New research also reveals high interest in alternatives to the Big 3 PBMs and continued demand for meaningful industry change
DALLAS–(BUSINESS WIRE)–Pharmaceutical Strategies Group (“PSG”), an EPIC company, today released its 2026 Pharmacy Benefit Manager (PBM) Customer Satisfaction Report, finding that overall PBM satisfaction stabilized in 2026, while key pain points around transparency, flexibility, and partnership in managing drug trend remain. For over two decades, PSG has provided independent, comprehensive research on PBM performance through its annual report on PBM customer satisfaction.
Overall Satisfaction Stabilizes, but Willingness to Renew Hits Low Point
PSG’s report found that overall satisfaction with PBMs stabilized at 7.2 on a 10-point scale in 2026, nearly unchanged from 2025 but down substantially from a high of 8.2 in 2021. While overall satisfaction has stopped sliding, concerns around transparency and trend management have not gone away.
Meanwhile, respondents’ likelihood to renew their PBM contract without issuing a competitive RFP fell to 6.4, its lowest point to date.
“Customers are demanding more from their PBMs, especially when it comes to managing costs and providing greater visibility,” said Mike Medel, Senior Vice President and Practice Lead, Plan Sponsor at PSG. “We’re also starting to see satisfaction decline among non-Big 3 PBMs, which drives home that these challenges aren’t exclusive to the biggest players in pharmacy benefit management.”
Alternative PBMs Draw Strong Interest in Procurements
The report also found that interest in alternatives to the Big 3 PBMs remains high, with 69% of customers reporting they included at least one non-Big 3 PBM in their last RFP. Additionally, 82% said they would be at least moderately interested in including PBMs beyond just the Big 3 if conducting a procurement today. Also, while pricing is always a critical factor in PBM decisions, this year’s research found respondents increasingly valuing better clinical management rather than price alone.
Non-Big 3 PBM customers continue to report higher satisfaction in general, despite declines in specific areas and a notable drop in overall satisfaction from 7.9 in 2025 to 7.3 in 2026.
Sources of Revenue Are a Major Transparency Gap for PBMs
Sources of revenue continues as the least transparent area of the PBM relationship, with 20% of respondents rating their PBM as not at all transparent in how it makes money. While transparency improved slightly in some areas, including access to data, formulary strategies, and utilization management strategies, sources of revenue transparency did not improve and remained the lowest-rated aspect of PBM transparency.
Customers of non-Big 3 PBMs reported substantially higher perceptions of transparency than Big 3 customers across all areas.
“We’re continuing to see that customers lack full visibility into how their PBM makes money and whether its revenue sources are creating conflicts of interest,” said Morgan Lee, Vice President of Research and Marketing at PSG. “There’s an opportunity for more transparency in this area, which would empower customers to make more informed decisions on strategies they may want to pursue to ensure their pharmacy benefit is managed in accordance with their priorities.”
Additionally, over half of respondents were moderately or very interested in carving out specialty pharmacy, but 41% were not sure whether their PBM contract allows use of carve-out vendors, and only 15% were confident they could do so without restrictions or penalties.
Customers Want Change but Doubt Recent Reforms Will Deliver
Nearly two-thirds of respondents rated their desire for PBM industry change at seven or higher on a 10-point scale, but most expect recent regulatory, legislative, and enforcement developments to have only a minor to moderate impact on PBM transparency and the customer experience.
“This year’s findings show that customers want real change across the industry as they grapple with high costs in pharmacy benefits and healthcare more broadly,” said Mike Lonergan, President of PSG. “For over 20 years, our Pharmacy Benefit Manager Customer Satisfaction Report has helped us understand where the biggest concerns are, where PBMs are making progress, and where there’s still room for improvement.”
The full report is available here. Organizations interested in more detailed insights on satisfaction with specific PBMs can access a supplemental fee-based version of the report here.
The 2026 Pharmacy Benefit Manager Customer Satisfaction Report is based on PSG’s analysis of responses from 250 benefits leaders representing employers, health plans, hospital and health systems, and unions. Additional PSG research and prior reports can be found here.
About Pharmaceutical Strategies Group (PSG)
Pharmaceutical Strategies Group (PSG) is an independent pharmacy benefits consultant, relentlessly advocating for healthcare payers as they navigate complex and ever-changing drug cost management challenges. As a strategic partner, PSG empowers clients by providing industry-leading intelligence and technologies to improve clinical outcomes and realize billions of dollars in drug cost savings for clients every year.
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