Product Updates
Mployer Launches Expanded AI Release Powered by Anthropic
Mployer, the industry's leading employee benefits and insurance intelligence platform, today announced its Expanded AI Release powered by Anthropic. This release is a major expansion of the AI and agentic abilities already built across its products, and it includes the broad release of its MCP (Model Context Protocol) Server and Claude Connectors
July 16, 2026

Mployer materially expands the AI and agentic capabilities across its product suite and expands access to its MCP Server and Claude Connectors, making Mployer's proprietary 2 billion data points across benefits and insurance accessible inside partners' own LLMs.


Nashville, TN, July 16, 2026 /PRNewswire-PRWeb/ --


Mployer, the industry's leading employee benefits and insurance intelligence platform, today announced its Expanded AI Release powered by Anthropic. This release is a major expansion of the AI and agentic abilities already built across its products, and it includes the broad release of its MCP (Model Context Protocol) Server and Claude Connectors. This Expanded AI release allows our partners to access Mployer's 2 billion proprietary benefit and insurance data points both inside Mployer and inside their own LLM.

This functionality is coupled with an expert benefit AI-agent trained on these 2 billion data points to provide superior strategic advice and support for our partners at every step in their workflow, across every Mployer solution - from market analytics to benchmarking, claims and compliance. It is similar to having a highly educated insurance expert with 30+ years of experience sitting side by side with every individual partner at every step.

In addition, in line with the company's goal of better enabling all industry participants, Mployer is releasing a limited, free version of every product. There will be a national training on July 28 and August 5 that is for everyone in the industry. To sign up for limited free access and the national training on July 28th, or request access to the Mployer MCP, please see further details below.

"This release raises the bar for what AI can do for our industry," said Brian Freeman, CEO of Mployer. "Applying this next level of AI
across our platform and the broker and carrier workflows gives insurance industry leaders powerful, proprietary market data to support their strategies and decisions. We are entering an awesome era for our industry, where the brokers and carriers using the best analytics will deliver differentiated outcomes for their employer partners. That will continue to drive collective, positive industry impact. We're excited for our partners and for Mployer to play a material role in this next era."

Infusing AI into every step of the workflow:
Mployer's benefits and insurance AI Agent has been highly trained on Mployer's 2 billion unique benefits and insurance data points, and sits alongside leading producers across each step of their workflow, including:

  • Catalyst - Market Intelligence: See the market more clearly than others, with deeper research and AI recommendations on
    proprietary employer and employee market signals.
  • Insights - Benefits Benchmarking: Run real-time benchmarks against localized, custom cohorts, paired with Mployer's expert
    benefit AI to guide custom strategies for each unique plan.
  • Vista - Claims Analytics: Simplify manual client reporting across carrier, Rx, stop-loss, and more, down to just minutes, layering in
    expert-recommended strategies for your review and market trends.
  • Pulse - HR & Compliance: Industry-leading compliance, HR support, and content for brokers and their employer partners have
    reached a next level of ease and engagement.
  • Atlas - Employer Engagement: Extend benefits intelligence across compliance, benchmarking, and claims analytics to employer
    clients directly through an AI-first broker-branded portal.


"Imagine being a producer today and starting your morning with updates from your expert benefits AI assistant: 'Your client's renewal is trending 14% above their cohort benchmark, attached are draft strategies for your review,' or 'An HR director from one of our partners is now the CHRO at a new company, attached is a draft congratulatory email,' or 'A new proposed Texas law impacts three of our groups, attached is a communication for your review.' That is the reality of what this release and the next era bring," said Anthony Waters, Chief Growth Officer of Mployer. "It is a great time to be a part of this industry."


To receive limited, free access to every product, you need to attend one of the trainings:

Each product training is 20 minutes. You can join only the specific solutions you would like to learn more about.


To request access to Mployer's MCP Server and Claude Connectors, please reach out to [email protected].

About Mployer

Mployer is the industry's leading employee benefits and insurance intelligence platform, built for brokers, carriers, GAs, PEOs, and the employers they serve. Powered by more than 2 billion unique benefit data points and Anthropic, Mployer's suite of Catalyst, Insights, Vista, Pulse, and Atlas works for industry leaders benchmarking plans, analyzing claims, recommending growth strategies, and interpreting complex policies and legislation, in one platform. With its MCP Server and Claude Connectors, Mployer's data and AI are accessible across its products and directly within Claude. Learn more at MployerAdvisor.com.

Media Contact: Anthony Waters Chief Growth Officer, Mployer [email protected]

Media Contact
Anthony Waters, Mployer, 1 774 2879741, [email protected], https://MployerAdvisor.com

Product Updates
Product Updates, July 2026
July brings one of our most substantial releases yet, with major updates across Insights+, Catalyst, and Vista. Insights+ is now faster and more efficient, with reports generated automatically the moment a request is submitted, along with real-time edits. Catalyst also gets significantly more powerful, with new AI-powered exports tailored to each employer, deeper visibility into commercial lines, and expanded AI assistant coverage into retirement and peer benchmarking. Vista makes report generation simpler and more flexible, building a broker-branded financial report from whatever benefits and carrier documents you have. Read on for the full details.
Author:
July 1, 2026

July brings major updates across Insights+, Catalyst, and Vista, focused on helping our partners work faster with more automation, deeper intelligence, and expanded AI capabilities, from instant benchmarking reports and smarter prospecting to more flexible reporting. Explore the updates below.

Insights+

  • Automated Report Generation — Insights+ reports now generate automatically the moment a request is submitted.
  • Redesigned Report View — The report now renders natively in the browser: cleaner, more readable, and a closer match to the final output.
  • Real-Time Edits — You can instantly edit and generate reports in real-time. No more wait periods or help needed to edit and generate a new report.
  • Strategic Recommendations in Mployer AI — Generate consultative, mode-specific recommendations directly in the report's AI panel across six modes — General, Cost Strategy, Plan Design, Coverage Gaps, Funding Strategy, and Underwriter Notes — then refine with follow-ups before sharing with a client.
  • Add Medical Plans on Upload Documents Flow — The "Do you have another medical plan?" question is now available on the Upload Documents flow, matching the flexibility already in Manual Entry.

Catalyst

  • AI-Powered PDF Export — A dynamic PDF export is now available from each company profile page. Choose between an Executive Summary or Full Report format, with content automatically tailored to the employer's available data, surfacing the most relevant sections, charts, and insights for each company.
  • Commercial P&C Data on Company Snapshot — The Company Snapshot now includes Commercial P&C Broker and Carrier Display Cards, giving you a consolidated view of an employer's commercial relationships without leaving the snapshot.
  • Commercial Lines Insights for Licensed Users — Users with a commercial license now see a Commercial Lines Insights section on the Opportunity & Signals tab, surfacing filing information from Commercial P&C data alongside benefits context.
  • Advanced Salesforce Entity Matching — Send-to-Salesforce now supports more precise account linking through advanced entity matching. A token-sharing fix also means one admin's Salesforce connection now covers the whole account.
  • Retirement Plan Quality Queries — The AI assistant can now answer questions about retirement plan quality, advisor relationships, and compliance status, extending natural language search into the retirement vertical.
  • Broker Classifier Filters — Filter brokers by scope (national vs. regional), retirement advisor status, and commercial lines activity, making it easier to ask targeted questions about broker specialization and positioning.
  • Broker Column on Commercial P&C Results — The Commercial P&C results page now shows a Broker column, so commercial broker relationships are visible directly from the search grid.

Vista

  • Simpler, More Flexible Report Generation — Upload a client's benefits and carrier documents, now several at once, and Vista builds a structured, broker-branded financial report from what's provided, without requiring every detail upfront. The output adapts to the documents you have, so you can generate a report for any group.
  • The Mployer Assistant, Inside Every Report — Every report now includes an AI assistant panel where you can ask questions about a client's numbers and get instant, report-grounded answers and talking points, pulled directly from the report.
  • A Redesigned Workspace — Vista is now built around a cleaner three-panel layout: quick actions on the left, your reports and report history in the center, and at-a-glance stats with search and filtering.

Product Updates
Product Updates, June 2026
June's product updates are here, and there's a lot to be excited about. We're continuing to build on the foundation we've established across Catalyst and Insights benchmarking, with this month's updates focused on giving users more precision in how they search, prospect, and manage data.
Author:
June 2, 2026

June's product updates are here, and there's a lot to be excited about. We're continuing to build on the foundation we've established across Catalyst and Insights benchmarking, with this month's updates focused on giving users more precision in how they search, prospect, and manage data.

On the Catalyst side, that means expanded AI assistant capabilities, more flexible export controls, and deeper CRM customization. For benchmarking, we've added AI-powered recommendations and made meaningful improvements to the report experience, including how you access completed reports and how data flows through the submission wizard.

Read on for the full details.

Catalyst

  • Proximity-Based Geographic Search — The AI assistant now supports radius-based company searches around a city, so territory prospecting works the way territories actually do — not just by state, city, or zip.
  • Product Line Gap Queries — Ask the AI assistant which product lines — Stop Loss, EAP, Voluntary, TPA — an employer has or is missing. Cross-sell identification now happens in a conversation, not a spreadsheet.
  • Headcount Milestone Flags — The AI assistant can surface employers who've recently crossed key thresholds: 50, 100, 500 employees. Growth signals and compliance triggers, surfaced automatically.
  • Flexible Export Range Selection — When exporting data, users can now choose the current page, a page range, or a specific record count. Providing precise control without bumping into system limits.
  • Experience Mod Data on Account View — Experience Modification data now appears directly on the Company Overview and Commercial P&C tab, so risk context is right there when you need it.
  • Custom CRM Field Mapping — Account admins can now map platform fields to custom CRM fields, including custom schemas. Providing full control over how data flows in without overwriting existing records.
  • Retirement Search: Total Assets Filter — The Retirement Search Assets filter now filters on Total Assets.

 

Insights+

  • AI-Powered Recommendations in Insights+ Users can now access AI-generated recommendations directly within Insights+. The new recommendations tool surfaces actionable guidance across four categories. Highest Impact, Cost Strategy, Coverage Gaps, and Underwriter Notes, giving users a faster path from report data to next steps.
  • Completion Email Links to HTML Report — When your report is ready, the notification email now links directly to the interactive HTML report including Mployer AI and all report tools, instead of a PDF download.
  • Redesigned Chart Layout — Plan Score and Cohort Market Data sections are now clearly differentiated, and Dental and Vision pages consolidate their left-side tables. Easier to read, faster to interpret.
  • Report Opens Without Losing Your Place — Clicking a company name in the Request History Grid now opens the HTML report in a new tab, so your search state stays exactly where you left it.
  • Rate Availability Edits No Longer Clear Rate Data — Adjusting Rate Availability selections mid-wizard no longer wipes Medical, Dental, or Vision rate and contribution data previously entered. No more lost work.
  • Age-Banded Entry Hidden When Not Applicable — When 'Use employee contributions only' is selected, Age-Banded rate entry is no longer shown — cleaner form, fewer distractions.

That's a wrap! Stay tuned for what's coming next month.

Product Updates
Product Updates, May 2026
Whether you're prospecting new accounts, managing an existing book, or benchmarking benefits for a client, there's something meaningful here for you.
Author:
May 6, 2026

We're excited to share details on the new enhancements and features added to Catalyst and Insights/Insights+ this month. Every update we make is grounded in feedback from our users. Whether you're prospecting for new accounts, managing an existing book, or benchmarking benefits for a client, there's something meaningful here for you.

 

Catch up on all the new features and updates:

Catalyst

  • Microsoft Dynamics 365 Integration — Brokers using Microsoft Dynamics can now push companies and contacts directly from Catalyst into their CRM, consistent with the existing Salesforce and HubSpot workflows.
  • Construction Risk Data — Commercial Search now includes property-level Construction Risk intelligence within the employer snapshot, covering building details, valuation, location, and sales history, with a dedicated summary section for quick risk assessment.
  • Expanded Alert Triggers — Alert notifications now cover job changes, broker and carrier changes, renewal dates, and retention risk signals.
  • For You Page Personalization — You can now set location, industry, and company size preferences, so relevant searches are surfaced immediately on login.
  • Salesforce ID Matching — The Salesforce integration now supports matching Salesforce ID fields, improving sync accuracy and reducing duplicate records.
  • Opportunity & Signals Enhancements — The Opportunity & Signals tab now includes broker and carrier tenure flags, premium and commission trends with year-over-year comparisons, and enrollment changes drawn from 5500 filing data.
  • State Legislative Activity in Pulse — The Pulse news feed now surfaces state legislative bill activity, keeping users informed of policy developments relevant to their prospects and clients.
  • Employer Search Filter Additions — Employer Search now includes filters for Broker Compensation, Premium Range, and Missing Filings.
  • OSHA Risk Rating Filter — You can now filter Commercial P&C employers by OSHA Risk Rating, from Very Low to Very High, for faster compliance-based targeting.
  • LinkedIn Fallback Search — When a contact has no personal LinkedIn profile on file, clicking the LinkedIn icon now opens a people search filtered by company and last name.
  • Snapshot PDF Exports Include Phone Numbers — Revealed phone numbers now appear in the Key Contacts section of exported PDFs, with the most reachable contacts prioritized at the top.
  • Consolidated Settings Page — Account, company, and preference settings have been merged into a single Settings page for easier profile management.
  • Redesigned Dashboard and Portal Home — Both the Catalyst dashboard and portal home page have been refreshed with cleaner layouts, surfacing recent activity and making navigation faster from login.

Insights/Insights+

  • Flexible Rate Availability in Request Form — The Insights+ request form now supports a flexible Rate Availability section, allowing you to choose between full premium and contribution data, benchmark rates, or employee-paid premiums only — so submissions are no longer blocked when full rate data isn't available.
  • Two-Tier Rate Structure Support — Insights+ now supports a two-tier rate structure (EE and EE+Family) in addition to the existing three- and four-tier options.
  • Five New Voluntary Benefit Lines — Hospital Indemnity, Cancer Insurance, Pet Insurance, Student Loan Assistance, and FSA have been added to the Voluntary Offerings section.
  • Medical Plan Reordering and Deletion — You can now drag and reorder medical plans within the Insights+ side stepper and delete plans with a confirmation prompt, with all changes reflected consistently across the stepper, plan detail screens, and final submission.
  • Award Download Progress Modal — A new progress modal now appears when downloading award files, providing visual confirmation that the file is being prepared and preventing duplicate clicks during packaging.
  • Refreshed Insights Home Page — The Insights home page has been updated with a cleaner layout and improved search helper text.
  • Improved Form Validation — The Insights+ wizard now validates employer contribution amounts against total premiums to prevent percentages from exceeding 100%, caps the Aggregate Risk Corridor field to prevent data entry errors, and routes brokers directly to flagged sections when errors are identified on review or submit.
  • Hyperlinked Company Names in Report History — Company names on the Insights Report History grid are now hyperlinked, making it faster to navigate from a report row directly to the relevant company.

That's a wrap! Stay tuned for what's coming next month.

Product Updates
Product Enhancements, February 2026
What’s New in Insights and Insights Plus We’re excited to share the latest updates to Insights and Insights+ for 2026. Each year, we take your feedback and turn it into meaningful improvements to our benchmarking tools, and this year is no exception. The conversations we have with our partners directly shape what we build. This year’s enhancements reflect exactly what you’ve been asking for: more granular benchmarking options, expanded coverage across emerging benefit areas, and deeper comparisons that strengthen your client conversations. These aren’t just new features; they’re tools designed to help you win more business, advise with greater confidence, and support every recommendation with the most accurate data available. We’re proud of these new enhancements, and we’re just getting started. There’s much more coming throughout the year as we continue investing in making Insights and Insights+ the most powerful benchmarking resources available. Here’s what’s new: Insights+ Updates: More granular employer size benchmarking options, expanding from the previous size groupings (100–499 and 500+) to: 100–249 250–499 500–999 1,000+ New 3-tier and 4-tier rate + contribution benchmarking 4-tier: Employee / Employee + Spouse / Employee + Children / Employee + Family 3-tier: Employee / Employee + Dependent / Employee + Family ‍Insights updates: Expanded benchmarking for alternative benefit delivery methods, including: Firm-paid through reference-based pricing Narrow network plans Direct primary care (DPC) Specialty provider networks New data visibility into waiting periods New menopause care reporting Ancillary lines split into dedicated pages for clearer benchmarking and navigation: Dental Vision Disability Life Insurance Carrier market share visibility added to each page Shows top carriers by market share based on the selected region New dental benchmarking metric: orthodontia (ortho) maximums New vision benchmarking metric: percentiles for max reimbursement Lenses Contacts New disability benchmarking detail STD elimination period shown in days LTD elimination period shown in days New retiree benefit reporting Medicare Advantage (MA) retiree benefit availability Whether MA resulted in lower cost per retiree ‍
Author:
February 26, 2026

What’s New in Insights and Insights+

We’re excited to share the latest updates to Insights and Insights+ for 2026. Each year, we take partner feedback and turn it into meaningful improvements to our benchmarking tools, and this year is no exception.  

This year’s enhancements reflect exactly what you’ve been asking for: more granular benchmarking options, expanded coverage across emerging benefit areas, and deeper comparisons that strengthen your client conversations. These aren’t just new features; they’re tools designed to help you win more business, advise with greater confidence, and support every recommendation with the most accurate data available.  

We’re proud of these new enhancements, and we’re just getting started. There’s much more coming throughout the year as we continue investing in making Insights and Insights+ the most powerful benchmarking resources available.

Here’s what’s new:

Insights+

  •  More granular employer size benchmarking options, expanding from the previous size groupings (100–499 and 500+) to:
    • 100–249
    • 250–499
    • 500–999
    • 1,000+
  • New 3-tier and 4-tier rate + contribution benchmarking
    • 4-tier: Employee / Employee + Spouse / Employee + Children / Employee + Family
    • 3-tier: Employee / Employee + Dependent / Employee + Family
  • View Insights+ reports directly inside your portal, making it easier to navigate, analyze, edit, and share instantly with colleagues and clients.
  • AI-Powered Benefits Assistant — You can now ask plain-language questions about your clients' benefits data and reports directly getting instant, accurate answers without digging through pages of data manually.  
  • The Benefits Award is now part of every Broker's Toolkit
    • After watching thousands of employers earn recognition through the program, we decided the award should be a standard part of every broker's toolkit. If your client qualifies, the badge and core award components are now available to instantly download, share, and celebrate with your client.

Insights

  • Expanded benchmarking for alternative benefit delivery methods, including:
    • Firm-paid through reference-based pricing
    • Narrow network plans
    • Direct primary care (DPC)
    • Specialty provider networks
  • New data visibility into waiting periods
  • New menopause care reporting
  • Ancillary lines split into dedicated pages for clearer benchmarking and navigation:
    • Dental
    • Vision
    • Disability
    • Life Insurance
  • Carrier market share visibility added to each page
    • Shows top carriers by market share based on the selected region
  • New dental benchmarking metric: orthodontia (ortho) maximums
  • New vision benchmarking metric: percentiles for max reimbursement
    • Lenses
    • Contacts
  • New disability benchmarking detail
    • STD elimination period shown in days
    • LTD elimination period shown in days
  • New retiree benefit reporting
    • Medicare Advantage (MA) retiree benefit availability
    • Whether MA resulted in lower cost per retiree

Employer Cost Management
The True Cost of an Open Role: Why Time-to-Fill, Turnover, and Benefits Strategy Are More Connected Than You Think
Hiring has never been cheap. But for many organizations today, it has quietly become far more expensive than traditional recruiting metrics suggest. Most companies track time-to-fill and cost-per-hire. These metrics are familiar, easy to report, and widely benchmarked. What they don’t capture is the full organizational cost of an open or recently filled role — and how benefit perception, retention, and productivity are deeply tied to that number. When recruiting effort, productivity loss, onboarding time, and early turnover risk are fully considered, the true cost of hiring for professional roles often reaches $80,000 to $90,000 per hire. For many HR and finance leaders, that figure is surprising. The reality is that most hiring models are incomplete by design.
Author:
January 18, 2026

Hiring has never been cheap. But for many organizations today, it has quietly become far more expensive than traditional recruiting metrics suggest.

Most companies track time-to-fill and cost-per-hire. These metrics are familiar, easy to report, and widely benchmarked. What they don’t capture is the full organizational cost of an open or recently filled role — and how benefit perception, retention, and productivity are deeply tied to that number.

When recruiting effort, productivity loss, onboarding time, and early turnover risk are fully considered, the true cost of hiring for professional roles often reaches $80,000 to $90,000 per hire. For many HR and finance leaders, that figure is surprising. The reality is that most hiring models are incomplete by design.

Why Traditional Cost-Per-Hire Models Underestimate Hiring Costs

Cost-per-hire calculations typically focus on direct expenses. Recruiter fees, job advertising, background checks, and onboarding costs are straightforward to track and easy to justify in a budget review.

The problem is that these line items represent only a fraction of the total impact.

The largest drivers of hiring cost tend to be indirect and dispersed across the organization. Extended vacancies delay output. Teams redistribute work, creating burnout and inefficiency. Managers spend time filling gaps instead of driving strategic initiatives. New hires take months to reach full productivity. And roles filled under pressure carry a higher likelihood of early turnover.

When these factors are included, organizations frequently underestimate the true cost of hiring by 30 to 50 percent. The impact rarely appears as a single expense line. Instead, it shows up as slower execution, missed growth opportunities, and persistent retention challenges.

Time-to-Fill Is a Compounding Business Cost

Time-to-fill is often treated as a static recruiting metric — something to optimize, but not something that actively accumulates cost. In reality, every day a role remains open increases organizational drag.

Across industries, typical time-to-fill ranges look like this:

  • Administrative roles: 20–40 days
  • Professional and technical roles: 40–60 days
  • Senior leadership roles: 60–90+ days

During that time, work doesn’t disappear. Output is delayed or redistributed. Overtime increases. Manager attention shifts away from growth initiatives. Team velocity slows. These effects compound quietly, making vacancies far more expensive than they appear on paper.

Once a role is filled, the cost accumulation doesn’t stop. Onboarding and ramp-up often extend the total time-to-productivity window to 90 to 180 days. Until that point, teams continue to operate below capacity.

This is how a role with a $120,000 salary can translate into an $80,000 or greater organizational cost, even before factoring in turnover risk.

Early Turnover Magnifies Hiring Costs

Turnover inside the first 12 months is one of the most expensive and least visible hiring failures. The costs are rarely isolated or formally reported, yet the impact is significant.

When an employee leaves early, the organization absorbs:

  • The full recruiting cost again
  • Another vacancy period
  • A second ramp-up cycle
  • Lost institutional knowledge
  • Reduced team morale

Early turnover effectively doubles many of the hidden costs associated with hiring. It also creates skepticism around recruiting effectiveness, even when the underlying issue isn’t talent quality.

In many cases, the root cause isn’t compensation or role mismatch. It’s misaligned expectations and poor understanding of total rewards.

Benefits Play a Bigger Role in Retention Than Most Companies Realize

Benefits consistently rank as the second most important reason employees stay with or leave an employer, yet they are one of the most misunderstood components of total compensation.

Research shows that employees undervalue their benefits by nearly 50 percent. When employees don’t understand the value of what they receive, even strong benefit plans fail to influence retention, recruiting conversations, or offer acceptance decisions.

This disconnect has tangible consequences. Employees who underestimate their benefits are more likely to explore external opportunities. Candidates hesitate during offer negotiations. Hiring cycles lengthen. Time-to-fill increases.

None of this requires increasing benefit spend. It requires credible context.

Why Total Compensation Statements Rarely Change Behavior

Most organizations rely on total compensation statements to communicate benefits value. While well-intentioned, these statements often fail to change perception or behavior.

The reason is simple: information alone does not create credibility.

Employees are not asking how much their employer spends. They are asking whether their benefits are competitive compared to peers. Without external context, internal summaries and dollar totals feel abstract and unconvincing.

Effective benefits communication requires three elements:

  • Peer-aligned benchmarks
  • Independent validation
  • Clear, easy-to-understand scoring

Without these, even objectively competitive plans are perceived as average, or worse.

The Problem With Most Benefits Benchmarking

Many employers attempt to solve this gap with benchmarking. Unfortunately, most benchmarking tools introduce new problems.

Broker-aligned benchmarks reflect the book of business they support. Carrier-driven data emphasizes product placement. Self-reported surveys lack consistency and comparability. As a result, employers struggle to trust the results or use them confidently in internal conversations.

When benchmarking lacks independence, it fails to provide the credibility employees and leaders are seeking.

Independent Benefits Benchmarking: A Clearer Way Forward

Independent benefits benchmarking changes the conversation. Instead of focusing on plan design alone, it answers a more relevant question:

How does our benefits package actually compare to employers like us?

Mployer provides the only independent benefits benchmarking in the U.S., free from broker or carrier influence. Organizations use it to identify retention risk, improve benefit perception without increasing spend, support recruiting narratives, and assess eligibility for the Mployer Benefit Award.

The results are often eye-opening, particularly for companies that believe their benefits are “about average.” In many cases, the data reveals hidden strengths that simply weren’t being communicated effectively.

What This Means for HR, Total Rewards, and Finance Leaders

Rising hiring costs, extended time-to-fill, and persistent turnover are rarely isolated problems. They are symptoms of broader gaps in how organizations position, communicate, and validate their total rewards strategy.

Benefits are not just an expense line. They are a lever for retention, recruiting efficiency, and productivity — when employees understand their value and trust the comparison.

A short benchmarking conversation can help clarify where your benefits truly stand, how employees likely perceive them, and whether your organization qualifies for independent benchmarking and the Mployer Benefit Award.

Health Insurance Trends
The PBM Challenge in Today's Market
With Mployer's Insights+ platform, employers can now evaluate their 401(k) offering with the same rigor as salary benchmarking, leading to a powerful edge in recruiting and retention.
June 16, 2025

The PBM Challenge in Today's Market

(An easy to understand guide)

Prescription drug costs have surged dramatically in recent years, placing increasing strain on employer-sponsored health plans. Between 2000 and 2020, retail prescription drug spending in the U.S. nearly doubled (a 91% increase) and continues to climb—outpacing most other healthcare cost categories. The rise stems from two primary factors: expensive new specialty therapies (like weight-loss and biologic treatments) and the opaque role of Pharmacy Benefit Managers (PBMs) in setting prices. What makes matters worse is that Americans pay dramatically more than people in other high-income nations—U.S. drug prices average 2.78 times higher than in 33 comparable countries, and brand-name drugs can cost more than four times as much. This steep cost trajectory and global overpayment emphasize why understanding and managing PBMs has become essential for employers aiming to control healthcare spend and protect employees.

How PBMs Actually Work

When an employer designs its health plan, it either chooses a PBM directly or selects a carrier that already has a PBM embedded in its plan. From there, the PBM takes control of the prescription drug benefit. They build the formulary—the list of drugs that are covered—and negotiate with manufacturers to decide which drugs make the list. By narrowing coverage to certain products, PBMs gain leverage to demand better deals. They also restrict which pharmacies are in-network, again concentrating volume to maximize bargaining power.

This means PBMs effectively set the market, costs, and tiers employees experience: whether a drug falls into Tier 1 with a $10 copay or Tier 4 with a 25% coinsurance is dictated by the PBM’s design. On the back end, PBMs collect rebates from drug makers. A rebate is essentially a kickback payment from the manufacturer to the PBM, offered in exchange for favorable placement of a drug on the formulary or higher expected utilization. For example, if two similar drugs treat the same condition, the manufacturer willing to pay a higher rebate is more likely to have their drug chosen. Some portion of these rebates is passed back to the employer to lower plan costs, but a significant share is often kept by the PBM—one of the biggest transparency concerns in the system

How Drug Tiers and Payment Structures Work

Most employer health plans organize prescription coverage into tiers, which determine both access and cost-sharing for employees.

  • Tier 1 (Generics): Lowest-cost drugs, usually just a $10–$20 copay. They are widely accessible and often encouraged as first-line therapy.
  • Tier 2 (Preferred Brands): Brand-name drugs that PBMs have negotiated discounts on. Employees typically pay $30–$50 copays or around 20% coinsurance.
  • Tier 3 (Non-Preferred Brands): Higher-cost brand drugs not favored on the formulary. Employees may owe 40%+ coinsurance, leading to hundreds in out-of-pocket costs.
  • Tier 4 (Specialty Drugs): High-cost therapies for serious conditions like cancer or hemophilia. These usually require coinsurance (20–30%), which can mean thousands of dollars per month. Although they make up less than 2% of prescriptions, specialty drugs drive nearly half of total drug spending.

Copays vs. Coinsurance

  • A copay is a fixed, predictable dollar amount per prescription.
  • Coinsurance is a percentage of the total drug cost until the deductible or out-of-pocket maximum is reached. While it helps share costs, it creates unpredictability—especially for specialty drugs, where 25% coinsurance could mean $250 on a $1,000 medication or much more on therapies costing thousands each month.

For employers, understanding how tiers and cost-sharing are structured is critical, since they directly affect both plan expenses and employee affordability.


High-Cost Drugs and Their Outsized Impact

While high-cost drugs represent only a small fraction of total prescriptions, their impact on employer health plans is staggering. Specialty medications—such as those for cancer, hemophilia, and autoimmune disorders—account for less than 2% of prescriptions but drive close to 50% of all drug spending. Their costs have grown at double-digit rates year over year, fueled by new biologics, gene therapies, and infusion-based treatments that can run into hundreds of thousands of dollars annually. According to Sun Life’s High-Cost Claims Report, in many catastrophic claim categories like hemophilia or leukemia, prescription drugs make up more than 90% of the total cost of care. For employers, this means a single claimant on a specialty drug can dramatically shift overall plan spend, making pharmacy benefits one of the most volatile and financially significant areas to manage.

How Carriers Handle High-Cost Drugs

Carriers cover most FDA-approved specialty drugs but tightly manage access and cost. They use formularies to decide which drugs are included (and on what tier), require prior authorization or step therapy before approving treatment, and often restrict dispensing to their own specialty pharmacy networks. Coverage is generally limited to drugs deemed medically necessary, while experimental or non-formulary drugs are excluded unless appealed. For employees, this can mean higher coinsurance, delays in approval, and fewer choices on where prescriptions can be filled.

Who Controls the PBM Market—and Who’s Challenging It

Today, most carriers are tied to the “Big Three” PBMs, which together control more than 75% of the market:
  • Aetna/CVS → CVS Caremark
  • Cigna → Express Scripts
  • UnitedHealthcare → OptumRx
  • Anthem/Blue Cross (varies by region) → Caremark or Express Scripts

This consolidation means that for many employers, pharmacy benefits are automatically bundled with one of these large PBMs, leaving little room for visibility or flexibility.  

The remaining 25% is made up of disruptors offering more transparent models. Players like SmithRx (pass-through pricing with detailed reporting), MedOne (independent PBM with customizable formularies and full rebate pass-through), and Mark Cuban’s Cost Plus Drugs (a direct-to-consumer model selling drugs at cost plus a small margin) are challenging the status quo. For employers, knowing which PBM their carrier relies on—and whether a carve-out to one of these disruptors is possible—can be a critical step in controlling pharmacy costs.

Legislation and Reform Efforts

In recent years, lawmakers have increasingly targeted the opaque practices of PBMs, introducing multiple federal bills like the Pharmacy Benefit Manager Transparency Act (S. 127, 2023) and the PBM Transparency Act of 2025 (S. 526). These aim to ban spread pricing, require full rebate pass-through, and mandate detailed reporting—but none have passed into law yet. Similarly, a 2025 House bill dubbed the PBM Reform Act proposes greater transparency around Medicare Part D contracts and delinking PBM compensation from drug prices, but it remains pending in committee.

At the state level, all 50 states have enacted some degree of PBM regulation. Few states have gone further: for example, Iowa is considering a law imposing minimum pharmacy dispensing fees, and Arkansas passed legislation curbing PBMs’ ownership of pharmacies—though that law has been temporarily blocked by a federal judge

In short: there's plenty of activity at both federal and state levels—but no sweeping reforms have become law yet, leaving employers to manage PBM challenges proactively on their own.

Be Educated: Key Questions to Ask Your Broker

  1. Who is our PBM, and is it bundled with our carrier?
  1. Do we receive 100% of rebates, or are they retained?
  1. Can we carve out our PBM given our size and funding model?
  1. Which high-cost drugs are driving our spend?
  1. Do we get claim-level reporting from our PBM? (often not)
  1. What specialty drug management strategies are in place?
  1. How does our plan compare to industry peers?

Closing Thoughts

Prescription drug costs are no longer a side issue—they’re a central driver of employer healthcare spend. The combination of high-cost specialty therapies and the opaque role PBMs play in setting formularies, controlling access, and managing rebates makes this one of the most complex and consequential areas of benefit management. For employers, the path forward starts with awareness: knowing which PBM you’re tied to, how rebates flow, which drugs are shaping your spend, and what levers you have to push for transparency or carve out alternatives.

While legislation at the federal and state levels may eventually bring more clarity and accountability to the PBM market, employers cannot afford to wait. By asking sharper questions, exploring disruptive PBM models, and partnering with brokers who understand this space, employers can take meaningful steps today to control costs and support employees more effectively.

Bottom line: Prescription drug costs are only going up. Employers that engage now—by digging into the details and holding PBMs and carriers accountable—will be best positioned to protect both their budgets and their people.