Survey: Health Plans Want Value, Flexibility from PBMs

Health plans are looking for flexibility from their PBMs with solutions tailored for their patient populations, according to a recent survey of health plans by consulting company PSG.

Sharon Phares, Ph.D.

“This is why PBMs with fewer than 20 million members get better ratings. Plans are selecting PBMs that are midsize or smaller because they are often looking for a different solution beyond just the best pricing,” Sharon Phares, Ph.D., senior vice president of research at PSG, said in an interview.

PSG surveyed 291 people at health plans, employer-sponsored plans, health systems, and unions that are responsible for drug benefit decisions for their organizations. The consulting company asked respondents about their satisfaction with their PBM and their likelihood they would recommend that benefit manager to other organizations.

Overall satisfaction ratings for PBMs with more than 20 million members ranged from 7.3 to 8.5, on a scale of 1 to 10, with 10 being most satisfied. The likelihood of respondents to recommend their PBM ranged from 7.6 to 8.5. The likelihood of renewing their contract with their PBM without a competitive request for proposal ranged from 6.8 to 8.0.

Overall satisfaction ratings for PBMs with 20 million or fewer members ranged from 8.1 to 9.9 on the same scale. The likelihood of renewing their contract with their PBM without a competitive request for proposal ranged from 7.8 to 9.6.

PSG has been conducting this survey for 25 years, but last year because of the COVID-19 pandemic, the company didn’t publish a report. They didn’t have enough respondents to provide meaningful results.

Still, Phares said, over time, the smaller PBMs have received higher ratings.

Plan sponsors, Phares said, are looking for value. “Cost savings are important. But value is even more important. Plans are looking for services that they feel are worth it. They want a good deal but also want to know that their members are getting a great experience.”

Additionally, she said, plans are looking for transparency, with PBMs that provide good reporting and information on programs and their value. “Financial transparency is very important. Plans want to know if their PBM is in alignment with their goals.”

Among PBMs with more than 20 million members, on average, 88% of respondents said PBMs are aligned with their goals, but perception varied from 60% to 100%. Among PBMs with 20 million or fewer members, 96.4% reported that their PBM was aligned with the goals.

New this year was a question about whether plans believed their PBM was a proactive partner in managing drug spend. “It’s really important for people to feel like their PBM is looking out for them and making the best decisions for them. They want to know that their PBM is being proactive, not just in cost savings, but also in making sure that people have appropriate clinical care. It's a complex relationship,” Phares said.