPs, this is often the reality — gambling on whether it's better to pay out of pocket for medications, or to go through their health plan and likely not meet their deductible unless there’s an emergency.

That’s where organizations like Mark Cuban Cost Plus Drug Company and GoodRx come in, making it easier for people to save on their medications, supporting both individual financial wellness and overall cost containment.

Justin Holland is CEO & Co-Founder of HealthJoy.