Instead of just settling for one of the “big 3,” an increasing number of employers are beginning to shop around for pharmacy benefit managers (PBMs). Panelists at a session on the “employer mindset” at the 2025 Pharmacy Benefit Management Institute (PBMI) Annual National Conference said employers want transparency, partnership and out-of-the-box thinking from PBMs.

“It is a balancing act, for sure,” said Karen van Caulil, Ph.D., president and CEO of the Florida Alliance for Healthcare Value, a purchasers’ coalition, noting the importance of affordability for the health plan and access for the plan members.

“They're looking for a true partner in the PBM space,” added van Caulil, “and some of the relationships are adversarial, and that's what they're getting rid of, and that’s why they are

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