This year’s PBMI conference made one thing clear: the PBMs that will succeed in 2026 must be flexible, digital-first, and built around the member experience.
While delivering real-time prior authorization status, drug cost transparency, and even access to high-demand therapies like GLP-1s once felt like competitive differentiators, those days are gone.
Member expectations are now reshaping core operations, impacting call center volumes, influencing benefit design, and determining how PBMs compete for health plan contracts. As members demand clarity, speed, and affordability, PBMs are being pushed to evolve into digital-first service providers.
PBMI 2025 highlighted four critical areas where member portal capabilities directly impact business success.
Here's what every PBM leader needs to know about these trends and how to position your organization for success in this new member-centric reality.
Demand for GLP-1 therapies like Ozempic and Wegovy is skyrocketing. Providers are seeing a significant increase in patients requesting access, often for weight loss and other uses outside of traditional prescribing pathways.
With the average yearly cost for these drugs totaling $8,000–$15,000 per patient, employers and plan sponsors are bracing for steep cost increases as more members seek coverage.
Yet, inconsistent benefit designs mean some plans include GLP-1s, some narrowly restrict them, and others exclude them entirely. That patchwork creates administrative complexity and member frustration.
Generics and oral formulations may eventually ease the pressure by lowering costs and expanding access. But until those options hit the market, plan sponsors face rising affordability concerns and operational headaches.
Takeaway: With the popularity of these medications, take a look at how your benefit design handles GLP-1s. Aim to balance affordability with member expectations by building digital tools that:
Doing this not only helps control costs but also reduces call center strain and improves your member experience.
Electronic prior authorization adoption is accelerating, hitting record highs according to data at PBMI.
What was even more exciting was seeing that when systems pulled standardized clinical data directly from electronic health records (EHRs) such as EPIC, it led to 88% fewer appeals and cut denials by 68%.
Codified data flowing automatically from the EHR to the PBM proved that “no-touch by design” approvals benefit each stakeholder involved as:
Takeaway: Prioritize digital Prior Auth visibility in your member portal. By having real-time status updates, expiration alerts, and clear next steps, you can build trust, give providers and members a smoother experience, and deflect routine calls from your service center.
The line between pharmacy and medical benefit drug management is fading. Many health plans are moving to unified platforms that manage Prior Auth, site-of-care, and specialty drug programs.
Instead of dealing with duplicated reviews, higher admin costs, and members having confusing experiences and questions, a best-in-class utilization management (UM) platform makes the process seamless.
What a Best-in-Class UM Platform Does
The payoff:
Takeaway: Evaluate how your UM systems are set up and whether pharmacy and medical workflows are still siloed. An integrated system lowers costs, improves efficiency, leads to better data for identifying cost-saving opportunities, and making for a clear, consistent member experience.
For years, AI in PBM sounded more like a future promise than a practical tool. Now it’s showing measurable results:
PBMs that move past pilots and integrate AI responsibly are already freeing up staff, reducing errors, and improving ratings.
Takeaway: AI is no longer experimental, so it’s time to get started if you haven’t integrated it already. Be strategic and use AI to automate repetitive tasks like document intake or reporting. Measure your results and apply those gains to higher-value member support initiatives.
Whether it was GLP-1s, prior auth, or UM, PBMI 2025 underscored that the PBMs who succeed are data-driven, AI-enabled, and most importantly: member-first.
Members now expect real-time visibility, affordability, guidance, and digital tools that solve their problems without a phone call. And health plans are writing these expectations into RFPs.
At Praxent, we’ve helped PBMs design and engineer the type of member portals that deliver what PBMI spotlighted:
The foundation for sustainable growth and member trust is built with regulatory agility, smart benefit design, and intuitive, modern digital experiences.