Industry Terms

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According to Mployer Insights’ 2026 analysis of 50,000+ employer health plans, prescription drugs account for over 25% of total benefit expenses, with Tier 4 specialty drugs driving the majority of high-cost claims. While Tier 4 copays average $123 with coinsurance requirements in 31% of plans, individual oncology therapies like Darzalex Faspro ($170,800/yr) and Keytruda ($158,200/yr) frequently exceed average individual stop-loss deductibles ($141,938). To mitigate exposure, self-funded employers are increasingly turning to independent, transparent PBM models and biosimilar substitution—which yields up to a 73% net cost reduction per patient.

Most U.S. employers now offer paid maternity leave beyond the legal minimum, but coverage varies widely once you look past the basics. According to Mployer Insights' 2026 analysis of more than 50,000 employer benefit plans, 68% of employers provide paid maternity leave on top of short-term disability, typically adding 8 extra weeks, and half now cover 100% of salary during the disability period. Support drops off from there: only 41% of employers offer paid bonding leave for non-birth parents, and advanced family-building benefits remain even less common, with just 28% covering IVF and 11% offering adoption financial assistance. The data suggests that while baseline maternity leave has become standard, more comprehensive family-building support is still the exception rather than the norm.