New drug benefits companies need employers to pick them

The big picture: Three pharmacy benefit managers — Express Scripts, CVS Caremark and OptumRx — control roughly 80% of the market.

• All three have high client retention rates, usually 95% or higher. But many employers don't leave those PBMs because it's a pain to do so.

Yes, but: Large companies like Boeing, Disney, Intel and Walmart make up the Purchaser Business Group on Health, which is starting a PBM called EmsanaRx. "The industry has really been unresponsive to their concerns," said Elizabeth Mitchell, PBGH's CEO.

• PBGH can't force its member companies to end or switch their PBM contracts, but the group is "very encouraged" about winning employers during open bids, Mitchell said.

The bottom line: These new companies are looking to strip away the games within drug pricing contracts, like rebates and spread pricing. There's a big appetite for change, but success ultimately will depend on employers ditching the current oligopoly.

Go deeper: The drug pricing contract Express Scripts doesn't want you to see