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News
Plan sponsors are keeping a closer eye on their pharmacy benefit managers — and they're not entirely impressed. A new PSG survey of 250 benefits leaders found overall PBM satisfaction barely budged at 7.2 out of 10, while the likelihood of renewing contracts without a competitive bid hit a record low. Transparency around how PBMs make money remains a major sticking point.
Pharmacy benefit managers (PBMs) are holding onto their clients — but just barely. A new 2026 survey from Pharmaceutical Strategies Group (PSG), drawing on responses from 250 benefits leaders across employers, health plans, and union plans, found that overall PBM satisfaction ticked up slightly to 7.2 out of 10 (from 7.1 in 2025). But beneath that stable surface, key trust indicators are eroding.
The likelihood of renewing a PBM contract without issuing a competitive request for proposal (RFP) dropped to 6.4 — described by analysts as the lowest point in recent history. Meanwhile, the net promoter score (NPS) for PBMs landed at -13, reflecting a substantial decline over the past five years. Interestingly, satisfaction with the "Big Three" PBMs (CVS Caremark, Express Scripts, and Optum Rx) actually rose to 7.1, while non-big three PBMs saw a dip from 7.9 to 7.3.
By the Numbers:
Why it matters: As PBM scrutiny intensifies across the healthcare industry, plan sponsors are demanding more cost visibility and fewer conflicts of interest. The record-low renewal confidence signals that PBMs — big and small — may face growing competitive pressure if transparency gaps aren't addressed.
