Employers increasingly eyeing more transparent PBMs

Employers are becoming more interested in switching to a pharmacy benefit manager they perceive as being more transparent than the “big three,” according to new data published by the National Alliance of Healthcare Purchaser Coalitions.

Use of alternative PBMs increased from 2024 to 2025 (31% versus 12%, respectively), while reliance on the big three – CVS  Caremark, Express Scripts and Optum Rx – fell over the same period (61% versus 72%). 

The 324 public and private employees who responded to the poll perceive a number of benefits to having more transparent PBMs, including lower-than-annual average premiums. In fact, employers using a PBM they believed offered transparency were more than one-and-a-half times more likely to report lower premiums (42% versus 27%) and about 30% less likely to report higher premiums (29% versus 41%) than the big three users.

Access to data appeared linked to confidence. Purchasers using a PBM they perceived as transparent reported substantially higher confidence than those using one of the big three counterparts, citing high administration integrity and lack of conflicts, and the reasonableness of compensation.

WHAT’S THE IMPACT

Employers see a number of threats to affordability, including drug prices, hospital prices and high-cost claims.

Healthcare costs are thwarting employers’ ability to compete, with 92% of respondents saying higher healthcare costs will result in further cost-shifting to employees. Ninety percent agree that rising healthcare costs are impacting their organization’s competitiveness, while 80% agree that healthcare cost increases often lead to trade-offs with salary or wage increases.

Employers that report complete claims access are consistently more likely to be engaging in hands-on strategies across PBM contracting, the poll found. 

It matters where employers store their data. Employers that store claims data inhouse (93%) or in a coalition warehouse (82%) are much more likely to have full access to claims data than those keeping it with a health plan/TPA (61%) or consultant warehouse (72%), data showed.

The poll also revealed attitudes about GLP-1 coverage. About 65% of employers in 2025 offer or are considering GLP-1 coverage versus 67% in 2024. Compared to last year, fewer are using strict limits such as limiting to specific populations, while more are managing programs with point-solution vendors. Slightly more allow compounded GLP-1s.

THE LARGER TREND

PBM reform, to change the way drugs are distributed in this country, has long been an issue before Congress and individual states. The American Medical Association released data last year showing that the four largest pharmacy benefit managers in the country control roughly 70% of the national market.

The analysis, based on 2022 data on commercial and Medicare Part D prescription drug plan (PDP) enrollees, also found a high prevalence of vertical integration of PBMs with health insurance companies.

In late August, the House Committee on Oversight and Government Reform said it’s expanding its investigation into the role of pharmacy benefit managers by seeking information about how they use foreign headquartered group purchasing organizations, claiming that some evade transparency and oversight in the United States.

The National Alliance of Healthcare Purchaser Coalitions represents employers and other purchasers who are seeking more transparent and value-driven solutions from their PBM service providers.