2025 PBM Satisfaction: Navigating Change and Opportunity in Pharmacy Benefit Management
Posted on November 5, 2025
How Payer Feedback Can Help Improve the Pharmacy Benefit Management Industry
As pharmacy benefit management continues to evolve, the latest findings from the 2025 PBM Customer Satisfaction Report offer a timely snapshot of where the industry stands and where it may be headed. This year’s data reveal shifting attitudes, new priorities, and a growing appetite for change among employers and health plans. While some trends are cause for concern, others point to opportunities for greater transparency, partnership, and innovation. In the sections that follow, we’ll explore what’s driving these changes, how different stakeholders are responding, and what PSG sees as the most constructive paths forward.
What are the Results of the 2025 PBM Customer Satisfaction Report?
The 2025 PBM Customer Satisfaction Report surveyed 269 benefits decision makers from across the country who represent employers, health plans, unions, and health systems. This year’s findings include:
- Overall satisfaction with PBMs hit a 10-year low, dropping by half a point compared to 2024.
- Net Promoter Score (NPS), a measure of loyalty, fell into negative territory for PBMs overall for the first time.
- Health plans reported lower satisfaction than employers (e.g., NPS: –32 versus –6), but both groups declined.
- Big 3 PBMs (i.e., CVS, Express Scripts, OptumRx) experienced a sharp drop in satisfaction (e.g., overall satisfaction declined from 7.4 to 6.8), while non-Big 3 PBMs experienced little or no decline (e.g., overall satisfaction held steady at 7.9).
- Likelihood to renew PBM contracts without a competitive RFP fell from 7.1 to 6.5.
- Transparency around rebates and revenue remains a top concern, especially for customers of Big 3 PBMs.
- Appetite for change is rising: Approximately two-thirds of respondents rate their desire for change in the industry at or above a 7 on a 10-point scale.
Why Do PBM Satisfaction Scores Matter?
These trends aren’t just numbers. They reflect real challenges and opportunities for payers and members. Lower satisfaction and loyalty mean more organizations are rethinking their PBM relationships, exploring competitive bids, and considering carve-outs, especially for specialty pharmacy and rebate management (see the report for details). Respondents expect these changes to deliver better pricing, more transparency, and greater flexibility.
At the same time, concerns about vertical integration, rebate GPOs, and biosimilar strategies highlight the need for clearer communication and alignment. When PBMs manufacture or market drugs, steer formularies toward specific products, or are responsible for managing utilization that they benefit from, stakeholders want to understand the impact on cost, choice, and member experience.
PSG’s Perspective: Navigating Change and Building Trust in Pharmacy Benefit Management
At PSG, we believe there’s no single “perfect” PBM model. Success comes from alignment, contract design, and ongoing oversight. The data points to three practical steps for moving forward:
- Prioritize transparency, especially around rebates and revenue. Make sure audit rights extend to all relevant relationships.
- Design for control, but understand the pros and cons of customization. Carve-outs can restore leverage, but they require thoughtful planning and clear accountability.
- Balance price with outcomes. Price remains the top PBM selection factor, but transparency, clinical management, and member experience are also critical.
Most importantly, we encourage data-led conversations that replace “black box” processes with open dialogue. When stakeholders work together, everyone benefits.
What’s Next for the PBM Market?
Looking ahead, expect more diverse procurement strategies, tighter governance, and continued focus on specialty pharmacy and biosimilars. Watch for:
- More competitive RFPs and renewals: Organizations are increasingly willing to issue competitive requests for proposals (RFPs) rather than automatically renewing PBM contracts. This trend signals a more active search for value, better pricing, and improved service.
- Greater demand for transparency and auditability: Employers and health plans are prioritizing clear visibility into PBM revenue sources, rebate flows, and contract terms. There’s a growing expectation for robust audit rights and independent verification to ensure accountability.
- Ongoing innovation in contracting and technology: The market is seeing new contracting models, such as cost-plus pricing and flexible carve-outs, alongside advances in pharmacy technology. These innovations aim to improve member experience, increase transparency, and support more dynamic benefit designs.
The appetite for change is real. Those who act with discipline and base their decisions on data will be best positioned to thrive.
The Road Ahead
The challenges in pharmacy benefit management are complex, but they’re not insurmountable. The 2025 PBM Customer Satisfaction Report is a reminder that progress happens when stakeholders work together with integrity and shared purpose.
Let’s move beyond frustration and toward partnership. By combining transparency, flexibility, and a commitment to better outcomes, we can build a healthcare future where clinically appropriate care can be delivered at an affordable cost.
Ready to take the next step? Connect with PSG to explore solutions, benchmark your PBM arrangement, or start a conversation about what’s possible. Together, we can make meaningful change.
