The pharmacy benefits market is more unsettled than it’s been in years and your clients feel it. Costs keep climbing. Transparency is now expected, not rewarded. New laws have pulled back the curtain on how advisors and pharmacy benefits managers (PBMs) get paid. As a result, employers are questioning arrangements that once felt long-term, including their relationships with their advisor and their PBM.
How do we know? The numbers say so. The 2026 State of Pharmacy Benefits Decisions report, conducted by FTI Consulting on behalf of RxBenefits, surveyed 601 employers and 300 benefits consultants and advisors, all with decision-making authority over pharmacy benefits. The data shows a market in transition and raises the stakes for every advisor who wants to protect and grow their book of business.
Here are four signs the churn has taken hold, what each one means for your client relationships, and how you can break the cycle.
1. Client Loyalty Is No Longer Guaranteed
Your clients still rely on you for guidance. What’s changed is how quickly that trust can dissipate.
According to the RxBenefits survey data, three out of four employers have changed their pharmacy benefits consultant in the past 12 months or expect to in the next 12 months. That’s not a slow drift. That’s a market openly reconsidering who earns its trust.
Why are clients walking away? They point to three main concerns:
- How advisors get paid
- A lack of proactive guidance
- Rising costs without demonstrated savings
Greater visibility into pay structures has raised the bar. Solid service alone no longer keeps a client relationship intact.
What advisors can do: Bring documented, comparable proof of value to every client conversation. Contract comparisons, performance guarantees, case studies from similar employers, and peer references now carry the weight that assurances once did. Influence without evidence doesn’t last, but evidence builds the kind of trust that keeps clients through renewal after renewal.
2. Transparency Stopped Being a Differentiator
For years, “transparent” was the word that set a PBM apart. Not anymore.
When nearly every provider claims transparency, the label stops meaning anything, and your clients know it. In the 2026 survey, an overwhelming majority said they’d consider a transparent PBM. but they’re no longer taking the word at face value. They’re asking harder questions: Will switching actually lower net cost? Where do the rebates really go? How do guarantees work in practice, not just on paper?
The line between “transparent” and “traditional” models is blurring, too. Employers don’t fully agree on what transparency even means anymore. As a result, your clients judge value on outcomes the label can’t guarantee: net cost, service quality, and clinical results.
What advisors can do: Look past the label for your clients. Transparency is the price of admission now, not the prize. Evaluate each provider on how the pricing actually works, where rebates land, what the guarantees cover, and how members experience the plan. When you can answer those questions with specifics, you become the expert your clients can’t afford to replace.
3. A Low Price Alone Won’t Win the Decision
A one-note pitch used to work. A better price could offset a weak spot elsewhere. But today, that math no longer holds.
The survey data shows employers and advisors spreading their attention almost evenly across four factors:
- No single factor dominates. When all four carry roughly equal weight, trade-offs get harder to justify and gaps get exposed faster.
- This shift explains part of the churn. When your recommendation is strong on price but quiet on service or clinical management, your clients notice. And they act. A recommendation that covers only part of the picture reads as incomplete, and it fuels both PBM and advisor switching.
- What advisors can do: Evaluate providers across every dimension at once and then show your clients the full picture. Ask what evidence would justify a switch before you recommend one. In the survey, employers ranked a transparent contract comparison and performance guarantees as the strongest triggers for change. Build both into every recommendation you bring forward.
No single factor dominates. When all four carry roughly equal weight, trade-offs get harder to justify and gaps get exposed faster.
This shift explains part of the churn. When your recommendation is strong on price but quiet on service or clinical management, your clients notice. And they act. A recommendation that covers only part of the picture reads as incomplete, and it fuels both PBM and advisor switching.
What advisors can do: Evaluate providers across every dimension at once and then show your clients the full picture. Ask what evidence would justify a switch before you recommend one. In the survey, employers ranked a transparent contract comparison and performance guarantees as the strongest triggers for change. Build both into every recommendation you bring forward.
4. GLP-1 Management Became Its Own Test
GLP-1 drugs have moved from a footnote to a standalone evaluation standard in just a few years. The spending curve made sure of it. GLP-1 spending rose more than 500% between 2018 and 2023, climbing from $13.7 billion to $71.7 billion.
That kind of growth demands its own plan. Employers no longer treat GLP-1s as one line item among many and they expect a defined GLP-1 strategy Coverage is already widespread, and most employers plan to expand it, but not with a blank check. The survey shows a clear preference: expand coverage with tighter controls.
The question is no longer whether a provider covers GLP-1s. It’s whether they can manage them. Employers are already testing a mix of approaches including direct-to-consumer (DTC) or direct-to-employer (DTE) programs, coverage based on prior authorization (PA), weight management integration, and step therapy.
What advisors can do: Judge providers on how they manage GLP-1 utilization and program integration, not just whether coverage exists. A defined, managed strategy is now table stakes. Advisors who help clients expand access responsibly, with clear controls, prove their value in the category that’s keeping CFOs up at night.
Breaking the Churn Trap
Here’s the trap hiding in all four trends: in a market defined by advisor and PBM churn, simply moving from one vendor to the next repeats the cycle without solving the core problem. Another switch rarely delivers lower net cost, and it may not earn you lasting loyalty.
Active management does. Aggregated purchasing power, independent clinical management, and specialty protection give you a way to guide clients out of the constant reshuffling. The strongest recommendations aren’t about model labels. They’re about measurable proof, and that proof is what turns you from a vendor into an indispensable strategic consultant.
These four signs are only part of the story. The full 2026 State of Pharmacy Benefits Decisions report covers all seven data trends, complete with the survey findings behind them.
See the full picture: Download the 2026 State of Pharmacy Benefits Decisions report to learn what the most unsettled market in years is signaling and how you can respond for your clients.
Watch our recent webinar. “The Loyalty Gap: What 601 Employers and 300 Advisors Told Us About Pharmacy Benefits in 2026” unpacked what employers are telling us about value, trust, and the future of pharmacy benefits decisions. View the webinar.
Learn more:
2026 State of Pharmacy Benefits Decisions: The Churn Trap, Oct. 8, 2026
PBM Contract Terms Decoded: A Plain-Language Glossary for Benefits Advisors, Aug. 26, 2026
4 Reasons the Biosimilar Boom Could Save Your Clients $232 Billion, Aug. 18, 2026
