What's Happening?
A recent survey conducted by the National Alliance of Healthcare Purchaser Coalitions reveals a growing trend among U.S. employers to switch to transparent pharmacy benefit managers (PBMs). The survey, which included 324 public and private employers, found that 31% of respondents now have their primary PBM contract with a transparent organization, up from 12% in 2024. This shift comes as the share of employers contracting with traditional PBMs like CVS Caremark, Express Scripts, and Optum Rx has decreased from 72% to 61%. Rising health costs are a significant concern for employers, with 53% stating that these costs hinder their competitive edge. Transparency in PBM relationships is seen as a crucial strategy to manage these expenses, although access to claims data remains a challenge for many, particularly smaller employers.
Why It's Important?
The move towards transparent PBMs is significant as it reflects employers' efforts to combat escalating healthcare costs, which are outpacing economic growth. Transparent PBMs offer potential savings, with employers reporting lower premiums. This shift could lead to increased pressure on traditional PBMs to offer more transparency and competitive pricing. Employers who gain full access to claims data can better negotiate prices and ensure equitable access to healthcare services, potentially leading to broader industry changes. The trend also highlights the growing importance of data ownership and audit rights in healthcare contracts.
What's Next?
With 55% of surveyed employers considering a switch from traditional PBMs within the next one to three years, the industry may see significant shifts in market dynamics. Employers are likely to continue advocating for greater transparency and data access, which could lead to regulatory changes or new industry standards. The upcoming negotiations and potential changes in PBM contracts could impact healthcare costs and access for millions of employees across the U.S.
