Big Three PBM Use Is Falling. Alternative Models Must Be Ready to Deliver.

Changing pharmacy benefit managers is a major undertaking, especially for a large organization. That transition calls for coordination across eligibility data, benefit rules, pharmacy networks and financial processes. Even so, the latest survey findings suggest that many purchasers are willing to consider making that move.

RxLogic Gives Alternative PBMs the Capacity to Compete

Alternative PBMs may offer a different commercial model but serving larger and more complex purchasers requires technology that can execute that model consistently. Claims must apply the right pricing, eligibility, network and benefit rules. Rebate activity and financial outputs must stay connected to the transactions that produced them. An alternative PBM must also be able to add new groups while administering different plan designs consistently.

RxLogic provides that operational foundation. Its configurable platform supports real-time claims adjudication, rebate-related workflows, network connectivity, financial processes and traceable decision execution. Since RxLogic is not a PBM, it supports clients without competing for their business. Clients retain control over program design, data and vendor relationships while using the capabilities they need individually or through a connected platform.

The survey doesn’t point to a predetermined winner. It shows that interest in alternatives is not limited to the smaller purchasers that drove the latest recorded movement. If a broader field of PBMs can meet the needs of complex purchasers, employers will gain greater leverage, and incumbent size may carry less weight in future procurement decisions.

The Recorded Movement Began with Smaller Employers

The Pulse of the Purchaser 2026 Survey Results show that the share of employers naming one of the Big Three PBMs dropped from 63.4% in 2025 to 54.3% in 2026. The survey defines the Big Three as CVS Caremark, Express Scripts/Evernorth and OptumRx.

The year-over-year change should still be viewed as directional because the PBM question format, response base and employer-size composition differed between surveys. Within those findings, however, the decline was concentrated among employers with fewer than 1,000 employees. Their reported use of a Big Three PBM fell from 69.7% to 43.8%. The share remained essentially flat among employers with 1,000 to 9,999 employees and shifted only modestly among organizations with at least 10,000.

Because the survey identifies respondents’ current PBMs rather than their previous providers, it can’t show where switching employers came from or why they chose their current administrators.

Larger Employers May Shape the Next Phase

The survey’s forward-looking results tell a different story. Among current Big Three clients, 55.7% said they were considering changing PBMs within the next one to three years, compared with 31.1% of employers using other PBMs.

Interest rose with organization size. The share of Big Three clients considering a change increased from 47.4% among employers with fewer than 1,000 employees to 57.4% among those with 1,000 to 9,999 and 60.4% among employers with at least 10,000.

Considering a change is not the same as completing one. The report points out that larger employers often use formal procurement cycles and need time to evaluate pricing, operations and member impact. Any challenger pursuing that business must therefore show it can manage a complex implementation and maintain reliable performance after the transition.

RxLogic was built to make this transition straightforward, and our clients who have gone through implementation can speak firsthand to how smoothly the process moved from planning to execution. That track record gives procurement teams a clear answer to the operational risk this stage of evaluation is designed to surface.

Contact RxLogic today to learn how independent technology can support scalable pharmacy benefit operations.