Why Are Our Pharmacy Costs Exploding? Understanding PBMs and Prescription Spend

105 wellness plans vs SIMRP

Most “1 05 wellness plans” are sold as a tax hack, not a real benefit, and that is exactly why owners end up nervous later. In this episode, Matthew Abbott breaks down where those wellness style 1 oh 5 arrangements go off the rails, how recent IRS guidance changed the game, and why a properly structured SIMRP inside ProfitGuard Plus is a different animal altogether. If you want lower payroll tax, stronger benefits, and a structure that is built to last instead of a loophole pitch, this walkthrough will help you spot the red flags and understand what a compliant, sustainable strategy should actually look like for your W2 team.

What Can We Do About High-Cost Specialty Medications?

High cost specialty medications and GLP 1 drugs are blowing up pharmacy costs for small and midsize employers, but “just raise copays” is not a strategy. In this episode, Matthew Abbott breaks down a practical playbook for owners who feel like one or two prescriptions are hijacking their health plan. He explains what makes specialty meds so expensive, how PBM contracts and weak utilization management quietly drive costs, and what you can actually do about it as a trades or home service employer. You will hear how to tighten prior auth and step therapy without blocking appropriate care, why transparent pharmacy and site of care strategies matter, and how SIMRP style medical reimbursement and defined allowance models for GLP 1s can help you support the right employees without writing a blank check. If you are tired of being surprised by pharmacy at renewal, this conversation gives you a clear framework to turn specialty drugs from an uncontrollable expense into a managed part of your benefits strategy. #employeebenefits #pharmacycosts #specialtydrugs #GLP1 #smallbusiness #tradesbusiness #HVACbusiness #plumbingbusiness #benefitsstrategy #SIMRP

Protecting Yourself So You Do Not Have to Raid Retirement in the First Place

Employees do not wake up wanting to raid their 401k. They reach for loans and hardship withdrawals because the rest of their financial safety net failed first. In this episode, Matthew Abbott walks through a simple way for employers to reframe vesting, loans, and hardship withdrawals so employees see the retirement plan as a future paycheck, not an emergency ATM. He explains how to talk about vesting as “how you earn the company money,” why loans are really borrowing from your future self, and why hardship withdrawals should be treated as a true last resort, not just another option on a form. You will also hear how smarter benefit design—especially supplemental coverage and SIMRP style medical reimbursement strategies—can create a practical safety net for medical and income shocks so employees are less likely to touch retirement dollars in the first place. If you are a small or midsize employer who feels the pain when people cash out or borrow from their 401k, this episode gives you a clear, repeatable framework you can use in orientations, safety meetings, and annual benefit reviews. #employeebenefits #401k #vesting #retirementplan #smallbusiness #tradesbusiness #HVACbusiness #plumbingbusiness #benefitsstrategy #financialwellness

Why Are Our Pharmacy Costs Exploding? Understanding PBMs and Prescription Spend

Pharmacy costs are hammering small and midsize employers, and many business owners don’t understand why their prescription drug spend is suddenly exploding. In this episode, Matthew Abbott breaks down what’s really driving rising pharmacy costs for employers and explains how Pharmacy Benefit Managers (PBMs) influence your prescription drug benefit behind the scenes. You’ll hear how specialty drugs, GLP‑1 medications, and opaque PBM pricing models can quietly push your group health insurance renewal higher—and what a practical, hands‑on employer can actually do to regain control. We cover: * What PBMs are and how they affect drug pricing, formularies, and pharmacy networks * How spread pricing, rebate‑driven formularies, and limited transparency drive up employer prescription costs * Action steps for small employers to improve PBM contracts, tighten specialty pharmacy management, and design smarter pharmacy benefits that support cost control If you run a trades or home‑service business and feel every dollar in payroll and benefits, this episode will help you understand why pharmacy costs are rising, how PBMs impact your prescription spend, and where you can push back as part of an overall, tax‑efficient employer benefits strategy.

PPO vs HMO vs HSA: How Small Employers Should Choose a Health Plan (and Where SIMRP Really Fits)

In this episode, Matthew Abbott breaks down one of the most confusing decisions for small and midsize employers: how to choose the right health plan structure for your team—and how a Self‑Insured Medical Reimbursement Plan (SIMRP) fits into that strategy. We cut through the alphabet soup of PPO, HMO, HSA‑eligible high‑deductible plans, MVP, MEC, ICHRA, and individual health insurance, and put them in the correct order: * First: decide your core medical strategy (PPO, HMO, HDHP/HSA, MVP, MEC, ICHRA, or individual private plans with employer contributions). * Then: use SIMRP as a tax‑efficient enhancement layer that sits on top of your medical offering to strengthen benefits and reduce payroll tax exposure. You’ll learn: * The real‑world tradeoffs between PPO, HMO, and HSA‑eligible plans for small employers * How MVP, MEC, ICHRA, and individual plans function as alternatives to traditional group health insurance * Why SIMRP (Self‑Insured Medical Reimbursement Plan) is not an alternative to medical coverage, but an add‑on once you’re offering a qualifying plan * Practical examples of how SIMRP can make a lean medical plan feel richer without simply increasing wages or premiums If you’re an employer who cares about payroll costs, recruiting, retention, and tax‑efficient compensation, this episode gives you a simple framework to use in your next renewal or benefits strategy meeting. Matthew closes with a three‑step process to sequence your medical decisions first, then layer SIMRP on top as a strategic benefits and tax tool.