Three out of four US employers have either changed their pharmacy benefits advisor in the past 12 months or plan to in the next 12. That churn rate reflects compounding pressure from rising drug costs, new federal disclosure requirements, and growing employer frustration with advisors who are not keeping pace with either.
Those are the headline findings from the 2026 State of Pharmacy Benefits Decisions report, published by RxBenefits, Inc., a pharmacy benefits optimizer based in Birmingham, Alabama. The survey, fielded by FTI Consulting on behalf of RxBenefits from June 23 to July 21, captured responses from 601 employers and 300 employee benefits consultants and advisors with decision-making authority over pharmacy benefits. This is the fourth wave of the tracker, which was first conducted in 2023. RxBenefits operates in the same market as the pharmacy benefit managers and advisors its survey evaluates.
The reasons employers cited for changing or planning to change advisors are specific. Concerns about compensation arrangements with providers or vendors topped the list at 31%, tied with a lack of proactive guidance or recommendations. High commissions or fees were cited by 30%, compliance or regulatory concerns by 28%, and rising costs or a lack of demonstrated savings by 29%. Separately, 87% of employers said they were likely to switch their pharmacy benefits manager at contract renewal.
That last figure sits alongside a separate finding: 78% of advisors said their clients are significantly or somewhat more willing to switch providers than in prior years. The two numbers together suggest a market where both the advisor relationship and the underlying vendor arrangement are under simultaneous review.
Employers are no longer evaluating whether a pharmacy benefits manager claims to be transparent as nearly every provider does. The survey found that employers now weigh transparency against net cost, service quality, and clinical execution, with each of those dimensions carrying roughly equal weight in provider decisions.
GLP-1 spending climbed from $13.7 billion in 2018 to $71.7 billion in 2023, according to data cited in the report from AMA/CDC and IQVIA sources. Employers have responded not by abandoning coverage but by raising the bar on how it is managed.
The survey found that 87% of employers in the RxBenefits sample currently cover GLP-1 medications for weight loss. That figure sits well above the 36% of corporate employers found to cover GLP-1s for both diabetes and weight loss in a separate 2026 survey by the International Foundation of Employee Benefit Plans (IFEBP), reflecting differences in employer size and plan type across the two samples. Of those in the RxBenefits survey, 77% plan to expand coverage but with tighter controls.
That expectation is shaping provider evaluations in ways that go beyond formulary design. Employers who have not reviewed their PBM arrangement recently are working off terms that predate both the GLP-1 cost surge and the legislative changes now reshaping how pharmacy benefits are structured.
Both employers and advisors rank data quality and reporting as the top account management priority, but their emphases diverge from there. Employers lean harder on proactive strategic guidance, while advisors lean harder on responsiveness and issue resolution. On member experience, employers prioritize service quality and digital access, while advisors weight prior authorization speed more heavily.
The gaps are not large individually. Cumulatively, the report found, they can produce recommendations that de-emphasize what clients value most. In a market where 39% of employers have already changed advisors in the past year, small misalignments are not staying small for long.
“Employers are stuck in a churn trap, and another vendor swap won’t break it,” said Kyra Hagan, senior vice president of marketing and communications at RxBenefits. “What ends the cycle is proof, not promises.”
