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

Description

List of Tables

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

Product Code: Sample_Pharmacy Benefit Management (PBM) Market in the US - Industry Outlook & Forecast 2022-2027_Arizton.pdf

1 RESEARCH METHODOLOGY

2 RESEARCH OBJECTIVES

3 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