Satisfaction with pharmacy benefit managers (PBM) has sunk to the lowest level in nearly a decade, a new industry report has found.
The 2023 Pharmacy Benefit Manager Customer Satisfaction Report, released by the Pharmaceutical Strategies Group (PSG), is in its 26th year, and this year's report sampled 229 benefits leaders from employers, health plans, health systems, and unions. The data for the 2023 report was collected in 2022.
Mike Lonergan, president of PSG, suggested that market consolidation may be adding to the declining public perception of PBMs. "This is an industry in which three PBMs command nearly 80% of the market share," he said. "Diminishing satisfaction with these goliaths may create avenues of potential growth for competitors, who have higher customer satisfaction across multiple metrics. These insights are important as plan sponsors weigh their options in selecting their PBM partners."
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The report found that the overall satisfaction with PBMs among respondents was at 7.6 on a 1-10 scale, representing a drop from 8.2 in 2021. This represents the lowest overall satisfaction rating since 2014. "Rising drug trend, predominantly negative public perception, and targeted political rhetoric likely have contributed to the decline in satisfaction," a statement from PSG said.
In addition, a growing number of respondents said they were less likely to renew with their current PBM: In 2019 that number (on a scale from 1 to 10) was 8.1; in 2021 it was 7.4, and in 2022 it was 6.9. Respondents also said they were much more reluctant to recommend their PBM to a colleague than in recent years. The survey compiled a Net Promoter Score and found it had suffered a steep decline, from a 38 score in 2021 to 8 in the 2023 report. The researchers also found that benefits officials say they are more hesitant to renew their existing PBM contract with seeking a competitive proposal.
The data did support the finding that the Big Three were not viewed as favorable by customers; Big Three PBMs rated lower than other PBMs in overall satisfaction (7.5 versus 7.9 on a ten-point scale) likelihood to recommend (7.2 versus 7.7) and likelihood to renew (6.9 versus 7.3). The report's authors said those differences were small, but significant.
More satisfaction with contracts, integration
There were areas of progress; the 2023 numbers found greater satisfaction with how PBMs manage contractual language, and their willingness to integrate with other pharmacy solutions. PBM customers are also looking for more help with affordability of high-cost gene therapies. Those expensive treatments can cost health plans millions and are expected to continue to grow substantially in coming years. "Addressing the affordability concerns of these plans will be of paramount importance for PBMs that wish to improve their standing in the marketplace," the PSG statement said.
The survey data showed that customers were most satisfied with PBMs in the areas of "meets financial guarantees" (80%), "commitment to serving the needs of your organization" (78%) and "manages to contractual language" (75%). The lowest areas of satisfaction were in the areas of "effective tools to manage drug benefit costs" (68%), "offers customizable solutions" (65%), and "delivers products that are differentiated in the marketplace" (56%).
In addition, the survey found that the top three factors in choosing a PBM were pricing/cost, member experience/customer service, and honoring guarantees and commitments.
Transparency was another area that respondents seemed to value. When asked if they were satisfied with their PBM in terms of disclosure, accountability, and straightforwardness, 25% said they were very satisfied, 35% said somewhat satisfied, and 22% said either somewhat or very dissatisfied (18% were neutral).
"We asked respondents who indicated they were dissatisfied are neither satisfied nor dissatisfied what specific areas they would like to see their PBM to be more transparent," the report said. "The dominant theme in respondents' open-ended answers was cost/pricing (especially rebates), with additional theme of reporting and general communication. Minor themes included business decisions and clinical and cost management programs—respondents wanted more transparency about why certain decisions were made about the inner workings of programs like prior authorization and step therapy."
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