National Alliance Board members only. 

Open to Coalition All-Member Meeting attendees only.

All-Member Meeting participants only. 

Coalition employer members are invited to attend this meeting with their coalition.

Open to all Annual Forum attendees.

All-Member Meeting participants only.

For High-Cost Claims Workshop registered guests only. If interested, register on the High-Cost Claims Workshop page.

A small number of forward-thinking philanthropies are investing in affordability, recognizing that rising costs are placing increasing pressure on families, communities, employers, and the healthcare system itself. But the challenge is too significant for a limited number of philanthropic organizations to address alone. More philanthropies are needed to bring resources, innovation, and long-term commitment to efforts that can drive meaningful changes in how healthcare is purchased, delivered, and paid for.
Employers are uniquely positioned to help drive that change. As major purchasers of healthcare, employers have the opportunity to use their collective influence, data, and purchasing power to challenge unsustainable costs and advance more affordable, high-value care.
This session will explore why philanthropy is investing in healthcare affordability, why greater philanthropic engagement is needed, why employers are a critical part of the solution, and how strategic partnerships between philanthropies and employer purchasers can translate investment into measurable impact. Together, philanthropy and employers can help move healthcare affordability from an emerging priority to a sustained movement for meaningful, systemic change.

Open to all Annual Forum attendees.

(By invitation only).

Open to NHLC members, coalition members, coalition employer members, and invited guests. 

If you have any questions, please contact madewole@nationalalliancehealth.org.

Breakfast will be in the Exhibit Hall.

Open to all Annual Forum attendees.

As healthcare costs continue to outpace inflation and wage growth, medical care, prescription drugs, and health insurance are becoming increasingly difficult to afford for millions of Americans. This session will examine the post-midterm election outlook and what it could mean for the future of healthcare policy and affordability, as well as how potential policy shifts may impact employers.

Networking Break will be in the Exhibit Hall. 

Why this matters to employers:
Monthly dialysis costs can run $60,000-180,000 per patient yet most employers have no strategy in place until a catastrophic claim arrives. This session gives employers the intelligence and tools to get ahead of CKD before it devastates their plan. Experts have spent over two decades proving that prevention is not only possible, but financially transformative. Employers will leave knowing exactly what to look for, and exactly what to do next.

Actionable takeaways:
1. Why CKD is the hidden driver of catastrophic claims and why waiting for a diagnosis is not an option
2. How to proactively identify undiagnosed at-risk members using biomarkers, claims data, and predictive analytics
3. The clinical and financial case for early intervention and how it can prevent members from ever reaching dialysis
4. A real employer success story: measurable outcomes in cost savings, member health, and plan sustainability

Beyond the Standard Playbook: Personalizing Metabolic and Inflammatory Care

Digbi Health is rethinking how we approach metabolic and inflammatory conditions like obesity, diabetes, and digestive issues. These conditions are often connected and influenced by a combination of biology, food, and lifestyle, and environment, yet healthcare has traditionally treated them separately and relied on many of the same recommendations for everyone. Digbi takes a different approach based on a simple idea: if everybody is different, care should be different too. By bringing together genetics, gut health, metabolic information, and everyday health data, Digbi can build a more complete picture of what may be driving each person's conditions. Al helps connect these pieces and turn complex information into practical, personalized guidance. The goal is to identify the small changes that can make the biggest difference for each individual, helping people improve their health in a way that is more personal, sustainable, and relevant to their everyday lives. 

GLP-1 Costs Are a CFO Level Problem: TRU-1 by Blue Genes Changes the Equation

GLP-1s represent one of the fastest-growing and most expensive drug categories in U.S. pharmacy spend, with total expenditure exceeding $130 billion in 2025.  For context, total U.S. prescription-drug spending was about $915 billion in 2025, meaning GLP-1s represented roughly 14.4% of total prescription-drug expenditures.  Research studies report that 18-20% of the population are non-responders to GLP-1 therapy.  TRU-1 by Blue Genes provides a genetic pre-treatment stratification tool that identifies likely responders and non-responders to GLP-1 receptor agonist therapy – before costly therapy is initiated. 

TRU-1 by Blue Genes Lab addresses this problem at its root.  By testing six genetic variants across three genes directly linked to GLP-1 response, TRU-1 produces a single, actionable risk score that enables: 1) identification of likely non-responders before therapy initiation, 2) reduction in effective therapy starts and associated waste, 3) improved persistence and outcomes for patients who are genetically positioned to benefit, and 4) more efficient utilization aligned with existing PA and care management workflows. 

Note: our base Blue Genes program is the only PGx platform that integrates with PBMs to create real-time claim denials, ensuring the right drug is prescribed the first time.

Lunch will be in the Exhibit Hall.

2026 Coalition Member Leadership Award

Recognizing a coalition that demonstrates leadership and commitment to health and healthcare value on behalf of employers/purchasers and their employees, their community, and the National Alliance.

2026 Employer/Purchaser Excellence Award 

Recognizing a jumbo- and a mid-sized employer or purchaser demonstrating leadership and innovation in advancing health and healthcare value through benefit strategy and design, employee engagement, and support of coalition efforts.
 

Increase employee awareness of perimenopause/menopause symptoms and resources. Develop an understanding of the barriers and constraints experienced by the Public Employer employees and beneficiaries who are in the perimenopause and menopause life stages, while improving care and benefit navigation for a whole-health approach to care for employees and beneficiaries experiencing perimenopause and menopause. This will help destigmatize this life stage for people experiencing perimenopause and menopause, and empower them to self-advocate at work and with their care providers.

Obesity is a complex, chronic disease with implications for employee health, workforce experience, and health care costs. As employers consider how best to respond, they are navigating evolving treatment options, benefit design questions, and the needs of employees living with obesity. Drawing on new employer research and perspectives from a patient, provider, and employer, this session will explore the factors shaping coverage decisions, the role comprehensive obesity care can play, and practical approaches employers can consider both within their benefits and across the workplace.

Our health plan is inundated with requests from our members, networked providers, and AI vendors to classify this or that predictive model as a covered benefit.  We are often presented with compelling marketing materials for these models, but as we have limited resources in our medical plan we have fashioned a framework to be used to help us make the right decisions for our members. We propose illustrating this framework at the meeting with a case study as this may be beneficial to others. 

Networking Break will be in the Exhibit Hall. 

Certain HPV Cancers are Preventable and there is a vaccine that can impact this life-altering disease and is a cost-effective solution to high-cost claims.  Learn how employers and other stakeholders examined the low utilization of preventative services and how they implemented an initiative to combat this issue. You will obtain FREE easy to implement tools and resources to activate this HPV vaccine initiative resulting in a great ROI. 

Fertility and family-building benefits are increasingly being recognized as a strategic investment in workforce health, engagement, and retention. Join us for an overview of Ferring's Fertility Benefits Initiative, including tools, resources, and an employer-focused framework designed to support informed decision-making around fertility and family-building benefits. Learn how organizations can create more inclusive, supportive benefit programs that meet the needs of today's diverse workforce while aligning with broader talent and well-being goals.

Biosimilars have the potential to generate significant savings for employers and health plans, yet many organizations struggle to translate that opportunity into action. What does it actually take to implement a successful Biosimilars First approach?
Join employer, policy, and healthcare leaders as they discuss real world strategies for increasing biosimilar adoption through plan design, purchaser engagement, stakeholder alignment, and policy innovation. The discussion will highlight both the opportunities and challenges associated with implementation and explore how employers can reduce specialty drug spending while maintaining quality, access, and employee satisfaction.
Attendees will gain actionable insights and practical considerations for evaluating biosimilars within their own benefits strategy.

Gateway Business Health Coalition (BHC), who runs a PBM coalition representing 43 employer groups and 300,000 covered lives, recognized that its PBM contract left its member employers with limited visibility and little leverage. BHC built a structured, coalition-driven competitive evaluation process. Partnering with Foundational Pharmacy Strategies (now part of MacroHealth), BHC designed and executed a rigorous process that analyzed employer's actual claims data against transparent and traditional PBM models. The results were concrete: the coalition formally selected a preferred transparent PBM partner estimated to save members 25% on overall pharmacy cost, and added a specialty pharmacy benefit option estimated to reduce specialty drug spend by 40%, both announced in early 2026.
This session tells that story in full and gives attendees a blueprint to replicate it.
Attendees will leave with:
A replicable framework for running a coalition-driven PBM evaluation, including how to structure vendor participation, scoring, and employer education
An understanding of how to evaluate true net cost vs. contractual guarantees.
Real financial results from the BHC employer claims data analysis, including 25–41% reductions in specialty drug spend for participating employers
A blueprint for using CAA fiduciary obligations and claims data ownership rights to demand greater accountability from PBM partners
Guidance on how to engage transparent and specialty PBM vendors and what questions to ask

Open to all Annual Forum attendees.

Open to NPLC members and their coalition leaders only.

Breakfast will be in the Exhibit Hall.

This session shares how an employer adopted a comprehensive approach to payment integrity—with independent claims oversight as a critical pillar. By partnering with SmartLight Analytics, the employer has driven meaningful, measurable savings. Real case studies illustrate root causes that continuous monitoring uncovers, and what it takes to hold carriers and TPAs truly accountable.

Key Takeaways:
•    Why traditional claims auditing methods are structurally limited and leave significant overpayments uncaptured
•    How claims integrity monitoring differs from periodic auditing approaches
•    Real case studies illustrating the types of hidden waste that continuous monitoring uncovers
•    Practical guidance for plan sponsors seeking to bridge the gap between carrier knowledge and employer cost accountability

This session shares how an employer adopted a comprehensive approach to payment integrity—with independent claims oversight as a critical pillar. By partnering with SmartLight Analytics, the employer has driven meaningful, measurable savings. Real case studies illustrate root causes that continuous monitoring uncovers, and what it takes to hold carriers and TPAs truly accountable.

Key Takeaways:
•    Why traditional claims auditing methods are structurally limited and leave significant overpayments uncaptured
•    How claims integrity monitoring differs from periodic auditing approaches
•    Real case studies illustrating the types of hidden waste that continuous monitoring uncovers
•    Practical guidance for plan sponsors seeking to bridge the gap between carrier knowledge and employer cost accountability

Hidden fees in TPA/Network contracts using existing laws to fight anticompetitive contract provisions. State law survey to get an understanding of which states have laws that can be leveraged by employers and have low risks of preemption challenge.

Networking Break will be in the Exhibit Hall. 

As rising drug costs continue to challenge healthcare budgets, many organizations are reassessing how true savings are defined and captured. This session explores how net effective cost frameworks—combined with innovative delivery models—can unlock value beyond traditional PBM approaches. Attendees will gain practical perspectives on identifying hidden savings opportunities and making more informed, end to end purchasing decisions.

As specialty drug costs continue to rise, plan sponsors are seeking effective cost-control strategies, including specialty pharmacy carve-out programs. While the potential savings can be appealing, cost is only one of several factors employers should consider when evaluating whether a carve-out fits their benefits strategy. Milliman’s research examines both the net cost and key qualitative considerations, supported by a real-world employer case study highlighting issues to assess before implementation.
 

Lunch will be in the Exhibit Hall.

In this session, the Healthcare Purchaser Alliance of Maine provides an inside look at the strategic battle to advance a hospital price and growth cap bill in the state legislature. Attendees will explore the anatomy of the advocacy effort, dissecting the core messaging strategies, tactics for effective legislator engagement, and the realities of navigating intense hospital pushback. By breaking down both the progress made and the hurdles encountered, this presentation equips health policy advocates and purchasers with a practical playbook for pursuing structural affordability reforms in their own markets.
 

"Transparent." "Pass-through." "Fiduciary." Every PBM claims all three, and no two employers, or PBMs, define them the same way. In this session, we introduce a clear, employer-built framework for how the PBM/employer relationship should actually work: the minimum expectations every plan sponsor should have, and the new Employer Bill of Rights that spells out exactly what you should expect, and be able to ask for, from your PBM.

(This is a private workshop open to coalitions, employers, and invited guests only.)

Claims data holds tremendous potential to help employers and coalitions better understand healthcare spending, identify opportunities for improvement, and make more informed purchasing decisions. 
This workshop will provide an overview of the Peterson Health Analytics (PHA) claims data platform: what it is, what it does, and the value it delivers to employers and other stakeholders. Participants will discuss their needs, priorities, and challenges and explore how the National Alliance, coalitions, and employers can work together to build and strengthen an offering designed to deliver meaningful value for healthcare purchasers.

Open to all Hill Visit participants.

Open to coalitions and their employer members.