Survey Finds Payers are Looking for Change in Pharmacy Benefits

Payers are increasingly dissatisfied with pharmacy benefit managers (PBMs) and want some degree of change, finds the 2024 Pharmacy Benefit Manager Customer Satisfaction Report published by Pharmaceutical Strategies Group (PSG).

Customers of the Big 3 PBMs report lower satisfaction across most measures, including overall satisfaction, and they are less likely to recommend their PBM. Additionally, employers remain more satisfied with PBMs than health plans on nearly all measures of satisfaction.

Morgan Lee, Ph.D.

The survey found that there have been moderate declines in satisfaction with PBMs across the board, Morgan Lee, Ph.D., MPH, CPH, senior director of Research & Strategy at PSG, said during an interview.

“We have a story this year of declining satisfaction with PBMs, and there is also a real strong appetite for change, and for some, a willingness to be part of change,” she said. “Health plans continue to have some major satisfaction issues, and employers are starting to have some areas where we're seeing their satisfaction decline as well. In past years, the larger PBMs were excelling above other PBMs. This year, it was a little bit more of a uniform story of other PBMs having higher satisfaction rates.”

PSG conducted the satisfaction survey in May and June 2024. The survey was sent to the PSG customer base, and 248 payers responded representing plans ranging in size from less than 50 to more than 25 million covered lives. Employers made up 55% of those who responded to the survey. Nearly two-thirds reported that their drug benefit was carved out.

Lee said this year PSG added several questions about interest in change. “We intentionally included the question: ‘are you willing to be part of the change?’ It's easy to say you want change, but it’s a lot harder to say that you think your organization is ready to jump in and be part of it.”

According to the survey, almost of half of those who responded said they would be very willing or moderately willing to be part of the change in the industry. Additionally, interest in PBMs outside the Big 3 appears to be growing. About half of the respondents said they would be extremely interested or very interested in including companies other than the large PBMs in the request for proposal (RFP) process.

Payers consider a wide range of factors when selecting a PBM, but cost and pricing are top, selected by 68% of survey respondents. Within the top factors considered are member experience, formulary and clinical programs and transparency.

Lee said payers are looking for innovation. “They want more help with things like trend management,” she said. “The cost of GLP-1s, for example, has become a major stressor. They were facing a specialty trend that was already tough to manage, and now you have these nonspecialty drugs that are driving up trend.”

Additonally, more payers, she said, are looking for increased transparency. Customers of the Big 3 PBMs had a lower perception of the company’s transparency. In fact, just 1 in 4 respondents are satisfied with their PBM’s overall level of transparency. “This year, we specifically asked about transparency around rebates and transparency around sources of revenue,” Lee said. “We had few respondents giving PBM ratings at the top of the scale.”

Also new this year was a question about PBMs' rebate group purchasing organizations (GPOs). Respondents said they had concerns about GPOs, with 47% saying they are moderately concerned. Another 25% said they are either extremely concerned or very concerned about the GPOs.

“We did have a segment of our respondents who weren't really aware of rebate GPOs,” Lee said. “They didn't know a lot about them, and this speaks to the fact that even within this group of decision makers, some are going to be more or less informed about all of the connections happening within the market. Some of them may not know that even if they’re working with PBMs who don’t own these big GPOs, they may very well be working through one of those GPOs anyway.”

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This survey comes at a time when the larger PBMs are facing increased scrutiny from the Congress, the Federal Trade Commission and other critics for many of its practices, including lack of transparency, rebate programs, formulary restrictions, and pharmacy reimbursement.

Some of the dissatisfaction may be coming from the news about PBMs, Lee said. “There’s a lot of negative media attention on PBMs,” she said. “Just few years ago, you might occasionally read a headline about a PBM, and now it’s just everywhere you look, even on consumer news.”