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Pharmacy Benefit Management Market in the US - Industry Outlook & Forecast 2022-2027

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    Report

  • 212 Pages
  • May 2022
  • Region: United States
  • Arizton
  • ID: 5591819
UP TO OFF until Aug 31st 2022
1h Free Analyst Time
1h Free Analyst Time

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FEATURED COMPANIES

  • Abarca Health
  • Centene
  • CVS Health
  • Magellan Rx Management
  • Navitus Health Solutions
  • Rite Aid
1h Free Analyst Time

Speak directly to the analyst to clarify any post sales queries you may have.

The study considers a detailed scenario of the present U.S. pharmacy benefit management market and its market dynamics for 2022−2027. It covers a detailed overview of several industry growth enablers, restraints, and trends. The report offers both the demand and supply aspects of the market. It profiles and examines leading companies and other prominent ones operating in the market.

The U.S. pharmacy benefit management market is expected to grow at a CAGR of 5.53% during 2022-2027

MARKET INSIGHTS


The PBM industry refers to companies that act as intermediaries between insurance companies, pharmacies, and pharmaceutical companies. PBM is responsible for reducing insurers and their drug costs. They achieve this by negotiating with pharmacies and pharmaceutical companies. The pharmacy benefit management systems entered the pharmaceutical industry in the 1960s to meet the needs of employer-based health benefits. They soon became an important stakeholder in the entire pharmaceutical supply chain.

Pharmacy costs represent almost 32% of the total health care spending, and this expenditure is expected to grow more than two times during the forecast period. Currently, pharmacy benefit management plays a major role and acts as an intermediary between payers, drug manufacturers, and pharmacies.

Since PBMs play a significant role in influencing out-of-pocket costs and patient access to medications owing to their management tools, formulary power, and price concessions. They are in a position of power to pass savings to customers. According to PBM lobby groups, between 2020 to 2029, PBM tools will reduce consumer and plan sponsors' spending by more than $1 trillion.

There is a growing criticism of PBMs with claims that they are driving up costs of drug prices, making huge gains via pharmacy spreads, rebates from manufacturers, and fees from the supply chain. This is being spurred by the opaqueness of the true cost of drugs to PBMs owing to the rules of engagement between manufacturers and PBMs.

The future of PBMs is going to be dictated by the implementation of state and national-level policies in terms of their revenue streams and business practices in the pharmaceutical space.

U.S. Pharmacy Benefit Management Market Segmentations

  • Based on services, specialty pharmacy services are the major contributor in the pharmacy benefit management market in the US, and it is likely to witness high incremental growth of $48.24 billion during the forecast period.
  • Based on health plans, commercial health plans are the major contributor in the pharmacy benefit management market in the US, and it is likely to witness high absolute growth of 34.69% during the forecast period.

Segmentation by Health Plan

  • Commercial Health Plans
  • Medicare
  • Medicaid
  • Others

Segmentation by Services

  • Specialty Pharmacy Services
  • Retail Pharmacy Networks
  • Mail-Order Pharmacy Services
  • Claims Processing
  • Formulary Management
  • Drug Utilization Review
  • Price, Discount, & Rebate Negotiations
  • Disease Management & Adherence Initiatives

Segmentation by Business Model

  • Insurance Companies and Retail Pharmacies
  • Pure Play PBMS

VENDOR ANALYSIS


The presence of prominent market players, increasing favorable healthcare reforms, rising e-prescription, and growing adoption of healthcare plans by us residents are the primary factors for the significant market share in the country.

Key Company Profiles
  • CVS Health
  • Cigna
  • UnitedHealth Group

Key Companies to Watch
  • Humana Pharmacy Solutions
  • Medimpact
  • Prime Therapeutics

Other Prominent Vendors

  • Abarca Health
  • AscellaHealth
  • BeneCard PBF
  • CaptureRx
  • Centene
  • Change Healthcare
  • Citizens Rx
  • EnvisionRxOptions
  • Excelera
  • Magellan Rx Management
  • MedalistRx
  • MaxorPlus
  • Navitus Health Solutions
  • PerformRx
  • ProCare Rx
  • RxAdvance
  • Rite Aid
  • WellDyneRx
  • Walgreens Boots Alliance

FEATURED COMPANIES

  • Abarca Health
  • Centene
  • CVS Health
  • Magellan Rx Management
  • Navitus Health Solutions
  • Rite Aid

1 Research Methodology2 Research Objectives3 Research Process
4 Scope & Coverage
4.1 Market Definition
4.1.1 Inclusions
4.1.2 Exclusions
4.1.3 Market Estimation Caveats
4.2 Base Year
4.3 Scope of the Study
4.4 Market Segmentation
4.4.1 Market Segmentation by Service
4.4.2 Market Segmentation by Health Plan
4.4.3 Market Segmentation by Business Model
5 Report Assumptions & Caveats
5.1 Key Caveats
5.2 Currency Conversion
5.3 Market Derivation
6 Market at a Glance
7 Introduction
7.1 Us Economy & Healthcare Industry Landscape
7.2 Pharmacy Benefit Management
7.2.1 Role of Pbms in Money Spent on Prescription Drugs
7.2.2 Reforms to Regulate Pbms
8 Pharmaceutical Ecosystem
8.1 Overview
8.2 Evolution of Pbm Ownership
8.2.1 Pbm Services Over Time
8.2.2 Pbms & Other Players in Pharmaceutical Ecosystem
9 Impact of Covid-19 on Pbm Market
9.1 Overview
9.1.1 Pbms Covid-19 Response Strategies
10 Gaps in Information & Care in Us Healthcare Industry
10.1 Overview
11 Market Opportunities & Trends
11.1 Increased Adoption of E-Prescription & Mail Order Pharmacy
11.2 Growing Fda Approvals of Biologics & Biosimilars
11.3 Market Entry of Payers Through M&As
11.4 Entry of Digital Health Solutions in Pbm Industry
12 Market Growth Enablers
12.1 Favorable Healthcare Reforms
12.2 Growing Adoption of Healthcare Plans by Us Residents
12.3 Prevalence of Fraud, Waste & Abuse in Healthcare
12.4 Increased Demand for Personalized Medicines
13 Market Restraints
13.1 Pbms More Susceptible to Lawsuits & Government Scrutiny
13.2 Lack of Transparency in Services by Pbms
13.3 Declining Growth from Generics
13.4 Legal Uncertainty & Impending Limitations on Pbm Tools
14 Market Landscape
14.1 Market Overview
14.2 Market Size & Forecast
14.2.1 Insight by Health Plans
14.2.2 Insights by Services
14.2.3 Insight by Business Model
14.3 Five Forces Analysis
14.3.1 Threat of New Entrants
14.3.2 Bargaining Power of Suppliers
14.3.3 Bargaining Power of Buyers
14.3.4 Threat of Substitutes
14.3.5 Competitive Rivalry
15 Health Plans
15.1 Market Snapshot & Growth Engine
15.2 Market Overview
15.3 Commercial Health Plans
15.3.1 Market Overview
15.3.2 Market Size & Forecast
15.4 Medicare
15.4.1 Market Overview
15.4.2 Market Size & Forecast
15.5 Medicaid
15.5.1 Market Overview
15.5.2 Market Size & Forecast
15.6 Others
15.6.1 Market Overview
15.6.2 Market Size & Forecast
16 Services
16.1 Market Snapshot & Growth Engine
16.2 Market Overview
16.3 Specialty Pharmacy Services
16.3.1 Market Overview
16.3.2 Market Size & Forecast
16.4 Retail Pharmacy Networks
16.4.1 Market Overview
16.4.2 Market Size & Forecast
16.5 Mail-Order Pharmacy Services
16.5.1 Market Overview
16.5.2 Market Size & Forecast
16.6 Claims Processing
16.6.1 Market Overview
16.6.2 Market Size & Forecast
16.7 Formulary Management
16.7.1 Market Overview
16.7.2 Market Size & Forecast
16.8 Drug Utilization Review
16.8.1 Market Overview
16.8.2 Market Size & Forecast
16.9 Price, Discount & Rebate Negotiations
16.9.1 Market Overview
16.9.2 Market Size & Forecast
16.10 Disease Management & Adherence Initiatives
16.10.1 Market Overview
16.10.2 Market Size & Forecast
17 Business Model
17.1 Market Snapshot & Growth Engine
17.2 Market Overview
17.3 Insurance Companies & Retail Pharmacies
17.3.1 Market Overview
17.3.2 Market Size & Forecast
17.4 Pure Play Pbms
17.4.1 Market Overview
17.4.2 Market Size & Forecast
18 Competitive Landscape
18.1 Competition Overview
18.2 Market Share Analysis
18.2.1 Cvs Health
18.2.2 Cigna
18.2.3 Unitedhealth Group
18.2.4 Humana Pharmacy Solutions
18.2.5 Medimpact
18.2.6 Prime Therapeutics
19 Key Company Profiles
19.1 Cvs Health
19.1.1 Business Overview
19.1.2 Service Offerings
19.1.3 Key Strengths
19.1.4 Key Strategies
19.1.5 Key Opportunity
19.2 Cigna
19.2.1 Business Overview
19.2.2 Service Offerings
19.2.3 Key Strengths
19.2.4 Key Strategies
19.2.5 Key Opportunity
19.3 Unitedhealth Group
19.3.1 Business Overview
19.3.2 Service Offerings
19.3.3 Key Strength
19.3.4 Key Strategies
19.3.5 Key Opportunity
20 Key Companies to Watch
20.1 Humana Pharmacy Solutions
20.1.1 Business Overview
20.1.2 Service Offerings
20.1.3 Key Strengths
20.1.4 Key Strategies
20.1.5 Key Opportunity
20.2 Medimpact
20.2.1 Business Overview
20.2.2 Service Offerings
20.2.3 Key Strengths
20.2.4 Key Strategies
20.2.5 Key Opportunities
20.3 Prime Therapeutics
20.3.1 Business Overview
20.3.2 Service Offerings
20.3.3 Key Strengths
20.3.4 Key Strategies
21 Other Prominent Vendors
21.1 Abarca Health
21.1.1 Business Overview
21.1.2 Service Offerings
21.1.3 Key Strengths
21.1.4 Key Strategies
21.2 Anthem
21.2.1 Business Overview
21.2.2 Service Offerings
21.2.3 Key Strategies
21.2.4 Key Strengths
21.3 Ascellahealth
21.3.1 Business Overview
21.3.2 Service Offerings
21.3.3 Key Strengths
21.3.4 Key Strategies
21.4 Benecard Pbf
21.4.1 Business Overview
21.4.2 Service Offerings
21.4.3 Key Strengths
21.4.4 Key Strategies
21.5 Capturerx
21.5.1 Business Overview
21.5.2 Service Offerings
21.5.3 Key Strengths
21.5.4 Key Strategies
21.6 Centene
21.6.1 Business Overview
21.6.2 Service Offerings
21.6.3 Key Strengths
21.6.4 Key Strategies
21.7 Change Healthcare
21.7.1 Business Overview
21.7.2 Service Offerings
21.7.3 Key Strengths
21.7.4 Key Strategies
21.8 Citizens Rx
21.8.1 Business Overview
21.8.2 Service Offerings
21.8.3 Key Strengths
21.8.4 Key Strategies
21.9 Envisionrxoptions
21.9.1 Business Overview
21.9.2 Service Offerings
21.9.3 Key Strengths
21.9.4 Key Strategies
21.10 Excelera
21.10.1 Business Overview
21.10.2 Service Offerings
21.10.3 Key Strengths
21.10.4 Key Strategies
21.11 Magellan Rx Management
21.11.1 Business Overview
21.11.2 Service Offerings
21.11.3 Key Strengths
21.11.4 Key Strategies
21.12 Medalistrx
21.12.1 Business Overview
21.12.2 Service Offerings
21.12.3 Key Strength
21.12.4 Key Strategies
21.13 Maxorplus
21.13.1 Business Overview
21.13.2 Service Offerings
21.13.3 Key Strengths
21.13.4 Key Strategies
21.14 Navitus Health Solutions
21.14.1 Business Overview
21.14.2 Service Offerings
21.14.3 Key Strength
21.14.4 Key Strategy
21.15 Performrx
21.15.1 Business Overview
21.15.2 Service Offerings
21.15.3 Key Strengths
21.15.4 Key Strategies
21.16 Procare Rx
21.16.1 Business Overview
21.16.2 Service Offerings
21.16.3 Key Strengths
21.16.4 Key Strategies
21.17 Rxadvance
21.17.1 Business Overview
21.17.2 Service Offerings
21.17.3 Key Strengths
21.17.4 Key Strategies
21.18 Rite Aid
21.18.1 Business Overview
21.18.2 Service Offerings
21.18.3 Key Strengths
21.18.4 Key Strategies
21.19 Welldynerx
21.19.1 Business Overview
21.19.2 Service Offerings
21.19.3 Key Strengths
21.19.4 Key Strategies
21.20 Walgreens Boots Alliance
21.20.1 Business Overview
21.20.2 Service Offerings
21.20.3 Key Strengths
21.20.4 Key Strategies
22 Report Summary
22.1 Key Takeaways
22.2 Strategic Recommendations
23 Quantitative Summary
23.1 Market by Health Plans
23.2 Market by Services
23.3 Market by Business Model
24 Appendix
24.1 Abbreviations
  • CVS Health
  • Cigna
  • UnitedHealth Group
  • Humana Pharmacy Solutions
  • Medimpact
  • Prime Therapeutics
  • Abarca Health
  • AscellaHealth
  • BeneCard PBF
  • CaptureRx
  • Centene
  • Change Healthcare
  • Citizens Rx
  • EnvisionRxOptions
  • Excelera
  • Magellan Rx Management
  • MedalistRx
  • MaxorPlus
  • Navitus Health Solutions
  • PerformRx
  • ProCare Rx
  • RxAdvance
  • Rite Aid
  • WellDyneRx
  • Walgreens Boots Alliance

Our research comprises a mix of primary and secondary research. The secondary research sources that are typically referred to include, but are not limited to, company websites, annual reports, financial reports, company pipeline charts, broker reports, investor presentations and SEC filings, journals and conferences, internal proprietary databases, news articles, press releases, and webcasts specific to the companies operating in any given market.

Primary research involves email interactions with the industry participants across major geographies. The participants who typically take part in such a process include, but are not limited to, CEOs, VPs, business development managers, market intelligence managers, and national sales managers. We primarily rely on internal research work and internal databases that we have populated over the years. We cross-verify our secondary research findings with the primary respondents participating in the study.



 

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