The U.S. pharmacy benefit management market is expected to grow at a CAGR of over 7% during the period 2019–2025.
The United States healthcare landscape is complex. It is riddled with wastage, drug abuse, and fraud due to a whirlwind of causative factors, putting patients at risk and creating a dilemma for insurers. It translates to high out-of-pocket costs, increased incidences of inappropriate spending, higher premiums, reduced benefits or coverage for consumers, increases cost of doling out insurance benefits for governments, and private employers. With a high number of consumers being enrolled in high-deductible health plans, there is a need for coordinated and broad effort to fix loopholes.
The following factors are likely to contribute to the growth of the US pharmacy benefit management market during the forecast period:
- Foray into Digital Health Solutions
- Growth in FDA Approvals for Orphan and Specialty Drugs
- Shift to Value/Outcomes-based Contracts
- Increased Engagement in High-touch Care Management
The study considers the present scenario of the U.S. pharmacy benefit management market and its market dynamics for the period 2019−2025. It covers a detailed overview of several market growth enablers, restraints, and trends. The study offers both the demand and supply aspects of the market. It profiles and examines leading companies and other prominent ones operating in the market.
U.S. Pharmacy Benefit Management Market – Vendor Profiles
Key Vendors
- CVS Caremark
- Express Scripts
- OptumRx
- Humana Pharmacy Solutions
Other Prominent Vendors
- Abarca Health
- Anthem
- AscellaHealth
- BeneCard PBF
- Centene
- Citizens Rx
- EnvisionRxOptions
- Excelera
- Magellan Rx Management
- MedalistRx
- MedImpact
- Prime Therapeutics
- MaxorPlus
- Navitus Health Solutions
- Perform Rx
- RxAdvance
- WellDyneRx
U.S. Pharmacy Benefit Management Market – Segmentation
Market Segmentation by Health Plans
- Commercial Health Plan
- Self-insured Employer Plan
- Medical Part D Plans
- Managed Medicaid Programs
- Other
Market Segmentation by Services
- Specialty Pharmacy Services
- Retail Pharmacy Services
- Mail-order Pharmacy Services
- Benefit Plan Design & Administration
- Formulary Management
- Clinical Programs & Services
- Others
Market Segmentation by Business Model
- Insurance Companies & Retail Pharmacies
- Pure Play PBMs
Market Segmentation by Geography
- US
U.S. Pharmacy Benefit Management Market – Table of Contents
1 Research Methodology
2 Research Objectives
3 Research Process
4 Scope & Coverage
4.1 Market Definition
4.1.1 Inclusion
4.1.2 Exclusion
4.2 Base Year
4.3 Scope Of The Study
4.4 Market Segments
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 State of the US Economy and healthcare industry
7.2 Pharmacy Benefits Management
7.2.1 Benefits
7.2.2 Value Chain
7.2.3 PBM Financial Arrangements
7.2.4 Success Factors
8 Growth Opportunities & Trends
8.1 Foray into Digital Health Solutions
8.2 Shift to Value / Outcomes-based Contracts
8.3 Move Away From a Standalone Mentality
8.4 Increased Engagement in High-Touch Care Management
9 Market Growth Enablers
9.1 Gaps in Information and Care in the Healthcare Industry
9.2 Growth in FDA Approvals for Orphan and Specialty Drugs
9.3 Prevalence of Fraud, Waste, and Abuse in Healthcare
9.4 Shift Towards Individualized Medicines
10 Market Restraints
10.1 Pbms Maligned And Scrutinized For Pricing
10.2 Declining Growth From Generics
10.3 Legal Uncertainty & Impending Limitations On Pbm Tools
10.4 Significant Delays Cause Dissatisfaction
11 Market Landscape
11.1 Market Size & Forecast
11.2 Five Forces Analysis
11.2.1 Threat of New Entrants
11.2.2 Bargaining Power of Suppliers
11.2.3 Bargaining Power of Buyers
11.2.4 Threat of Substitutes
11.2.5 Competitive Rivalry
12 Service
12.1 Market Snapshot & Growth Engine
12.2 Market Overview
12.3 Specialty Pharmacy Services
12.3.1 Market Size & Forecast
12.4 Retail Pharmacy Services
12.4.1 Market Size & Forecast
12.5 Mail-order Pharmacy Services
12.5.1 Market Size & Forecast
12.6 Benefit Plan Design and Administration
12.6.1 Market Size & Forecast
12.7 Formulary Management
12.7.1 Market Size & Forecast
12.8 Clinical Programs and Services
12.8.1 Market Size & Forecast
12.9 Others
12.9.1 Market Size & Forecast
13 Health Plan
13.1 Market Snapshot & Growth Engine
13.2 Market Overview
13.3 Commercial Health Plans
13.3.1 Market Size & Forecast
13.4 Medicare Part D Plans
13.4.1 Market Size & Forecast
13.5 Self-insured Health Plans
13.5.1 Market Size & Forecast
13.6 Managed Medicaid Programs
13.6.1 Market Size & Forecast
13.7 Others
13.7.1 Market Size & Forecast
14 Business Model
14.1 Market Snapshot & Growth Engine
14.2 Market Overview
14.3 Insurance Companies and Retail Pharmacies
14.3.1 Market Size & Forecast
14.4 Pure Play PBMs
14.4.1 Market Size & Forecast
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