Pills and money
Pharmacy benefit managers are facing heightened criticism and scrutiny from legislators and regulators. Customers are not happy with them, either, the 2025 Pharmacy Benefit Manager Customer Satisfaction Report from Pharmaceuticals Strategy Group found.
“The 2025 survey results for high-level satisfaction with PBMs are remarkable, showing declines in overall satisfaction, perception of how services align with expectations, likelihood to recommend and likelihood to renew the contract,” the report said. “Overall satisfaction is an illustrative example, declining sharply from 7.6 to 7.1 (on a 10-point scale) and reaching by far its lowest point in the last decade-and-a-half that we have been tracking the metric.”
Satisfaction with many specific PBM services and functions also declined. Respondents’ mean ratings are lower in 2025 than in 2024 in areas such as traditional and specialty drug discounts; responsiveness and issue resolution; and formulary management. Satisfaction also is persistently below average in areas such as offering differentiated products, being willing to integrate with other pharmacy solutions, providing effective tools to manage drug benefit costs and managing specialty drug benefits. This indicates that PBMs have made little progress in addressing several areas of ongoing customer concern.
However, overall scores and trends can mask important group differences, and deeper analysis reveals discrepancies based on plan sponsor type and PBM size:
- Employers and health plans both report declining satisfaction in key areas, but employers have higher satisfaction with their PBMs on most items.
- Comparisons based on PBM size reveal that customers of non-big three PBMs (CVS Caremark, Express Scripts and OptumRx) report higher satisfaction than customers of the big three on most items. In addition, downward trends in satisfaction are not as ubiquitous.
- Satisfaction is higher among employers (compared to health plans) and non-big three PBM customers.
Respondents are mildly accepting of how their PBMs have handled rebate adjustments and perceive some value from Humira biosimilars (lower-cost injectable medications used to treat several autoimmune conditions). However, they are relatively concerned about the practice of some PBMs that are manufacturing Humira biosimilars. Respondents also continue to question the level of transparency provided by their PBMs. Although alternative vendors and strategies are proliferating rapidly, there are barriers to moving away from the status quo.
“We find that many respondents are interested in carving out specific services from their primary PBM and that most are at least somewhat willing to work with multiple vendors for PBM services,” the report said. “We also find a strong and growing desire for change in the PBM industry, with nearly half of respondents reporting their organizations are moderately or very willing to be part of the change.”
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.