I have just under 5,000 miles on my 2015 2500 6.4 with 4:10 gears. At least half of those miles were spent towing my 28' boat that, with the triple axle trailer, fuel, and gear, weighs in around 7500 lbs. While I'd agree with many that the towing power isn't mind blowing, I feel like its more than adequate for what I tow. I live in the Pacific Northwest and while the elevation isn't extreme, we do have our share of hills and many mountains to cross, and I find the 6.4 w/ 4:10 combination does a great job.
I've never experianced the harsh 4th to 2nd shift issue that so many talk about, and find the tranny seems to do it's job well enough. I have always used the Tow/Haul mode when dragging the boat around and it seems to work just fine, but I am glad I decided to go with the 4:10 gearing. The 6.4 seems to have plenty of power to accelerate my 7500 lb load up most any incline, but it does need the right gear and it wants to be rewarded with lots of fuel!
I just pulled my boat along with probably 600 lbs of gear in the bed to Lake Roosevelt and back which is about 200 miles each way, about half running 65 mph on the freeway and half on 2 lane road crossing rolling farm lands and got 10.5 mpg (via the computer) which is a little better than usual while towing,(typically 8.5 to 9.5) and never once felt like the engine was struggling. Even the 6 mile long climb out of the Porkipine Bay campground was a breeze. About the time it seems like the engine is getting loaded down, the tranny drops a gear and if I don't back off the throttle it will soon be moving faster than I want!
I'm sure a Cummins would do it a lot easier and return better mpg while it's doing it, but I'm more than happy with the 6.4 and love how the truck chassis and suspension handles the load! It drives so solid, nice and smooth while towing my boat that it's easy to forget there's a load on behind me!