How employees are spending their HSA dollars, from Amazon to GLP-1s

• Key Insight: Discover how HSAs are migrating spend from providers to e-commerce and digital health platforms.
• What's at Stake: Employers risk benefit misalignment as employees bypass plans to purchase care directly.
• Supporting Data: Amazon HSA spending rose 123% in 2025, signaling a major retail channel shift.
  Source: Bullets generated by AI with editorial review

Amazon has emerged as a top destination for Health Savings Account holders, as more consumers use the online giant to buy health and wellness products with their funds.
The eighth annual HSA Spend Report from benefits provider Lively shows how HSA spending is shifting from hospitals and doctors to a broader ecosystem of consumer health brands and e-commerce platforms.

HSA spending at Amazon increased 123% in 2025 compared to the previous year, making the company one of the leading merchants by transaction. "They have made a really big push into HSA and FSA-eligible items," says Shobin Uralil, co-founder and chief operating officer of Lively. "Amazon popped up on our list three or four years ago, but really it has risen quite a bit over that time."

In addition to Amazon, several other online and digital-first merchants saw increased HSA spending in 2025, including Hims & Hers, Ro Health, Warby Parker and 1-800 Contacts.  

These trends, Uralil says, underscore the need for employers and benefit leaders to pay closer attention to digital-first consumers.

"I think many employers think that their employees are only seeking care based on the plan design that they have put together," he says, "but what the data actually tells us is that consumers are way more educated than people give them credit for. When push comes to shove, if the employer is not offering them what they need, they will go out and find it on their own." 

Other highlights from the report

One of the other major trends revealed in the report was a major spike in HSA spending with manufacturers and platforms tied to GLP-1 medications. Spending at Lilly increased 5,610% year-over-year in 2025, while Hims & Hers saw a 134% increase. 

"The growth in spend at Lilly reflects increased adoption of branded medications, while the growth at Hims and Hers highlights how digital health platforms are packaging access, consultation, and fulfillment into simplified consumer experiences," the report states. 

Read more: Health savings accounts gain popularity as investment vehicles

Weight-loss medications have become more affordable in recent years, Uralil noted, as competition has increased and insurance coverage has gradually expanded.

Spending on platforms that support mental health such as Headway, BetterHelp and therapy-focused apps such as Ivy also increased in 2025. This is due to reduced stigma around mental healthcare, increased normalization of ongoing therapy and growing preferences for virtual access, according to the report. 

"We're seeing generationally more and more people who are much more aware of the issues that they have and are seeking assistance and help along the way," Uralil says. 

HSA balances on the rise

Despite increasing healthcare costs, HSA balances are continuing to rise. The average Lively HSA balance was $5,457 in 2025 — including unfunded accounts — marking an 11% increase from the previous year and the highest average balance since Lively began tracking the metric. 

The report suggests benefit leaders encourage contributions through education and plan design, while making it easier for workers to save and spend — and reinforcing the long-term value of HSAs.

"We're seeing HSA balances grow, and people are still able to ensure that they're growing their account balance over the long term, which makes for a really interesting dichotomy," Uralil says. 

Read more: Employees can use their HSA for their international medical tourism expenses

Whether these trends will continue in 2026 remains to be seen. HSAs, like many investment accounts, are not immune to economic shifts, particularly as geopolitical tensions and higher oil prices weigh on the broader economy.

That said, Uralil remains optimistic. "It's one of the most powerful vehicles that you can have out there for your healthcare expenses," Uralil says. "My personal belief is that this will be one of the last things to get impacted."