U.S. Pharmacy Benefit Management MarketU.S. Pharmacy Benefit Management Market Decade Long Trends, Analysis and Forecast 2024-2032
U.S. Pharmacy Benefit Management Market by Service (Specialty Pharmacy Services, Benefit Plan Design & Administration, Pharmacy Claims Processing, Formulary Management, Others), by Service Provider (Insurance Companies, Retail Pharmacies, Standalone PBMs), by Forecast 2024-2032
Base Year: 2023
100 Pages
U.S. Pharmacy Benefit Management Market Decade Long Trends, Analysis and Forecast 2024-2032
Key Insights
The U.S. Pharmacy Benefit Management Market size was valued at USD 498.5 USD Million in 2023 and is projected to reach USD 744.62 USD Million by 2032, exhibiting a CAGR of 5.9 % during the forecast period. Pharmacy Benefit Management (PBM), in other words, is the role of institutions responsible for the management of prescription drug programs for health insurance companies, employers, as well as government programs. PBMs do the following functions: negotiate drug costs with drug makers, process reimbursement claims, and control drug usage. The PBMs could be entities operating as stand-alone, PBMs implemented inside of health plans, or pharmacy chains that have PBM services. Main PBM components such as formulary management, proper usage of medication, and prescription networks are the most common. Along the same lines, PBMs are equipped with support services such as mail-order pharmacy and specialty pharmacy management. In the US, pharmacy benefit managers (PBMs) assume control over the costs of medications and patients, drug access is a necessity. Market trends currently existing in PBM US are characterized by a high level of consolidation of PBMs, the introduction of a value-based approach, and technology application for data analysis and medication adherence programs.
U.S. Pharmacy Benefit Management Trends
- Increasing prevalence of chronic diseases
- Rising healthcare expenditure
- Technological advancements
Driving Forces: What's Propelling the U.S. Pharmacy Benefit Management Market
- Growing demand for cost-effective healthcare solutions
- Adoption of value-based care models
- Government regulations and programs
Challenges and Restraints in U.S. Pharmacy Benefit Management Market
- High drug prices
- Complex regulatory landscape
- Competition from retail pharmacies
Emerging Trends in U.S. Pharmacy Benefit Management
- Precision medicine
- Biosimilars
- Artificial intelligence and machine learning
Growth Catalysts in the U.S. Pharmacy Benefit Management Industry
- Government initiatives
- Partnerships between PBMs and healthcare providers
- Expansion of specialty pharmacy services
Market Segmentation: U.S. Pharmacy Benefit Management Analysis
Service:
- Specialty Pharmacy Services
- Benefit Plan Design & Administration
- Pharmacy Claims Processing
- Formulary Management
- Others
Service Provider:
- Insurance Companies
- Retail Pharmacies
- Standalone PBMs
Leading Players in the U.S. Pharmacy Benefit Management Market
- CVS Health
- Cigna
- OptumRx, Inc.
- Anthem, Inc.
- Abarca Health LLC
- Express Scripts
- Medimpact
- Walgreens Boots Alliance
- Humana Pharmacy Solutions
- Magellan Rx Management
Significant Developments in the U.S. Pharmacy Benefit Management Sector
- November 2021 - Anthem, Inc. agreed to acquire Integra Managed Care to increase its network.
- April 2021 - CVS Caremark allowed CVS Health to regain its specialty pharmacy business by entering into a larger pharmacy benefit management contract with a Government-wide Service Benefit Plan.
- September 2020 - Medimpact introduced a new solution to integrate prescription discount card saving with a traditional plan.
Comprehensive Coverage U.S. Pharmacy Benefit Management Market Report
- Market Overview:
- Detailed analysis of market size, growth rate, and revenue projections
- Assessment of market segmentation by product type, distribution channel, and end-user
- Market Dynamics:
- Identification of key market drivers and restraints influencing growth
- Exploration of industry trends and emerging opportunities
- Analysis of the impact of regulatory policies and healthcare reforms
- Competitive Landscape:
- Profiles of major market players and their market share
- Analysis of competitive strategies, product offerings, and market positioning
- Assessment of mergers and acquisitions, partnerships, and other industry developments
- Market Impact of COVID-19 Pandemic:
- Evaluation of the impact on the demand for pharmacy benefit management services
- Assessment of changes in market dynamics and competitive landscape
- Analysis of industry recovery and resilience strategies
- SWOT Analysis:
- Identification of strengths, weaknesses, opportunities, and threats facing the market
- Assessment of the strategic implications for market participants
- Development of insights for informed decision-making and market positioning
DROCs
- Drivers: Rising healthcare expenditure, growing demand for cost-effective solutions
- Restraints: High drug prices, complex regulatory landscape
- Opportunities: Precision medicine, value-based care models
- Challenges: Competition, changing reimbursement models
Pricing Analysis
- Pricing models and strategies
- Impact of generic drugs
- Role of government regulations
Import And Export Analysis
- Import and export trends
- Major importing and exporting countries
- Impact of international trade agreements
Segmentation
- Market segmentation based on service, service provider, and end-user
- Revenue share and growth prospects of each segment
Patent/Trademark Analysis
- Number of patents and trademarks granted
- Major patent holders
- Importance of IP protection
U.S. Pharmacy Benefit Management Market REPORT HIGHLIGHTS
| Aspects | Details |
|---|---|
| Study Period | 2018-2032 |
| Base Year | 2023 |
| Estimated Year | 2024 |
| Forecast Period | 2024-2032 |
| Historical Period | 2018-2023 |
| Growth Rate | CAGR of 5.9% from 2018-2032 |
| Segmentation |
|
Frequently Asked Questions
Table Of Content
- 1. Introduction
- 1.1. Research Scope
- 1.2. Market Segmentation
- 1.3. Research Methodology
- 1.4. Definitions and Assumptions
- 2. Executive Summary
- 2.1. Introduction
- 3. Market Dynamics
- 3.1. Introduction
- 3.2. Market Drivers
- 3.2.1. Introduction of Cost-effective Manufacturing Processes to Drive Market Growth
- 3.3. Market Restrains
- 3.3.1. High Costs for Patients & Healthcare System by Pharmacy Benefit Managers to Hinder Market Growth
- 3.4. Market Trends
- 3.4.1. Increasing Number of Hospitals and ASCs Identified as Significant Market Trend
- 4. Market Factor Analysis
- 4.1. Porters Five Forces
- 4.2. Supply/Value Chain
- 4.3. PESTEL analysis
- 4.4. Market Entropy
- 4.5. Patent/Trademark Analysis
- 5. U.S. Pharmacy Benefit Management Market Analysis, Insights and Forecast, 2018-2030
- 5.1. Market Analysis, Insights and Forecast - by Service
- 5.1.1. Specialty Pharmacy Services
- 5.1.2. Benefit Plan Design & Administration
- 5.1.3. Pharmacy Claims Processing
- 5.1.4. Formulary Management
- 5.1.5. Others
- 5.2. Market Analysis, Insights and Forecast - by Service Provider
- 5.2.1. Insurance Companies
- 5.2.2. Retail Pharmacies
- 5.2.3. Standalone PBMs
- 5.3. Market Analysis, Insights and Forecast - by Region
- 5.3.1.
- 5.1. Market Analysis, Insights and Forecast - by Service
- 6. Northeast U.S. Pharmacy Benefit Management Market Analysis, Insights and Forecast, 2018-2030
- 6.1. Market Analysis, Insights and Forecast - By Service
- 6.1.1 Specialty Pharmacy Services
- 6.1.2 Benefit Plan Design & Administration
- 6.1.3 Pharmacy Claims Processing
- 6.1.4 Formulary Management
- 6.1.5 and Others
- 6.2. Market Analysis, Insights and Forecast - By Service Provider
- 6.2.1 Insurance Companies
- 6.2.2 Retail Pharmacies
- 6.2.3 and Standalone PBMs
- 7. Southeast U.S. Pharmacy Benefit Management Market Analysis, Insights and Forecast, 2018-2030
- 7.1. Market Analysis, Insights and Forecast - By Service
- 7.1.1 Specialty Pharmacy Services
- 7.1.2 Benefit Plan Design & Administration
- 7.1.3 Pharmacy Claims Processing
- 7.1.4 Formulary Management
- 7.1.5 and Others
- 7.2. Market Analysis, Insights and Forecast - By Service Provider
- 7.2.1 Insurance Companies
- 7.2.2 Retail Pharmacies
- 7.2.3 and Standalone PBMs
- 8. Midwest U.S. Pharmacy Benefit Management Market Analysis, Insights and Forecast, 2018-2030
- 8.1. Market Analysis, Insights and Forecast - By Service
- 8.1.1 Specialty Pharmacy Services
- 8.1.2 Benefit Plan Design & Administration
- 8.1.3 Pharmacy Claims Processing
- 8.1.4 Formulary Management
- 8.1.5 and Others
- 8.2. Market Analysis, Insights and Forecast - By Service Provider
- 8.2.1 Insurance Companies
- 8.2.2 Retail Pharmacies
- 8.2.3 and Standalone PBMs
- 9. Southwest U.S. Pharmacy Benefit Management Market Analysis, Insights and Forecast, 2018-2030
- 9.1. Market Analysis, Insights and Forecast - By Service
- 9.1.1 Specialty Pharmacy Services
- 9.1.2 Benefit Plan Design & Administration
- 9.1.3 Pharmacy Claims Processing
- 9.1.4 Formulary Management
- 9.1.5 and Others
- 9.2. Market Analysis, Insights and Forecast - By Service Provider
- 9.2.1 Insurance Companies
- 9.2.2 Retail Pharmacies
- 9.2.3 and Standalone PBMs
- 10. West U.S. Pharmacy Benefit Management Market Analysis, Insights and Forecast, 2018-2030
- 10.1. Market Analysis, Insights and Forecast - By Service
- 10.1.1 Specialty Pharmacy Services
- 10.1.2 Benefit Plan Design & Administration
- 10.1.3 Pharmacy Claims Processing
- 10.1.4 Formulary Management
- 10.1.5 and Others
- 10.2. Market Analysis, Insights and Forecast - By Service Provider
- 10.2.1 Insurance Companies
- 10.2.2 Retail Pharmacies
- 10.2.3 and Standalone PBMs
- 11. Competitive Analysis
- 11.1. Market Share Analysis 2023
- 11.2. Company Profiles
- 11.2.1 CVS Health (U.S.)
- 11.2.1.1. Overview
- 11.2.1.2. Products
- 11.2.1.3. SWOT Analysis
- 11.2.1.4. Recent Developments
- 11.2.1.5. Financials (Based on Availability)
- 11.2.2 Cigna (U.S.)
- 11.2.2.1. Overview
- 11.2.2.2. Products
- 11.2.2.3. SWOT Analysis
- 11.2.2.4. Recent Developments
- 11.2.2.5. Financials (Based on Availability)
- 11.2.3 OptumRx Inc. (U.S.)
- 11.2.3.1. Overview
- 11.2.3.2. Products
- 11.2.3.3. SWOT Analysis
- 11.2.3.4. Recent Developments
- 11.2.3.5. Financials (Based on Availability)
- 11.2.4 Anthem Inc. (U.S.)
- 11.2.4.1. Overview
- 11.2.4.2. Products
- 11.2.4.3. SWOT Analysis
- 11.2.4.4. Recent Developments
- 11.2.4.5. Financials (Based on Availability)
- 11.2.5 Abarca Health LLC. (U.S.)
- 11.2.5.1. Overview
- 11.2.5.2. Products
- 11.2.5.3. SWOT Analysis
- 11.2.5.4. Recent Developments
- 11.2.5.5. Financials (Based on Availability)
- 11.2.6 Express Scripts (U.S.)
- 11.2.6.1. Overview
- 11.2.6.2. Products
- 11.2.6.3. SWOT Analysis
- 11.2.6.4. Recent Developments
- 11.2.6.5. Financials (Based on Availability)
- 11.2.7 Medimpact (U.S.)
- 11.2.7.1. Overview
- 11.2.7.2. Products
- 11.2.7.3. SWOT Analysis
- 11.2.7.4. Recent Developments
- 11.2.7.5. Financials (Based on Availability)
- 11.2.8 Walgreens Boots Alliance
- 11.2.8.1. Overview
- 11.2.8.2. Products
- 11.2.8.3. SWOT Analysis
- 11.2.8.4. Recent Developments
- 11.2.8.5. Financials (Based on Availability)
- 11.2.9 Humana Pharmacy Solutions
- 11.2.9.1. Overview
- 11.2.9.2. Products
- 11.2.9.3. SWOT Analysis
- 11.2.9.4. Recent Developments
- 11.2.9.5. Financials (Based on Availability)
- 11.2.10 Magellan Rx Management
- 11.2.10.1. Overview
- 11.2.10.2. Products
- 11.2.10.3. SWOT Analysis
- 11.2.10.4. Recent Developments
- 11.2.10.5. Financials (Based on Availability)
- 11.2.1 CVS Health (U.S.)
List of Figures
- Figure 1: U.S. Pharmacy Benefit Management Market Revenue Breakdown (USD Million, %) by Product 2023 & 2031
- Figure 2: U.S. Pharmacy Benefit Management Market Value Share (%), by Service 2023 & 2031
- Figure 3: U.S. Pharmacy Benefit Management Market Value Share (%), by Service Provider 2023 & 2031
- Figure 4: U.S. Pharmacy Benefit Management Market Share (%) by Company 2023
List of Tables
- Table 1: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service 2018 & 2031
- Table 2: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service Provider 2018 & 2031
- Table 3: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Region 2018 & 2031
- Table 4: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service 2018 & 2031
- Table 5: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service Provider 2018 & 2031
- Table 6: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Region 2018 & 2031
- Table 7: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service 2018 & 2031
- Table 8: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service Provider 2018 & 2031
- Table 9: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Country 2018 & 2031
- Table 10: Northeast U.S. Pharmacy Benefit Management Market Revenue (USD Million) Forecast, by Application 2018 & 2031
- Table 11: Southeast U.S. Pharmacy Benefit Management Market Revenue (USD Million) Forecast, by Application 2018 & 2031
- Table 12: Midwest U.S. Pharmacy Benefit Management Market Revenue (USD Million) Forecast, by Application 2018 & 2031
- Table 13: Southwest U.S. Pharmacy Benefit Management Market Revenue (USD Million) Forecast, by Application 2018 & 2031
- Table 14: West U.S. Pharmacy Benefit Management Market Revenue (USD Million) Forecast, by Application 2018 & 2031
- Table 15: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service 2018 & 2031
- Table 16: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Service Provider 2018 & 2031
- Table 17: U.S. Pharmacy Benefit Management Market Revenue USD Million Forecast, by Country 2018 & 2031
| Aspects | Details |
|---|---|
| Study Period | 2018-2032 |
| Base Year | 2023 |
| Estimated Year | 2024 |
| Forecast Period | 2024-2032 |
| Historical Period | 2018-2023 |
| Growth Rate | CAGR of 5.9% from 2018-2032 |
| Segmentation |
|
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