Reliance on Big 3 PBMs is shrinking: Survey

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Employers are gravitating toward “transparent” pharmacy benefit managers this year, according to a survey from the National Alliance of Healthcare Purchaser Coalitions. 

The 2025 “Pulse of the Purchaser” survey collated responses from purchasers and employers across the country.

With nearly two-thirds of purchasers either considering changing their PBMs in the coming years or having already done so recently, transparency is becoming more of a factor in the decision. 

While contracts with transparent PBMs more than doubled in the past year, the share of employers relying on CVS Caremark, Express Scripts — an arm of Evernorth Health Services — and OptumRx dropped from 72% to 61% since 2024.

Employers also reported lower average annual premium costs with transparent PBMs.

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