Birmingham, Ala. – October 12, 2026 -- Eighty-seven percent of employers say they are likely to switch their pharmacy benefit manager (PBM) at contract renewal, according to a new RxBenefits report that describes the most unsettled pharmacy benefits market in years.
The report, "2026 State of Pharmacy Benefits Decisions: The Churn Trap," draws on survey data fielded by FTI Consulting on behalf of RxBenefits. It covers 601 employers and 300 employee benefits consultants and advisors, all with decision-making authority over pharmacy benefits.
Three in four employers have changed or plan to change advisors within 12 months
Three out of four employers have replaced their pharmacy benefits advisor in the past 12 months or plan to do so in the next 12 months. RxBenefits says the advisor relationships and vendor arrangements that once anchored pharmacy decisions are losing their hold.
Rising costs show no sign of leveling off, according to the report. New federal disclosure requirements have put advisor compensation and fiduciary obligations under heavier scrutiny than the market has previously seen.
Transparency becomes table stakes as clinical management takes center stage
The report finds that transparency has shifted from competitive advantage to baseline expectation. Employers are now pressing providers on guarantees, rebates and clinical results. The line between transparent and traditional PBMs is also blurring, as employers no longer accept the label at face value.
Clinical management has become the primary lens for evaluating providers. With net drug spend exceeding $600 billion, employers want proof that a partner can move the cost trend, not just measure it.
GLP-1 strategy emerges as a standalone evaluation criterion
Employers now treat GLP-1 trend management as its own test of provider readiness. They expect a defined approach to coverage controls, step therapy and program design.
RxBenefits argues optimization beats replacement
The report's conclusion is that another vendor swap rarely solves the underlying problem in a market defined by switching. It calls for active management backed by measurable proof.
"Employers are stuck in a churn trap, and another vendor swap won't break it," said Kyra Hagan, senior vice president of marketing and communications at RxBenefits. She said documented savings, performance guarantees and clinical results give clients a credible reason to stop switching.
RxBenefits will present the findings in a webinar on Oct. 13 at 11 a.m. CT / 12 p.m. ET, aimed at benefits advisors representing self-insured plans. The panel features Jasmine Aral, senior vice president of PBM strategy and partnerships, and Bradley Nelson, vice president of clinical services.