Payer Perspectives on PBM Satisfaction Signal Greater Need for Trust and Accountability in Pharmacy

February 1, 2024

In 2023, the pharmacy benefit management (PBM) industry witnessed a significant shift in client sentiment. Health plans, employers, health systems and unions reported a notable decrease in satisfaction with their PBM vendors, as detailed in the 2023 Pharmacy Benefit Manager Customer Satisfaction Report by Pharmaceutical Strategies Group (PSG). 

These trends are multifaceted and in this article we will take a deeper look at the key elements identified by survey respondents as contributing factors.  

1. Overall Satisfaction Decline

Overall client satisfaction with their PBMs, declined slightly to 7.6 out of 10 in 2023, from 7.8 in 2022. This represents the lowest satisfaction score since 2014, signaling a continued downturn in client contentment with their PBM vendors. Factors identified by survey respondents influencing this decline include:  

  • Continually rising drug cost trends 
  • Negative public perception, exacerbated by political rhetoric and 
  • Legislative pressure on plan sponsor fiduciary responsibilities 

The trend suggests an erosion in the perceived value and trust of PBMs among their clients. 

2. Decreased Loyalty and Likelihood to Recommend

The Net Promoter Score (NPS) in 2023 fell to 8, a stark contrast to the NPS of 38 recorded just two years prior. This substantial drop reflects a growing reluctance among clients to endorse their PBMs. The reduction in the likelihood to recommend underscores a waning trust and a potential shift towards exploring alternative PBM options or services. A recent example of this occurred when Blue Shield of California announced a multi-year plan to transition away from the traditional PBM model and instead move towards a value-based delivery model aimed at transparency and lowering drug costs.

3. Challenges in Meeting Expectations

Clients rated their PBMs’ services in comparison to expectations with an average score of 6.8 out of 10. While this data suggests PBMs are somewhat meeting expectations, this data indicates over 30% of clients still believe their PBMs could do a better job meeting their performance expectations. The top areas indicated for improvement were in service delivery and responsiveness.

4. Transparency Concerns

Only about a quarter of respondents expressed high satisfaction with their PBM’s transparency, especially concerning cost/pricing and reporting. The dissatisfaction and desire for improved transparency, particularly in financial dealings and decision-making processes, highlight a critical area where PBMs need to enhance their communication and information sharing to rebuild client trust.

5. Contract Renewal Hesitancy

The average likelihood of renewing contracts without seeking competitive bids dropped from 7.6 in 2021 to 6.9 in 2023. This ongoing decline reflects growing client interest in evaluating new PBM options, influenced by the evolving market and a reassessment of strategies post-COVID-19. The report suggests conducting a competitive RFP process at least every 3 to 6 years to ensure alignment with market dynamics and best-in-class terms. While conducting timely RFPs is an important practice for plan sponsors, HDS would suggest exploring an RFP closer to every 3 years.

6. Desire for Improvement and Change

Respondents were asked to highlight key areas that would contribute to improved PBM satisfaction and reasons why they would leave their PBM. Areas identified that would lead to the greatest increases in satisfaction were:  

  • Cost/pricing 
  • Client service  
  • Account management, and  
  • Transparency  

When it came to identifying reasons respondents would leave their PBM, financial performance, service quality, network access, mergers, and overall market competitiveness were most frequently cited. The results from this feedback underscore the greater need for PBMs to evolve and adapt to meet changing client demands and preferences. 

The 2023 Pharmacy Benefit Manager Customer Satisfaction Report by Pharmaceutical Strategies Group (PSG). makes it clear that 2023 has been a watershed year in the perception of PBMs. Clients are increasingly scrutinizing their PBM relationships, driven by a combination of lower satisfaction levels, transparency concerns, and the desire for more competitive and effective service offerings. PBMs must address these challenges head-on to adapt to the changing landscape and meet the evolving needs of their clients. 

What Plan Sponsors can do to Drive Greater Transparency and Accountability from Their PBMs

In light of these challenges, HealthPlan Data Solutions continues to recommend a more proactive approach to enhancing transparency and accountability between plan sponsors and their PBM vendors. Ongoing pharmacy claims monitoring solutions can help plan sponsors address key PBM concerns such as lack of transparency, inadequate service delivery, and the need for more competitive pricing strategies. By implementing ongoing claims monitoring, plan sponsors can gain critical insights into their PBM’s performance, ensure contractual obligations are met on a claim-by-claim basis, and understand if pricing is aligned with market competitive rates. The HDS approach is PBM-agnostic and ensures all plan sponsors are protected whether they have a traditional or non-traditional PBM. 

Ongoing claims monitoring solutions can arm plan sponsors with the tools to hold their PBMs accountable for their service quality and drive greater transparency into financial performance. Importantly, this strategy fosters a stronger, more collaborative relationship between plan sponsors and PBMs, as it encourages open dialogue and continuous improvement throughout the plan year. By embracing this method, plan sponsors can take a significant step towards resolving many of the dissatisfaction issues identified in the PSG report, leading to more effective and transparent PBM partnerships. 

To learn more about the HDS’s ongoing pharmacy claims monitoring solution, Claim Scan, visit our website or speak with our business development team at (614) 515-2700. 

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