Global pharmacy benefit management market

Pharmacy Benefit Management Market Size, Share, Growth Analysis, By Services(Speciality pharmacy services, Benefit plan design & administration, Pharmacy claims processing, Formulary management), By Services Provider(Insurance companies, Retail pharmacies, Standalone PBMs), By Business Model(Government Health Programs, Employer-Sponsored Programs, Health Insurance Management), By Application(Mail-Order Pharmacy Services, Non-Mail Pharmacy Services), By Type(Commercial Health Plans, Self-Insured Employer Plans, Medicare Part D Plans, Federal Employees Health Benefits Program), By Region - Industry Forecast 2024-2031


Report ID: SQMIG45I2098 | Region: Global | Published Date: July, 2001
Pages: 157 |Tables: 147 |Figures: 78

Pharmacy Benefit Management Market Insights

Pharmacy Benefit Management Market size was valued at USD 60.75 billion in 2019 and is poised to grow from USD 66.87 billion in 2023 to USD 144.6 billion by 2031, growing at a CAGR of 10.12% in the forecast period (2024-2031).

PBM refers to a system in which a third-party administrator oversees prescription drug programmes on behalf of health insurers, pharmacies, drug makers, and so on. This system performs critical tasks at many levels of the pharmaceutical supply chain, from financing to determining dispensing policies. PBM firms also handle generic drug replacement, negotiate drug rebates with manufacturers and pharmacies, and work on drug formulary formulation and management. As a result, they offer a variety of services, such as specialised pharmacy services, retail pharmacy services, prescription formulary management, disease management services, benefit plan design and advice, and so on.

Due to factors such as an increase in the requirement to reduce medication errors, fast regionalization of pharmacies, an increase in the geriatric population, and an increase in labour expenses, the pharmacy benefit management market is predicted to grow significantly during the forecast period. However, a lack of willingness to implement pharmacy automation technologies, as well as tight legal procedures governing client confidentiality, are impeding the expansion of the pharmacy benefit management business. On the contrary, increased awareness among pharmacists and healthcare providers about cost-cutting strategies and Pharmacy benefit management services is likely to give attractive chances for market expansion throughout the projection period.

US Pharmacy Benefit Management Market  is poised to grow at a sustainable CAGR for the next forecast year.

Market Snapshot - 2024-2031

Global Market Size

USD 60.75 billion

Largest Segment

Speciality pharmacy services

Fastest Growth

Speciality pharmacy services

Growth Rate

10.12% CAGR

Global Pharmacy Benefit Management Market ($ Bn)
Country Share for North America Region (%)

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Pharmacy Benefit Management Market Segmental Analysis

Global pharmacy benefit management market is segmented based on service, service provider, business model, application, type, and region. Based on service market is segmented into speciality pharmacy services, benefit plan design & administration, pharmacy claims processing, formulary management, others. By business model, the Pharmacy Benefit Management Market is segmented into Government Health Programs, Employer-Sponsored Programs, and Health Insurance Management. Based on application, the Pharmacy Benefit Management Market is segmented into Mail-Order Pharmacy Services, Non-Mail Pharmacy Services. Based on type, the Pharmacy Benefit Management Market is segmented into Commercial Health Plans, Self-Insured Employer Plans, Medicare Part D Plans, Federal Employees Health Benefits Program, State Government Employee Plans. Based on service provider, Pharmacy Benefit Management Market is segmented into insurance companies, retail pharmacies, standalone PBMs. Based on region, market is segmented into North America, Asia Pacific, Europe, Latin America and Middle East Africa.

Pharmacy Benefit Management Market Analysis by Service:

Rising demand for specialty pharmaceuticals resulted in segment dominance. In 2022, the specialty pharmacy services sector held the most market share. The increasing prevalence of chronic and uncommon diseases is driving up demand for treatment options such as speciality medications. High-priced medications, on the other hand, are out of reach for the vast majority of patients. This increases the demand for these services, lowering the cost of specialised pharmaceuticals to an affordable level. This results in the specialist pharmacy services industry, among other services, dominating. 
The benefit plan design and administration industry, on the other hand, is predicted to increase at the fastest CAGR. The increasing number of people opting for medical insurance coverage and benefit plan design for their medical treatment is one of the primary causes ascribed to this segment's highest CAGR. According to the Indian Express Ltd., the proportion of Indians choosing for a medical insurance coverage with a bigger sum insured covered has risen from 35%in 2021 to 89% in 2022.

Global Pharmacy Benefit Management Market By Services, 2023 (%)

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Pharmacy Benefit Management Market Regional Insights

Based on region, global pharmacy benefit management market is segmented into North America, Asia Pacific, Europe, Latin America and Middle East Africa. In 2022, North America dominated the global market. The presence of a large patient population covered by medical insurance, the availability of advantageous government laws for pharmacy benefit managers, and the growing number of pharmacy benefit managers in the country are all important factors contributing to the region's supremacy. 
According to The National Association of Insurance Commissioners report, there will be around 66 PBM businesses serving more than 270 million Americans in March 2021. During the forecast period, Canada is expected to expand at the fastest CAGR. An increase in pharmaceutical spending and a rise in prescription filings in Canada are driving up demand for these services in this country.

During the forecast period, the Rest of the World market is expected to rise at a considerable CAGR. An increase in the number of health awareness initiatives and health plans offered by insurance carriers in Brazil and South Africa is expected to increase the adoption rate of pharmacy services. As a result, demand for and acceptance of these services will increase, significantly boosting market growth.

Global Pharmacy Benefit Management Market By Region, 2024-2031
  • Largest
  • Fastest

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Pharmacy Benefit Management Market Dynamics

Pharmacy Benefit Management Market Drivers

Increasing Pharmaceutical Costs Drive Market Growth

  • The rising prevalence of chronic diseases among the world's population is driving up demand for treatment solutions. As a result, several large pharmaceutical corporations are focusing their efforts on producing high-priced branded drugs for the treatment of chronic disorders. This has resulted in a huge increase in pharmaceutical spending in recent years. This, combined with an increase in prescription registrations in recent years for a wide variety of chronic conditions such as cardiovascular disease, chronic lung disease, and others, is driving up healthcare costs. 
  • As a result, a considerable increase in drug costs, combined with an increase in the number of prescriptions filed internationally, is increasing the health-care burden. This has resulted in increased demand and uptake for these services to lower drug costs and control pharmaceutical spending globally, as well as aid market expansion.

Pharmacy Benefit Management Market Restraint

Profit Earnings Lack Transparency Hampering Adoption

  • An increase in medicine spending and an increase in prescription filings internationally are important factors driving market expansion. However, concerns of transparency related to business models are constantly a subject of worry in pharmaceutical benefit management services. 
  • These services' revenue sources are rarely revealed to insurance providers, retail pharmacy units, or drug makers. As a result, a significant amount of medicine expenses are passed on to service providers. As a result, medication producers and insurance companies are seeing a huge drop in profits. As a result, the majority of insurance companies get into limited partnerships with PBMs. As a result, the adoption rate of these services is gradual which is expected to impede the market growth throughout the study period.

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Pharmacy Benefit Management Market Competitive Landscape

The pharmacy benefit management market is characterised by the presence of well-established players as well as several small and medium-sized players. These manufacturers are pursuing a variety of strategies, including new product launches, product portfolio expansion, and mergers and acquisitions. Several large firms are forming multiple strategic alliances in order to increase their market share and get a competitive edge.

Top Players in the Global Pharmacy Benefit Management Market

  • Express Scripts Holding Company
  • CVS Health Corporation
  • OptumRx, Inc.
  • Prime Therapeutics LLC
  • Humana Pharmacy Solutions, Inc.
  • MedImpact Healthcare Systems, Inc.
  • Magellan Health, Inc.
  • Cigna Corporation
  • Aetna Inc.
  • Anthem, Inc.
  • UnitedHealth Group Incorporated
  • WellDyneRx, LLC
  • Navitus Health Solutions, LLC
  • PerformRx, LLC
  • EnvisionRxOptions, LLC
  • IngenioRx, Inc.
  • Argus Health Systems, Inc.
  • ScriptCare, Ltd.
  • Catalyst Rx, Inc.
  • Curascript Specialty Distribution, Inc.

Pharmacy Benefit Management Market Recent Developments

  • In January 2022, Centene Corporation acquired Magellan Health, Inc. in order to provide whole-health, integrated healthcare solutions with improved health outcomes at a lower cost.
  • In 2022, Optum, a diversified health services company, and Change Healthcare, a leading provider of healthcare technology, collaborated to extend their merger agreement. Optum and Change Healthcare's merger intends to connect and simplify the core clinical, administrative, and payment processes that health care providers and payers rely on to serve patients. 

Pharmacy Benefit Management Key Market Trends

  • Increased Use of Machine Learning to Simplify Workflow:  The increasing acceptance of PBM services among insurance companies, retail pharmacy chains, and drug manufacturers is moving service providers' preferences from traditional workflow to advanced workflow incorporating machine learning. As a result, the companies can provide a simplified supply chain, speedy mail order delivery, and service a wide number of insurance and retail pharmacy chains in a short period of time. 
  • Use of Blended Technologies: Prominent players are integrating machine learning and artificial intelligence (AI) technologies to reduce human error. Thus, the incorporation of machine learning and Al technology into the workflow enables businesses to reduce the medical costs while increasing the efficiency of medical procedures.

Pharmacy Benefit Management Market SkyQuest Analysis

SkyQuest’s ABIRAW (Advanced Business Intelligence, Research & Analysis Wing) is our Business Information Services team that Collects, Collates, Co-relates, and Analyses the Data collected utilizing Primary Exploratory Research backed by the robust Secondary Desk research.

According to the global pharmacy benefit management market report analysis, affordability and customisation of healthcare plans are projected to attract a high number of people towards getting insured. As a result, increase in the healthcare provider numbers and better healthcare plans will drive market growth. More consumers are turning to PBM solutions for better access to medications across several retail pharmacy networks. Furthermore, the increased availability of equivalent pharmaceuticals with slight changes in their APIs on the market has enhanced the price sensitivity of these therapies. As a result, PBM systems that provide pharmaceutical formularies for all drugs covered by their benefit plans, with manufacturers prepared to offer discounts are in high demand.

Report Metric Details
Market size value in 2023 USD 60.75 billion
Market size value in 2031 USD 144.6 billion
Growth Rate 10.12%
Forecast period 2024-2031
Forecast Unit (Value) USD Billion
Segments covered
  • Services
    • Speciality pharmacy services, Benefit plan design & administration, Pharmacy claims processing, Formulary management, Others
  • Services Provider
    • Insurance companies, Retail pharmacies, Standalone PBMs
  • Business Model
    • Government Health Programs, Employer-Sponsored Programs, Health Insurance Management
  • Application
    • Mail-Order Pharmacy Services, Non-Mail Pharmacy Services
  • Type
    • Commercial Health Plans, Self-Insured Employer Plans, Medicare Part D Plans, Federal Employees Health Benefits Program, State Government Employee Plans
Regions covered North America (US, Canada), Europe (Germany, France, United Kingdom, Italy, Spain, Rest of Europe), Asia Pacific (China, India, Japan, Rest of Asia-Pacific), Latin America (Brazil, Rest of Latin America), Middle East & Africa (South Africa, GCC Countries, Rest of MEA)
Companies covered
  • Express Scripts Holding Company
  • CVS Health Corporation
  • OptumRx, Inc.
  • Prime Therapeutics LLC
  • Humana Pharmacy Solutions, Inc.
  • MedImpact Healthcare Systems, Inc.
  • Magellan Health, Inc.
  • Cigna Corporation
  • Aetna Inc.
  • Anthem, Inc.
  • UnitedHealth Group Incorporated
  • WellDyneRx, LLC
  • Navitus Health Solutions, LLC
  • PerformRx, LLC
  • EnvisionRxOptions, LLC
  • IngenioRx, Inc.
  • Argus Health Systems, Inc.
  • ScriptCare, Ltd.
  • Catalyst Rx, Inc.
  • Curascript Specialty Distribution, Inc.
Customization scope

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  • Market dynamics & outlook
  • Region

Historical Year 2019

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Table Of Content

Executive Summary

Market overview

  • Exhibit: Executive Summary – Chart on Market Overview
  • Exhibit: Executive Summary – Data Table on Market Overview
  • Exhibit: Executive Summary – Chart on Pharmacy Benefit Management Market Characteristics
  • Exhibit: Executive Summary – Chart on Market by Geography
  • Exhibit: Executive Summary – Chart on Market Segmentation
  • Exhibit: Executive Summary – Chart on Incremental Growth
  • Exhibit: Executive Summary – Data Table on Incremental Growth
  • Exhibit: Executive Summary – Chart on Vendor Market Positioning

Parent Market Analysis

Market overview

Market size

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • SWOT Analysis

KEY MARKET INSIGHTS

  • Technology Analysis
    • (Exhibit: Data Table: Name of technology and details)
  • Pricing Analysis
    • (Exhibit: Data Table: Name of technology and pricing details)
  • Supply Chain Analysis
    • (Exhibit: Detailed Supply Chain Presentation)
  • Value Chain Analysis
    • (Exhibit: Detailed Value Chain Presentation)
  • Ecosystem Of the Market
    • Exhibit: Parent Market Ecosystem Market Analysis
    • Exhibit: Market Characteristics of Parent Market
  • IP Analysis
    • (Exhibit: Data Table: Name of product/technology, patents filed, inventor/company name, acquiring firm)
  • Trade Analysis
    • (Exhibit: Data Table: Import and Export data details)
  • Startup Analysis
    • (Exhibit: Data Table: Emerging startups details)
  • Raw Material Analysis
    • (Exhibit: Data Table: Mapping of key raw materials)
  • Innovation Matrix
    • (Exhibit: Positioning Matrix: Mapping of new and existing technologies)
  • Pipeline product Analysis
    • (Exhibit: Data Table: Name of companies and pipeline products, regional mapping)
  • Macroeconomic Indicators

COVID IMPACT

  • Introduction
  • Impact On Economy—scenario Assessment
    • Exhibit: Data on GDP - Year-over-year growth 2016-2022 (%)
  • Revised Market Size
    • Exhibit: Data Table on Pharmacy Benefit Management Market size and forecast 2021-2027 ($ million)
  • Impact Of COVID On Key Segments
    • Exhibit: Data Table on Segment Market size and forecast 2021-2027 ($ million)
  • COVID Strategies By Company
    • Exhibit: Analysis on key strategies adopted by companies

MARKET DYNAMICS & OUTLOOK

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • Regulatory Landscape
    • Exhibit: Data Table on regulation from different region
  • SWOT Analysis
  • Porters Analysis
    • Competitive rivalry
      • Exhibit: Competitive rivalry Impact of key factors, 2021
    • Threat of substitute products
      • Exhibit: Threat of Substitute Products Impact of key factors, 2021
    • Bargaining power of buyers
      • Exhibit: buyers bargaining power Impact of key factors, 2021
    • Threat of new entrants
      • Exhibit: Threat of new entrants Impact of key factors, 2021
    • Bargaining power of suppliers
      • Exhibit: Threat of suppliers bargaining power Impact of key factors, 2021
  • Skyquest special insights on future disruptions
    • Political Impact
    • Economic impact
    • Social Impact
    • Technical Impact
    • Environmental Impact
    • Legal Impact

Market Size by Region

  • Chart on Market share by geography 2021-2027 (%)
  • Data Table on Market share by geography 2021-2027(%)
  • North America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • USA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Canada
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Europe
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Germany
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Spain
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • France
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • UK
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Europe
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Asia Pacific
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • China
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • India
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Japan
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Korea
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Asia Pacific
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Latin America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Brazil
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of South America
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Middle East & Africa (MEA)
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • GCC Countries
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Africa
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of MEA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)

KEY COMPANY PROFILES

  • Competitive Landscape
    • Total number of companies covered
      • Exhibit: companies covered in the report, 2021
    • Top companies market positioning
      • Exhibit: company positioning matrix, 2021
    • Top companies market Share
      • Exhibit: Pie chart analysis on company market share, 2021(%)

Methodology

For the Pharmacy Benefit Management Market, our research methodology involved a mixture of primary and secondary data sources. Key steps involved in the research process are listed below:

1. Information Procurement: This stage involved the procurement of Market data or related information via primary and secondary sources. The various secondary sources used included various company websites, annual reports, trade databases, and paid databases such as Hoover's, Bloomberg Business, Factiva, and Avention. Our team did 45 primary interactions Globally which included several stakeholders such as manufacturers, customers, key opinion leaders, etc. Overall, information procurement was one of the most extensive stages in our research process.

2. Information Analysis: This step involved triangulation of data through bottom-up and top-down approaches to estimate and validate the total size and future estimate of the Pharmacy Benefit Management Market.

3. Report Formulation: The final step entailed the placement of data points in appropriate Market spaces in an attempt to deduce viable conclusions.

4. Validation & Publishing: Validation is the most important step in the process. Validation & re-validation via an intricately designed process helped us finalize data points to be used for final calculations. The final Market estimates and forecasts were then aligned and sent to our panel of industry experts for validation of data. Once the validation was done the report was sent to our Quality Assurance team to ensure adherence to style guides, consistency & design.

Analyst Support

Customization Options

With the given market data, our dedicated team of analysts can offer you the following customization options are available for the Pharmacy Benefit Management Market:

Product Analysis: Product matrix, which offers a detailed comparison of the product portfolio of companies.

Regional Analysis: Further analysis of the Pharmacy Benefit Management Market for additional countries.

Competitive Analysis: Detailed analysis and profiling of additional Market players & comparative analysis of competitive products.

Go to Market Strategy: Find the high-growth channels to invest your marketing efforts and increase your customer base.

Innovation Mapping: Identify racial solutions and innovation, connected to deep ecosystems of innovators, start-ups, academics, and strategic partners.

Category Intelligence: Customized intelligence that is relevant to their supply Markets will enable them to make smarter sourcing decisions and improve their category management.

Public Company Transcript Analysis: To improve the investment performance by generating new alpha and making better-informed decisions.

Social Media Listening: To analyze the conversations and trends happening not just around your brand, but around your industry as a whole, and use those insights to make better Marketing decisions.

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FAQs

Pharmacy Benefit Management Market size was valued at USD 60.75 billion in 2019 and is poised to grow from USD 66.87 billion in 2023 to USD 144.6 billion by 2031, growing at a CAGR of 10.12% in the forecast period (2024-2031).

The pharmacy benefit management market is characterised by the presence of well-established players as well as several small and medium-sized players. These manufacturers are pursuing a variety of strategies, including new product launches, product portfolio expansion, and mergers and acquisitions. Several large firms are forming multiple strategic alliances in order to increase their market share and get a competitive edge. 'Express Scripts Holding Company', 'CVS Health Corporation', 'OptumRx, Inc.', 'Prime Therapeutics LLC', 'Humana Pharmacy Solutions, Inc.', 'MedImpact Healthcare Systems, Inc.', 'Magellan Health, Inc.', 'Cigna Corporation', 'Aetna Inc.', 'Anthem, Inc.', 'UnitedHealth Group Incorporated', 'WellDyneRx, LLC', 'Navitus Health Solutions, LLC', 'PerformRx, LLC', 'EnvisionRxOptions, LLC', 'IngenioRx, Inc.', 'Argus Health Systems, Inc.', 'ScriptCare, Ltd.', 'Catalyst Rx, Inc.', 'Curascript Specialty Distribution, Inc.'

The rising prevalence of chronic diseases among the world's population is driving up demand for treatment solutions. As a result, several large pharmaceutical corporations are focusing their efforts on producing high-priced branded drugs for the treatment of chronic disorders. This has resulted in a huge increase in pharmaceutical spending in recent years. This, combined with an increase in prescription registrations in recent years for a wide variety of chronic conditions such as cardiovascular disease, chronic lung disease, and others, is driving up healthcare costs. 

Increased Use of Machine Learning to Simplify Workflow:  The increasing acceptance of PBM services among insurance companies, retail pharmacy chains, and drug manufacturers is moving service providers' preferences from traditional workflow to advanced workflow incorporating machine learning. As a result, the companies can provide a simplified supply chain, speedy mail order delivery, and service a wide number of insurance and retail pharmacy chains in a short period of time. 

Based on region, pharmacy benefit management market is segmented into North America, Asia Pacific, Europe, Latin America and Middle East Africa. In 2022, North America dominated the market. The presence of a large patient population covered by medical insurance, the availability of advantageous government laws for pharmacy benefit managers, and the growing number of pharmacy benefit managers in the country are all important factors contributing to the region's supremacy. According to The National Association of Insurance Commissioners report, there will be around 66 PBM businesses serving more than 270 million Americans in March 2021. During the forecast period, Canada is expected to expand at the fastest CAGR. An increase in pharmaceutical spending and a rise in prescription filings in Canada are driving up demand for these services in this country.

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