Satisfaction with pharmacy benefit managers is on the decline, particularly among health plans, a new survey shows.
Pharmaceutical Strategies Group, a consulting firm, surveyed 236 benefits leaders who represented plan sponsors totaling 76 million lives in May and June of this year. Respondents were asked to rate satisfaction on a 10-point scale, with overall satisfaction with PBMs earning a 7.8 score, down from an 8.2 in 2021.
The average score on whether a respondent would recommend their PBM landed at 7.6, down from 8.1, and likelihood to renew without gathering other proposals was down to 7.4 from 7.6 last year, according to the survey.
Satisfaction among employers was 8.1 out of 10 on average, the survey found, but 6.9 out of 10 among health plans. Health plans were also less likely to recommend a PBM compared to employers.
"Employer respondents perceived better alignment between their PBM’s incentives and their organization’s goals, thought of their PBM as more of a proactive partner in managing their drug spend, were more satisfied with the transparency of their PBM, and were more likely to renew their contract with their PBM without issuing a competitive RFP," the authors wrote.
For example, employers gave PBMs a score of 4.3 on satisfaction with the delivery of promised services, while health plan leaders instead gave a 3.6 average score.
What is behind the decline in scores? The survey points to a number of factors. For one, plan sponsors are very concerned about drug trend, which is rising for many. Plus, while PBMs did secure some positive press during the COVID-19 pandemic as vaccines and therapies were distributed, most of the news about them more recently has been negative, including the announcement that the Federal Trade Commission would investigate the business practices of the largest companies in the market.
The survey also identified where plan sponsors are the least satisfied with their current PBM, marking areas of improvement for these companies. Areas with the lowest satisfaction among plan sponsors include a PBMs' willingness to integrate with other pharmacy solutions, customizability, management of drug trend and contract and service flexibility, according to the survey.
Plan sponsors also reported lower satisfaction with the product differentiation in the market as well as PBMs' clinical outcomes reporting.
The most used programs offered by PBMs are utilization management, used by 82% of plan sponsors, and formulary exclusions, used by 72%. However, just 8% had used gene therapy financial protections and 15% tapped into alternative funding programs, which indicate PBMs could do more to make plan sponsors aware of such offerings, and communicate the benefits clearly.
In addition, the survey digs into data for individual PBMs, including overall satisfaction with five of the largest companies. Express Scripts, a subsidiary of Cigna, and Optum Rx, a subsidiary of UnitedHealth Group, each earned a 7.9 score out of 10, the highest. CVS Health's Caremark earned a 7.7, Prime Therapeutics a 7 and MedImpact a 6.5.