Transparent Cash Prescription Market Pushes Employers to Expand Benefit Choice

The growing cash market for prescription drugs, especially high-demand medications, is exposing healthcare price gaps that are hard to ignore. Employees can now compare what they pay through employer-sponsored plans with cash prices, and in some cases the difference is substantial. As these gaps become more visible, employers face a new question: What is the real value of their health benefits when cheaper options are available?

To explore this shift, we spoke with Leon Wisniewski, Founder of Health Cost Labs, a healthcare pricing data firm, and a recognized Top 100 Magazine Innovator and Entrepreneur. With more than two decades of experience, Wisniewski has worked as both an actuarial modeler and a forensic audit expert, including time at Independence Blue Cross, modeling reimbursement scenarios and investigating corporate fraud. Today, he uses pricing data to challenge long-standing opacity in the healthcare system. "You don’t want to be in a position where you’re forcing your employees to overpay for health care. That’s simply a terrible thing to do, especially now that every price can be checked," he says.

• A dose of reality: Price discrepancies have existed for years, but limited to a small number of procedures or patients, these gaps didn’t spark widespread attention or change. That shifted with the explosive demand for GLP-1 drugs like Wegovy. Unlike hospital services, prescription drugs reach a far broader population, and aggressive marketing has pushed pricing into the public conversation. Because these medications are often available primarily through cash-pay models, they have forced a more direct reckoning with benefit design. "More people use drugs than go to hospitals, and GLP-1s address the number one health condition, obesity. Since they are often only available at a cash rate, it forces the conversation: Why have a benefit if cash is cheaper and it doesn't cover what people need most?" Wisniewski says.

• The price is wrong: Wisniewski points to a personal example to illustrate the gap. When his son needed an MRI, he paid $241 in cash after checking available pricing data, while insured rates for the same procedure ranged from $800 to $1,100. This ability to verify costs is putting pressure on the traditional, relationship-based benefits broker model. "The idea that cash is cheaper is almost blasphemy to a traditional benefits broker,” Wisniewski says. “It contradicts everything they’ve known for the last fifteen years and forces a different, uncomfortable conversation. That’s a good thing."

The traditional benefits broker market has long operated on longstanding relationships and established practices around pricing. As the focus shifts from trusting the system to checking the numbers, the bonuses and extra commissions that once went unnoticed are now out in the open. The industry is split, with long-time brokers sticking to the old ways while a new wave, led by figures like Mark Cuban, pushes a simple but disruptive idea: cash is often cheaper.

• A courteous exit: Wisniewski offers a clear solution for employers: update plan documents to let employees take cash instead of benefits. This gives employees choice and protects employers from frustration or backlash when people realize they could be overpaying. "The most courteous thing an employer can do is give employees a choice. Allow them to take their benefit money and buy coverage somewhere else if they want to," he says. By acknowledging that employers cannot control the price for everything, this approach provides a practical safeguard while helping organizations navigate a market increasingly shaped by transparency and new rules in pharmacy benefit management.

• Institutionalized helplessness: The solution starts with changing a long-standing cultural norm. The healthcare system has relied on opacity, training consumers not to question costs and creating what Wisniewski calls institutionalized helplessness. Re-education is key, starting with awareness that prices vary and that tools make costs visible. "The industry has trained people to think the only way to buy care is with an insurance card."

The employer health benefits landscape is changing. Price transparency and the rising cash market for prescription drugs are exposing gaps in traditional plans and challenging long-standing assumptions. Employers who embrace this shift by giving employees choice and making pricing visible can protect both their teams and themselves from unnecessary costs and frustration. As Wisniewski puts it, "Price transparency exists, and there are tremendous savings for those who learn how to use the data."