Replay - The 2027 Commercial PBM Selling Season: A Broker's View

Research evidence excerpt

Replay - The 2027 Commercial PBM Selling Season: A Broker's View

Health Care | Healthcare Technology & Distribution

June 25, 2026

Elizabeth Anderson Joanna Zhou Amir Farahani, CFA Ayush Vyas

212-446-5632 212-446-5659 646-551-8518 646-551-8512

elizabeth.anderson@evercoreisi.com joanna.zhou@evercoreisi.com Amir.Farahani@evercoreisi.com Ayush.Vyas@evercoreISI.com

On Tuesday we hosted a virtual webinar on the 2027 commercial PBM selling season, featuring an independent

pharmacy benefit consultant who runs commercial PBM RFPs for self-insured employers. We heard a market-side

view on how the season is shaping up versus prior years and who is winning and losing share across the Big 3 and

challengers, the evolving pricing model (traditional versus pass-through versus "transparent" offerings), the clinical

and cost levers swinging PBM selection (GLP-1 and Humira/Stelara biosimilar adoption), and the regulatory

backdrop of FTC scrutiny and state transparency mandates.

Our webinar replay is available here.

Key Takes:

• Big-3 share is slipping gradually. Big 3 still hold ~75–80% of the market; expert sees a slow drift toward

~72% over five years rather than a sharp loss.

• Some big-3 profit pools may be shifting. Big 3 are likely to recapture economics via GPO/manufacturer

deals and specialty pharmacy, even under full rebate pass-through.

• Big-3 share losses skew to the mid-market. In our expert’s book, just 3 of 13 clients now sit with big 3,

down from all 13 in 2021. Big 3 tend not to fight hard for ~6,000-life groups but defend 35,000+-life and

marquee accounts. The big 3 also likely to continue to evolve their competitive positioning over the next few

years.

• "2.0" challengers are becoming more credible. Capital Rx, Navitus, and SmithRx are winning on