The US pharmacy benefit manager market is highly lucrative in nature. It is anticipated to expand at a phenomenal CAGR during the forecast period (2017 to 2022). Growing geriatric population and high prevalence of chronic diseases are likely to drive the demand for pharmacy benefit manager (PBM) solutions. PBMs charge service fees to perform activities such as processing prescriptions, operating mail-order pharmacies, and negotiating with drug manufacturers.
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Growth in retail prescriptions and rising medical enrollments are anticipated to drive the market in the coming years. Increasing adoption of pharmacy benefit plans by senior citizens as a precautionary measure is expected to hike healthcare expenses. This, in turn, can impel the growth of the PBM market. Gradually increasing disposable income can also augment the uptake of pharmacy benefit manager in United States. In addition, improving economic conditions and growth in life expectancy rate are likely to contribute well to the growth of the market.
On the other hand, stringent legal regulations and high reimbursement rate pressure are likely to hinder market growth in the coming years. In addition, increasing prices of drugs and criticism faced by PBMs can create an obstruction in the growth of this market. Emerging popularity of biologics and generics is likely to increase competition in the market, thereby impeding the growth of the market.
Specialty drugs are highly effective in the treatment of chronic diseases such as rheumatoid arthritis, cancer, multiple sclerosis, and Hepatitis C. These drugs require proper prescription either by a physician or by a PBM. As these drugs are highly expensive, they are likely to create potential opportunities for pharmacy retailers.
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For instance, Amazon has recently obtained pharmacy licenses for around 12 states in the US and is likely to launch a pharmacy benefit manager business soon. The e-commerce giant is planning to resolve issues related to pricing and information of drugs in the market. For any marketplace to be efficient, it is important that consumers be provided with complete information about the product. In case of drugs, it is essential for any pharmacy benefit manager to provide complete information regarding the actual price of a drug, safety, effectiveness, and side effects. Amazon is planning to build two software systems to provide such information.
The United States pharmacy benefit manager market can be segmented on the basis of application and region. Based on application, the market can be segmented into drug stores, hospitals, department stores, surgery clinics, nursing homes, and medical clinics.
Regional segmentation of the pharmacy benefit manager market includes the West, Southwest, the Middle Atlantic, New England, the South, and the Midwest. Growing number of pharmacies in various parts of United States is likely to increase the demand for pharmacy benefit managers in the coming years. Supportive initiatives by the government to make people aware about the benefits of PBMs can augment growth in these regions. Growing necessity of PBMs to manage tough situations such as patent cliff and drug price inflation is likely to propel the market in United States during the forecast period (2017-2022).
Some of the key players contributing to the US pharmacy benefit manager market are CVS Health, Optum, Humana Pharmacy Solutions, Prime Therapeutics, and MedImpact.
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