A new employer survey shows a growing interest in making the switch to a transparent pharmacy benefit manager.
The National Alliance of Healthcare Purchaser Coalitions polled 324 public and private employers from across the U.S. and found 31% of respondents had their primary PBM contract with a transparent organization rather than one of the traditional leading companies.
That's up from 12% that had a primary contract with a PBM in 2024, per the report. The share of respondents contracting with the "Big Three"—CVS Caremark, Express Scripts and Optum Rx—declined in tandem, with 61% saying they contract with one of these companies.
By comparison, 72% were contracted with one of the Big Three in 2024.
Rising costs in pharmacy and beyond pose a massive challenge for employers, with 53% of those surveyed saying health costs are making it harder for them to compete. And greater transparency is a key tool they can use to better get their arms around rising costs.
However, many employers still struggle to access that information. Four in 10 of the survey participants said their vendors will not provide access to key claims data. Smaller employers, or those with 1,000 or fewer employees, were less likely than larger firms to have full access to claims.
With that backdrop, 55% of those surveyed said they were considering a switch from one of the Big Three PBMs in the next one to three years. Six percent said they had already made a change.
“A survey respondent aptly described the current healthcare environment as a dumpster fire with unlimited fuel as long as employers continue to put up with the status quo,” Shawn Gremminger, National Alliance president and CEO, said in a press release. “U.S. healthcare costs continue to grow exponentially and outpace economic growth, and it’s the innovative employers that have access to their claims data that are paving the way to fair price and equitable access.”
The survey found that employers who worked with transparent PBMs were 1.6 times more likely to report that their premiums were lower.
In addition, the study highlighted ways employers were seeking to secure greater transparency in their PBM relationships. Close to two-thirds (62%) said they currently have full and independent audit rights for their contracts, and 57% said they currently have ownership of all the data generated by their insurer.