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Big Three PBMs lose employer market share as more firms consider switching
A 2026 Pulse of the Purchaser survey finds 55.7% of employers that use Optum, CVS Caremark, or Express Scripts are considering switching within one to three years.
The Big Three pharmacy benefit managers, Optum, CVS Caremark, and Express Scripts, have continued to lose employer market share, according to Insurance Business America, citing a 2026 Pulse of the Purchaser survey.
The survey reported the Big Three's employer-market share fell from 63.4% in 2025 to 54.3% in 2026, and that 55.7% of employers still using one of the three say they are considering switching within the next one to three years.
Insurance Business America also said 92% of 408 employer respondents reported healthcare costs are actively hurting their competitiveness, a pressure plan sponsors are using to reassess PBM relationships.
The outlet further reported that 23.4% of employers with a Big Three PBM do not know what is in their contract, creating an opening for brokers to negotiate more transparency, while an industry shift is described as moving from smaller employers toward mid-market and large-group clients.