RxBenefits Releases Q1 2026 Pharmacy Benefits Market Report

Report examines legislative change, PBM pricing models, and the role of independent clinical management in controlling specialty drug costs

BIRMINGHAM, Ala. , May 14, 2026 /PRNewswire/ -- RxBenefits, Inc. announced the release of its Q1 2026 Market Report, An Industry in Flux: How to Navigate the Complex Pharmacy Benefits Landscape with Confidence, the first in a quarterly educational series for employee benefits advisors. The report is designed to help advisors navigate a rapidly transforming pharmacy benefits management (PBM) market and support self-funded employers seeking sustainable savings.

The report outlines major legislative and regulatory developments affecting pharmacy benefits. It examines federal reforms, including the Consolidated Appropriations Act of 2026, along with emerging state-level regulations that are intensifying compliance standards. RxBenefits said the report offers guidance for benefits advisors managing these overlapping compliance requirements and heightened fiduciary responsibilities for self-funded employer clients.

It also unpacks traditional and emerging pricing approaches now available in the PBM market, comparing traditional spread-based models with transparent models and modular approaches that include cost-plus network options. According to RxBenefits, the analysis is intended to help advisors understand how plan-specific utilization impacts pricing strategy, align recommendations with an employer's specific financial objectives, improve rebate performance and strengthen budget predictability.

The report also highlights continued budget pressure from specialty drug costs which now account for more than 55% of the typical plan's annual pharmacy spending while being used by about two percent of members. According to the report, this imbalance underscores the need for independent clinical management that is not influenced by PBMs' dispensing and rebate revenue. The company said that approach can help reduce waste, support appropriate utilization, and protect health outcomes in a complex specialty drug environment.

"The pharmacy benefits industry is at a critical turning point, and standing still is not an option for employers or their benefits advisors," said Kyra Hagan, senior vice president, marketing, at RxBenefits. "This report empowers benefits advisors with the critical insights necessary to help self-funded employers secure long-term savings and deliver high-quality member care, even as the market becomes increasingly complex."

The full Q1 Market Report is available at rxbene.fit/41WpHHg.  

For benefits advisors interested in learning more about how the latest legislative changes, emerging pricing models, and innovative solutions are reshaping the PBM landscape, join the RxBenefits webinar "PBM Disruption in 2026: Tools and Tactics for Benefits Advisors," May 19 at 11 a.m. CT/12 p.m. ET. Register at https://rxbene.fit/4wptoD5.

More information about RxBenefits is available at www.rxbenefits.com. 

About RxBenefits 

RxBenefits is the nation's first and only Pharmacy Benefits Optimizer (PBO), partnering with benefits advisors and self-funded plan leaders to deliver high-value, client-aligned pharmacy solutions. By combining deep marketplace expertise, aggressive PBM pricing negotiations, independent clinical oversight, and award-winning service, RxBenefits helps organizations control pharmacy costs while ensuring members receive seamless, high-quality care and best-in-class support. Headquartered in Birmingham, Alabama, RxBenefits serves more than 3 million members nationwide. For more information, visit www.rxbenefits.com.  

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SOURCE RxBenefits