Pharmacy Benefit Managers (PBMs) can use artificial intelligence to improve how drug benefits are designed, managed, and delivered by making sense of large, complex healthcare datasets. AI can enhance formulary management by analyzing real-world evidence, claims data, and utilization trends to predict drug performance, identify cost-effective therapies, and model the impact of formulary changes before implementation. It can also support more dynamic utilization management, such as refining prior authorization criteria, detecting inappropriate prescribing patterns, and flagging potential fraud, waste, or abuse earlier and with greater accuracy than traditional rules-based systems.

AI also enables more personalized and efficient member and provider experiences. For members, machine learning models can identify adherence risks, recommend targeted interventions, and power digital tools that guide patients to lower-cost or therapeutically equivalent alternatives. For providers, AI-driven automation can streamline prior authorization workflows, reduce administrative burden, and improve response times. At an enterprise level, predictive analytics can help PBMs anticipate drug spend trends, specialty drug growth, and supply disruptions, supporting better contracting strategies and value-based arrangements with manufacturers and payers.

PHSL’s January 2026 poll asked respondents which AI-enabled capability would be most attractive for Pharmacy Benefit Managers. The results show a clear preference for AI applications focused on cost and pricing optimization, with optimized drug pricing algorithms leading at 44%. Predictive analytics to reduce drug waste and real-time rebate forecasting were tied for second place at 22% each, highlighting strong interest in AI tools that improve financial forecasting and operational efficiency.

By contrast, patient-facing benefits received far less support. Improved patient communication tools garnered 11% of responses, while increased patient adherence received no votes, suggesting respondents view AI’s greatest near-term value for PBMs as driving pricing accuracy, waste reduction, and rebate management rather than directly enhancing member engagement.

What is the most attractive benefit that artificial intelligence (AI) could offer to PBMs?

Optimized drug pricing algorithms: 44%

AI predictive analytics to help PBMs reduce drug waste: 22%

Real-time rebate forecasting: 22%

Increased patient adherence: 0%

Improved patient communication tools: 11%