Specialty Care Accounts: How Cost Containment in Healthcare is Essential for Managing Medical Benefit Budgets

Rising specialty drug costs—especially GLP-1 weight management medications—are creating a new pressure point for employers. With the two main components, the price of healthcare services and plan utilization, steadily increasing—employers need solutions. A Mercer study found that 59% of employers expect to make cost-cutting decisions to their health plans, up from 48% in 2025 and 44% in 2024. The trend is clear: employers need new approaches to manage specialty care spend without compromising benefits. 

At the same time, employees feel the impact. Demand for specialty drug reimbursements continues to rise sharply, and Mercer reports that 1 in 4 employees say GLP-1 access influences how they perceive the quality of their benefits.

Specialty drugs—such as GLP-1 weight management medications, hormone replacement therapy (HRT), and advanced mental health treatments—are now among the fastest-growing drivers of benefit costs. Traditional medical plans weren’t designed to absorb these unique categories, leaving employers with limited options: restrict access or face unpredictable cost increases year after year.

Specialty Care Accounts are helping employers regain control of rising healthcare costs without cutting access to the care employees need.

Here’s what we’ll cover:

• What is a Specialty Care Account? A defined contribution approach to specialty care
• Cost containment in healthcare: GLP-1 and specialty drug reimbursements
• Managing GLP-1 and weight management costs without benefits plan disruption
• How Specialty Care Accounts work for employees and employers
• Why Specialty Care Accounts matter: A growing cost containment strategy

What is a Specialty Care Account? A defined contribution approach to specialty care

A Specialty Care Account (SCA) is an employer-funded benefit that provides employees with a defined annual allowance for high-demand specialty care like GLP-1 weight management medications, hormone therapy, and specialty mental health services.

Unlike traditional medical coverage, Specialty Care Accounts give employers a predictable, budget-certain way to support emerging care needs without taking on open-ended claims exposure.

Through an LSA-based allowance, employers set a pre-defined annual contribution for specialty care. This creates stability across high-impact categories that can otherwise cost employers $10,000–$12,000 per employee per year, while helping employees access the care they need with less financial burden.

Cost containment in healthcare starts when employers can afford to provide necessary care for their employees, and employees can access it without high costs.

Cost containment in healthcare: GLP-1 and specialty drug reimbursements

Specialty Care Accounts shift specialty care spending from an open-ended claims model to a defined, employer-controlled allowance. Employers set a fixed annual budget for specialty treatments, ensuring:

• Predictable healthcare spend
• Clear cost ceilings
• Protection from claims volatility
• No disruption to the core medical plan

GLP-1 medications are a clear example of why this matters. Blue Cross Blue Shield reports that GLP-1 coverage can raise premiums by as much as 14%. As more individuals qualify for these treatments—and claims continue to rise—employers are now seeing how quickly GLP-1 costs can accelerate when managed through traditional plan structures.

Research from the Employee Benefit Research Institute (EBRI) also suggests that fully covering GLP-1s through the medical plan is not an effective long-term strategy. Instead, defined contribution and cost-sharing approaches can expand access while avoiding broad premium increases across the entire workforce.

Supporting specialty drug reimbursement allows employers to  support employees seeking high-demand treatments without absorbing uncapped financial risk. For organizations already offering GLP-1 coverage, shifting from open-ended formulary exposure to a capped funding model can significantly reduce spend while preserving access and choice.

Managing GLP-1 and weight management costs without benefits plan disruption

Implementing Specialty Care Accounts into an existing benefits plan makes it possible to support GLP-1 and weight management coverage without disrupting the core medical plan. When specialty medications are added directly into traditional coverage, employers introduce three major risks:

• Unpredictable renewals driven by open-ended claims exposure
• Escalating demand for GLP-1s, hormone therapy (HRT), and specialty mental health care
• Delayed care and productivity loss when out-of-pocket costs rise too high

Over time, covering these treatments through a medical plan can lead to ongoing cost inflation and renewal volatility. Specialty Care Accounts offer a different approach–funding high-demand care outside the medical plan to avoid long-term claims exposure while still meeting employee expectations. The result: stronger healthcare cost control  without benefit erosion—and no renewal shock tied to GLP-1 utilization.

Employers need sustainable ways to support emerging care needs like menopause care, hormone therapy, and specialty mental health services. Specialty Care Accounts offer a compliant, flexible model that expands access while keeping employer liability capped and predictable—supporting both financial discipline and holistic employee wellbeing.

This approach helps organizations:

• Address evolving workforce needs
• Maintain financial discipline
• Strengthen benefits competitiveness

—all while keeping costs controlled, transparent, and sustainable.

How Specialty Care Accounts work for employees and employers

Specialty Care Accounts work similarly to standard Lifestyle Spending Accounts (LSA), giving employees a simple allowance to use for eligible specialty care expenses.

1. Employers set a fixed annual special care allowance and define eligible categories
2. Employees use funds for high-demand treatments such as GLP-1s, HRT, weight management, menopause support, and specialty mental health
3. Programs operate alongside existing health plans, using an LSA-based allowance to unify spend and  access
4. Employer spending remains capped, predictable, and transparent

With Specialty Care Accounts, employers move away from open-ended claims exposure and toward a defined contribution model that delivers financial clarity and long-term sustainability as specialty care demand continues to grow.

They no longer cope with claims uncertainty, operating with complete financial clarity. An SCA structure replaces claims uncertainty with renewed financial clarity—giving employers confidence as specialty drug coverage needs continue to rise.

Why Specialty Care Accounts matter: A growing cost containment strategy

Specialty Care Accounts are helping employers regain control of rising healthcare costs without cutting access to the care employees need.

As specialty drug demand accelerates, traditional medical plans are struggling to keep up. Employers need a more sustainable way to support treatments like GLP-1s and other emerging specialty categories while protecting budgets from unpredictable renewal increases.

By separating specialty care from traditional open-ended medical claims, employers can future-proof their benefits strategy—reducing cost volatility, expanding access, and supporting holistic employee wellbeing. Questions about how SCAs can work with your plan? Read our frequently asked questions or follow up with our team here.