56% of employers using Big 3 PBMs consider switch

 Fifty-six percent of employer clients of “Big Three” pharmacy benefit managers — CVS Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx — are thinking about switching in the next one to three years.

The 2026 “Pulse of the Purchaser” survey, released Aug. 11 by the National Alliance of Healthcare Purchaser Coalitions, included 408 responses from employers. The survey ran in May and June. 

Here are six things to know from the survey:

1. Of clients using alternative PBMs, 31% are considering a change in the next few years.

2. The share of employers relying on the Big Three dropped from 63% in 2025 to 54% in 2026. 

3. Employers with fewer than 1,000 workers are primarily responsible for these shifts away from the Big Three PBMs, with the Big Three share dropping from nearly 70% of those employers in 2025 to 44% in 2026.

4. Out of the 27 employers who migrated to a different PBM in the last year, only seven now use one of the Big Three.

5. Almost 39% of Big Three users reported higher-than-average premiums, versus nearly 28% of those using other PBMs.

6. Nearly one-quarter of Big Three clients were not aware of what was in their contracts, versus 12% of clients using other PBMs.

https://www.beckershospitalreview.com/pharmacy/56-of-employers-using-big-3-pbms-consider-switch/