The Big Six Payors: Solving Healthcare’s Toughest Problems

How to make money integrating technology into healthcare in 2025/2026

For over four years, I have immersed myself in the earnings transcripts, headlines, investor days, and financial reports (10-Ks and 10-Qs) of the six largest payers in the world—what I call the “Big Six Payors.” After absorbing this mountain of information, I decided it was time to share a big-picture framework: the largest pain points these payers face and the potential opportunities for digital health, healthcare startups, or healthcare SaaS companies to help solve them.

Who Should Care?

If you’re in medical devices, biotech, pharma, or healthcare technology/SaaS, you should care. Over the past four years, many tech startups have learned a hard lesson: solving for patient and provider pain points, while noble, often isn’t lucrative. The real stakeholders with the largest spendable income in the $5 trillion healthcare ecosystem are payers and pharma manufacturers.  

This article focuses on payers, who control 90 cents of every healthcare dollar and determine what gets paid for and what doesn’t. With that in mind, here are the top five ways your company can help the largest payers solve problems in 2025 and 2026.

1. Biosimilars and Specialty Drugs

Out of the $700 billion spent annually on pharmacy drugs, $400 billion goes toward specialty drugs. Another $30 billion is spent on biosimilars today, with projections nearing $100 billion by the decade's end. Together, these two categories represent about 9% of the total healthcare spend.  

Does your company, software, or digital health solution help large specialty pharmacy providers lower overall costs for their downstream health plan partners or employer groups? Or does it drive efficiency in delivery, improve clinical outcomes, or streamline the process for these high-cost drugs?  

These are difficult questions to answer, but tackling them can get you on the radar of the most powerful stakeholders in healthcare. If your solution addresses these areas, you’ll be solving one of the most pressing challenges for payers.

2. Elevated Utilization Containment