Pharmacy Benefit Management Global Market Report 2024

The pharmacy benefit management market size has grown strongly in recent years. It will grow from $597.17 billion in 2023 to $644.58 billion in 2024 at a compound annual growth rate (CAGR) of 7.9%. Historical growth can be attributed to a heightened focus on preventative care, expansion of pharmacy networks, partnerships with healthcare providers, emphasis on improving patient outcomes, and advancements in pharmaceutical therapies.

The pharmacy benefit management market size is expected to see strong growth in the next few years. It will grow to $878.37 billion in 2028 at a compound annual growth rate (CAGR) of 8.0%. The anticipated growth in the forecasted period is driven by demands to control healthcare costs, an increase in prescription drug usage, the expansion of health insurance coverage, compliance with evolving regulations, and a focus on patient-centric healthcare approaches. Major trends expected during this period include the adoption of value-based healthcare models, effective management of specialty medications, integration of data analytics and AI, the incorporation of telemedicine, and a rising emphasis on personalized medicine.

The increasing number of individuals opting for insurance significantly contributes to the expansion of the pharmacy benefit management (PBM) market. Insurance serves as a crucial solution to cope with rising medical costs by covering expenses related to treatment, hospitalization, health check-ups, and other healthcare-related expenses. In a parallel manner, pharmacy benefit management (PBM) plays a vital role in supporting comprehensive healthcare products by integrating both medical and pharmaceutical components. This integration allows insurers to access extensive information about patients, enabling them to develop efficient programs tailored to individual needs. As reported by the India Brand Equity Foundation (IBEF), new premiums of life insurers experienced a notable 22.2% growth in September 2021, marking a 2.9% increase from September 2020. Consequently, the upward trend in the number of individuals availing insurance is a key driver propelling the growth of the pharmacy benefit management market.

The escalating prevalence of chronic diseases is anticipated to drive the growth of the pharmacy benefit management (PBM) market in the coming years. Chronic diseases, characterized by long-term health conditions persisting for three months or more, pose a significant global health challenge. Pharmacy benefit management is instrumental in the effective management of chronic diseases by optimizing medication access, fostering adherence, and implementing cost-effective strategies. This approach ensures improved health outcomes and a higher quality of life for individuals dealing with long-term medical conditions. As of September 2023, the World Health Organization (WHO) reported that noncommunicable diseases (NCDs) or chronic diseases accounted for 74% of the 41 million annual global deaths. Notably, this figure includes 17.9 million deaths attributed to cardiovascular diseases, 9.3 million to cancer, 4.1 million to chronic respiratory diseases, and 2.0 million to diabetes. Consequently, the rising prevalence of chronic diseases stands as a significant factor propelling the growth of the pharmacy benefit management market.

Collaborative alliances represent a prominent trend within the pharmacy benefit management market, playing a pivotal role in facilitating market entry and expansion through the synergistic utilization of shared resources. A noteworthy illustration of this trend occurred in February 2021 when Navitus Health Solutions, a comprehensive pharmacy benefit management company based in the United States, forged a strategic partnership with WithMe Health, Inc. WithMe Health stands as a contemporary pharmacy benefit manager (PBM) alternative in the U.S., emphasizing a commitment to people, results, and overall cost of care. This strategic collaboration provides Navitus with access to WithMe Health's advanced medication guidance capabilities. This, in turn, enables employers and members to optimize the benefits derived from their medications by ensuring proper medication usage, offering support to maintain adherence, and effectively responding to therapy.

Prominent players in the pharmacy benefit management market are intensifying their emphasis on the introduction of digital prescription technology platforms as a strategic move to secure a competitive advantage. Digital prescription technology involves the utilization of electronic systems and software to generate, transmit, store, and manage prescriptions for medications. A notable example unfolded in October 2021 when Prescryptive Health, a healthcare technology company based in the United States, unveiled a Platform as a Service (PaaS) tailored for Pharmacy Benefit Managers (PBMs). This platform operates on the Prescryptive health intelligence platform and empowers PBMs to offer their members transparent pricing information for prescription drugs. The introduction of this service contributes to heightened prescription drug price transparency and consumer choice. Moreover, PBM sponsors leveraging this platform can achieve substantial savings of up to 40%, attributed to lower drug prices, strategic plan design, and enhanced employee engagement.

In January 2022, Centene, a prominent US-based managed care company specializing in healthcare solutions for individuals and families, successfully completed the acquisition of Magellan, a leading US-based entity renowned for its expertise in managing the most rapidly expanding and intricate segments of the healthcare industry. This strategic transaction, valued at $2.2 billion, positions Centene to deliver comprehensive, integrated healthcare solutions tailored for complex, high-cost populations. The acquisition aims to enhance health outcomes while concurrently achieving cost efficiencies within this specialized sector.

Major companies operating in the pharmacy benefit management market report are CVS Health Corporation, Cigna Corporation, Centene Corporation, Anthem Inc., OptumRx Inc., Humana Pharmacy Solutions Inc., Rite Aid Corporation, Magellan Health Inc., Prime Therapeutics LLC, MaxorPlus Ltd., RxAdvance Corp., MedImpact Healthcare Systems Inc., PerformRx LLC., Navitus Health Solutions LLC, WellDyneRx Inc., Healthesystems LLC., Catalyst Rx Inc., Argus Health Systems Inc., Innoviant Pharmacy Inc., Pharmaceutical Strategies Group, MedTrak Services LLC, ProCare Rx Inc., Managed Health Care Associates Inc., FutureScripts LLC., National CooperativeRx, ScriptCare Ltd., US Script Inc., LDI Integrated Pharmacy Services LLC, RxPreferred Benefits, ActiveRADAR Company, SinfoníaRx Inc.

North America was the largest region in the pharmacy benefit management market in 2023. Asia-Pacific is expected to be the fastest-growing region in the forecast period. The regions covered in the pharmacy benefit management market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa. The countries covered in the pharmacy benefit management market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The primary services offered by pharmacy benefit management (PBM) include mail-delivery, specialty pharmacy, and preferred network pharmacy. Mail-delivery involves the direct shipment of medicines to the desired location through mail-order delivery services. These services are extended across various types of PBMs, which include commercial health plans, self-insured employer plans, Medicare Part D plans, and the Federal Employees Health Benefits Program. Different types of PBMs serve major end-users, including pharmacy benefit management organizations, mail-order pharmacies, retail pharmacies, inpatient pharmacies, and outpatient pharmacies, catering to diverse needs within the healthcare sector.

The pharmacy benefit management market research report is one of a series of new reports that provides pharmacy benefit management market statistics, including pharmacy benefit management industry global market size, regional shares, competitors with a pharmacy benefit management market share, detailed pharmacy benefit management market segments, market trends and opportunities, and any further data you may need to thrive in the pharmacy benefit management industry. This pharmacy benefit management market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenarios of the industry.

The pharmacy benefit management market includes revenues earned by entities by providing case management, disease management, and drug utilization services. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.