U.S. Pharmacy Benefit Management Market Size to Cross $700 Billion by 2025 – Arizton

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.


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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


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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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