Satisfaction with PBMs Hits Historic Lows, Appetite for Change Surges

For over two decades, Pharmaceutical Strategies Group (“PSG”) has provided independent, research-driven insights into pharmacy benefit manager (PBM) performance through its annual report on customer satisfaction. The newly released 2025 Pharmacy Benefit Manager Customer Satisfaction Report reveals a pivotal shift in the market: Satisfaction with PBMs has reached historic lows, while plan sponsors’ desire for change in the industry and willingness to act are reaching new heights.

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3-Year View of PBM NPS by Plan Sponsor Type and PBM Size

This year’s report uncovers meaningful declines in satisfaction on key measures, including overall satisfaction and Net Promoter Score (NPS). While satisfaction in 2024 was already at a decade-long low, it dropped even lower in 2025 — from 7.6 to 7.1. “PSG has tracked satisfaction with PBMs for years, and this year’s findings mark a tipping point,” said Michael Lonergan, President of PSG. “Scrutiny of PBMs, coupled with rising drug trend, is prompting plans to seek better partnerships and more transparent solutions.”

Patterns of satisfaction with PBMs also differ substantially between employers and health plans and between customers of Big 3 PBMs (i.e., CVS Health, Express Scripts, and OptumRx) and customers of non-Big 3 PBMs. NPS is an illustrative example, where NPS for PBMs is higher among employers compared to health plans and among customers of non-Big 3 PBMs compared to customers of Big 3 PBMs. “This year’s data tell a striking story, where employers and health plans alike are expressing less satisfaction with their PBMs, but where the decline is not equal — satisfaction with Big 3 PBMs is declining much more than satisfaction with other PBMs. In fact, satisfaction is higher for non-Big 3 PBMs on nearly every item in our survey,” said Morgan Lee, Senior Director of Research and Strategy at PSG.

Pharmacy benefit management is experiencing increasing pressure toward transformative change, and the report also explores plan sponsors’ perspectives on change, finding:

• Interest in including non-Big 3 PBMs in procurements is high
• Most plans are at least somewhat willing to work with multiple vendors for PBM services
• Desire for PBM industry change is strong — and growing even stronger

The report also examines satisfaction with PBMs across dozens of services and functions, measures perceived transparency of PBMs, and assesses plan sponsors’ perceptions of recent trends such as PBMs manufacturing Humira biosimilars. The report showcases PSG’s deep understanding of the marketplace and commitment to providing powerful comparative intelligence to support decision-makers who select and manage services provided by PBMs.

The full Pharmacy Benefit Manager Customer Satisfaction Report can be downloaded here. Organizations interested in gaining more detailed insights on individual PBMs can access a supplemental fee-based report here, which offers valuable information about specific PBMs beyond the scope of the main report.

About Pharmaceutical Strategies Group (PSG)

Pharmaceutical Strategies Group, an EPIC company, relentlessly advocates for clients as they navigate complex and ever-changing drug cost management challenges. PSG is an independent consultant, empowering healthcare payers to manage their pharmacy program better. As a strategic partner, PSG helps clients by providing industry-leading intelligence and technologies to realize billions of dollars in drug cost savings for clients every year. www.psgconsults.com.

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