Pharmacy Benefit Management by the Numbers: 2026 and the Cost of Opacity

In the evolving world of pharmacy benefit management (PBM), numbers tell a compelling story. Behind every dollar spent and every member served, we’re seeing changes that point to a deeper truth: transparency matters. And plan sponsors are using their wallets to push for this change in a big way. As we enter 2026, let’s let the data reveal what’s at stake and why clarity is leading the way.  

Specialty Drugs: 52% of Net Spend

Specialty drugs accounted for over $400 billion in spend in 2025, adding up to more than half of net drug cost spend.¹ But the ratio is skewed by their high costs: while specialty medications only account for 2% of drugs sold, they make up 52% of net spend. Due to opaque practices, costs on these medications can vary by tens of thousands of dollars, depending on the PBM involved. On top of this, complex therapies and limited competition continue to drive these costs higher year over year. Without transparent pricing and utilization strategies, plan sponsors and payers risk overspending on their benefits and underserving their members.²  

Your Rebates Aren’t Making It Back to You

Traditional PBMs retain an unknown percentage of manufacturer rebates, and their opaque models often leave plan sponsors with little knowledge of where their money goes. Between markups and spread pricing, where clients are billed more than needed to reimburse pharmacies for medications, traditional PBMs raked in an estimated $8.7 billion in revenue between 2017-2022.³ These hidden rebate models not only create misaligned incentives; they erode trust. In Texas, where companies are required to file annual reports on rebates, fees and other payments, they still have to rely on PBMs to honestly self-report. Unfortunately, traditional PBMs found ways around these laws and the self-reporting dropped off dramatically after 2021.⁴ 

Transparent PBMs Lead the Way in Satisfaction 

More and more, plan sponsors are turning to PBMs that offer true clarity into their business practices, showing where every dollar goes, and it’s paying off. Transparent PBMs reported a 79% plan sponsor satisfaction rating, compared to lower scores among traditional models, especially the big three.⁵ This is a solid show of clarity not only leading to better overall experiences but a better perception of those transparent PBMs. When a plan sponsor can clearly understand their benefit, it allows them to maximize the potential of their plan, without having all the unanswered questions an opaque PBM may leave them with. 

Transparent PBMs Are on the Rise While Their Prices Fall 

According to Healthcare Finance News, between 2024 and 2025, the use of alternative PBMs, those viewed as more transparent, increased from 12% to 31%. During this same period, reliance on the big three PBMs fell from 72% to 61%.⁶ It seems that now more than ever, people really want a PBM they find trustworthy, and the number of plan sponsors that prefer transparency is increasing every year.  

Those plan sponsors working with transparent PBMs are finding another great advantage that just happens to stem from clarity: greater cost savings. Transparent PBMs are saving plan sponsors as much as 30%, thanks to pass-through pricing and aligned incentives.² It becomes plain to see that transparency isn’t just ethical, it’s economical.  

The Numbers Don’t Lie 

We believe 2026 is the year to look beyond the traditional model, and the numbers we’ve researched agree. Transparency drives better outcomes for plan sponsors and members, and those who don’t make the switch now will soon be left behind. 

There’s never been a better time to make the right choice. 

Ready to see how our decades of dedication to Transparency can improve your benefit plan?

Reach out to [email protected].

References

1. Tichy E et al. National trends in prescription drug expenditures and projections for 2025. American Journal of Health-System Pharmacy, Volume 82, Issue 14, 15 July 2025, Pages 806–821, https://doi.org/10.1093/ajhp/zxaf092 Published: April 23, 2025. Accessed December 16, 2025. https://academic.oup.com/ajhp/article-abstract/82/14/806/8117945?redirectedFrom=fulltext

2. 2024 Navitus Drug Trend Report. www.navitus.com/drug-trend-reports/2024-snapshot/

3. Federal Trade Commission. FTC Releases Second Interim Staff Report on Prescription Drug Middlemen. Published January 14, 2025. Accessed December 18, 2025. www.ftc.gov/news-events/news/press-releases/2025/01/ftc-releases-second-interim-staff-report-prescription-drug-middlemen 

4. Fein A. Transparency vs. Reality: Troubling Lessons from PBM Disclosure Laws (rerun).  Published June 20, 2025. Accessed December 18, 2025. www.drugchannels.net/2025/06/transparency-vs-reality-troubling.html 

5. Lonergan M et al. Pharmacy Benefit Manager Customer Satisfaction Report. Published Fall 2025. Accessed December 18, 2025.  www.psgconsults.com/industry-report/2025-pharmacy-benefit-manager-customer-satisfaction-report/ 

6. Lagasse J. Employers increasingly eyeing more transparent PBMs. Healthcare Finance. Published September 15, 2025. Accessed November 26, 2025. www.healthcarefinancenews.com/news/employers-increasingly-eyeing-more-transparent-pbms