U.S. Pharmacy Benefit Management Market Size, Share & Trends Analysis Report By Business Model (Standalone, Health Insurance Providers, Retail Pharmacy), By End Use (Commercial, Federal), And Segment Forecasts, 2023 - 2030
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U.S. Pharmacy Benefit Management Market Growth & Trends
The U.S. pharmacy benefit management market size is expected to reach USD 934.0 billion by 2030, exhibiting a CAGR of 8.77% from 2023 to 2030, according to a new report by Grand View Research, Inc. Increase in healthcare cost, the growing preference for pharmacy benefit management (PBM), and increased demand for prescription drugs are primarily driving the market growth.
PBMs operate with specialty pharmacies to enable beneficiaries to better adherence. These systems provide wide expertise and connections with pharmaceutical companies that can be beneficial to establish drug contracts. Payers find it difficult to establish value-based contracts with pharmaceutical companies. Therefore, payers promote themselves as negotiators and tend to receive considerable discounts on prescription drugs
The vertical integration of pharmacy benefit management (PBM) organizations with health insurance companies is poised to result in increased control of PBMs over distribution systems. This is likely to cause a rise in rebates, ultimately increasing the cost of drug list prices. Moreover, it will result in a monopoly of a certain market player, concentrating sales and revenue generation.
The business of insuring and administering employee benefit programs in the country, especially, health care programs, is heavily regulated by federal and state laws and administrative agencies, such as the Department of Health and Human Services (HHS), State Departments of Insurance, Centers for Medicare & Medicaid Services (CMS), Internal Revenue Services, and Departments of Labor.
The U.S. market for PBM is further fueled by the increasing number of mergers and collaborations between pharmacy benefit management businesses and health insurance providers for bettering the affordability and customization of health insurance policies. Additionally, the launch of enhanced benefit management services, such as disease management, drug utilization programmes, and pharmacy-medical integrated goods, is expected to bode well for the market.
U.S. Pharmacy Benefit Management Market Report Highlights
U.S. Pharmacy Benefit Management Market Growth & Trends
The U.S. pharmacy benefit management market size is expected to reach USD 934.0 billion by 2030, exhibiting a CAGR of 8.77% from 2023 to 2030, according to a new report by Grand View Research, Inc. Increase in healthcare cost, the growing preference for pharmacy benefit management (PBM), and increased demand for prescription drugs are primarily driving the market growth.
PBMs operate with specialty pharmacies to enable beneficiaries to better adherence. These systems provide wide expertise and connections with pharmaceutical companies that can be beneficial to establish drug contracts. Payers find it difficult to establish value-based contracts with pharmaceutical companies. Therefore, payers promote themselves as negotiators and tend to receive considerable discounts on prescription drugs
The vertical integration of pharmacy benefit management (PBM) organizations with health insurance companies is poised to result in increased control of PBMs over distribution systems. This is likely to cause a rise in rebates, ultimately increasing the cost of drug list prices. Moreover, it will result in a monopoly of a certain market player, concentrating sales and revenue generation.
The business of insuring and administering employee benefit programs in the country, especially, health care programs, is heavily regulated by federal and state laws and administrative agencies, such as the Department of Health and Human Services (HHS), State Departments of Insurance, Centers for Medicare & Medicaid Services (CMS), Internal Revenue Services, and Departments of Labor.
The U.S. market for PBM is further fueled by the increasing number of mergers and collaborations between pharmacy benefit management businesses and health insurance providers for bettering the affordability and customization of health insurance policies. Additionally, the launch of enhanced benefit management services, such as disease management, drug utilization programmes, and pharmacy-medical integrated goods, is expected to bode well for the market.
U.S. Pharmacy Benefit Management Market Report Highlights
- The standalone segment accounted for the largest revenue share in 2022 owing to the high number of claims processing by PBM. The health insurance segment is expected to witness a significant growth rate during the forecast period
- Based on end-use, the commercial segment accounted for the largest market share in 2022. The growth of the segment is attributed due to the proliferated usage of private insurance by the public and the increased cost of drugs
- In February 2022, Southern Scripts, one of the top PBM launched RxCompass, a new solution for mitigating the high cost of prescription drugs for companies and employees in the U.S.
- In July 2021, major insurers Humana and Anthem announced a partnership with SS&C, a software solutions provider to create a new PBM company named DomaniRx
CHAPTER 1 REPORT SCOPE AND OBJECTIVES
1.1 Market Segmentation
1.2 Regional Scope
1.3 Estimates and Forecast Timeline
1.4 Research Objectives
1.4.1 Objective -
1.4.2 Objective -
1.4.3 Objective -
CHAPTER 2 METHODOLOGY
2.1 Research Methodology
2.2 Information Procurement
2.2.1 Purchased Database
2.2.2 GVR’s Internal Database
2.2.3 Secondary Sources
2.2.4 Primary Research
2.2.5 Details of Primary Research
2.3 Information or Data Analysis
2.3.1 Data Analysis Models
2.4 Market Formulation & Validation
2.5 Model Details
2.5.1 Commodity Flow Analysis
2.6 List of Secondary Sources
2.7 List of Abbreviations
CHAPTER 3 EXECUTIVE SUMMARY
3.1 Market Outlook
3.2 Segment Outlook
3.2.1 Business Model
3.2.2 End - use
3.3Competitive Insights
CHAPTER 4 MARKET VARIABLES, TRENDS & SCOPE
4.1 Market Lineage outlook
4.1.1 Parent market outlook
4.1.2 Ancillary/related market outlook
4.2 Market Dynamics
4.2.1 Market driver analysis
4.2.1.1 Vertical integration of key market players
4.2.1.2 Introduction of improved health benefit plans
4.2.1.3 Growing prevalence of chronic diseases in the U.S.
4.2.2 Market restraint analysis
4.2.2.1 Stringent regulations to cut back rebates
4.3 Penetration & Growth Prospect Mapping
4.4 Business Environment Analysis Tools
4.4.1 Porter’s Five Forces analysis
4.4.1.1 Competitive rivalry
4.4.1.2 Threat of new entrants
4.4.1.3 Bargaining power of buyers
4.4.1.4 Bargaining power of suppliers
4.4.1.5 Threat of substitutes
4.4.2 PESTEL Analysis
4.4.2.1 Political landscape
4.4.2.2 Economic and social landscape
4.4.2.3 Technological landscape
4.3 Impact of COVID - 19: Qualitative Analysis
CHAPTER 5 U.S. PHARMACY BENEFIT MANAGEMENT MARKET: BUSINESS MODEL ANALYSIS
5.1 U.S. Pharmacy Benefit Management Business Model Market Share Analysis, 2022 & 2030
5.2 U.S. Pharmacy Benefit Management Business Model Market: Segment Dashboard
5.3 Market Size & Forecasts and Trend Analyses, 2017 to 2030 for the Business Model Segment
5.3.1 Standalone PBM
5.3.1.1 Standalone PBM market, 2017 - 2030 (USD Billion)
5.3.2 Health Insurance Providers
5.3.2.1 Health insurance providers market, 2017 - 2030 (USD Billion)
5.3.3 Retail Pharmacy
5.3.3.1 Retail pharmacy market, 2017 - 2030 (USD Billion)
CHAPTER 6 U.S. PHARMACY BENEFIT MANAGEMENT MARKET: END - USE ANALYSIS
6.1 U.S. Pharmacy Benefit Management End - use Market Share Analysis, 2022 & 2030
6.2 U.S. Pharmacy Benefit Management End - use Market: Segment Dashboard
6.3 Market Size & Forecasts and Trend Analyses, 2017 to 2030 for the End - use Segment
6.3.1 Commercial
6.3.1.1 Commercial market, 2017 - 2030 (USD Billion)
6.3.2 Federal
6.3.2.1 Federal market, 2017 - 2030 (USD Billion)
CHAPTER 7 COMPETITIVE ANALYSIS
7.1 Recent Developments & Impact Analysis, by Key Market Participants
7.2 Competition Categorization (Key innovators, Market leaders, Emerging Players
7.3 Company Market Position Analysis
7.4 Company Profiles
7.4.1 CVS HEALTH
7.4.1.1 Company overview
7.4.1.2 Financial performance
7.4.1.3 Service benchmarking
7.4.1.4 Strategic initiatives
7.4.2 Elixir Rx Solutions LLC
7.4.2.1 Company overview
7.4.2.2 Service benchmarking
7.4.2.3 Strategic initiatives
7.4.3 Optum, Inc
7.4.3.1 Company overview
7.4.3.2 Financial performance
7.4.3.2 Service benchmarking
7.4.3.3 Strategic initiatives
7.4.4 Cigna
7.4.4.1 Company overview
7.4.4.2 Financial performance
7.4.4.2 Service benchmarking
7.4.4.3 Strategic initiatives
7.4.5 Change Healthcare
7.4.5.1 Company overview
7.4.5.2 Service benchmarking
7.4.5.3 Strategic initiatives
7.4.6 MedImpact
7.4.6.1 Company overview
7.4.6.2 Financial performance
7.4.6.3 Service benchmarking
7.4.6.4 Strategic initiatives
7.4.7 Prime Therapeutics LLC
7.4.7.1 Company overview
7.4.7.2 Service benchmarking
7.4.7.3 Strategic initiatives
7.4.8 HUB International Limited.
7.4.8.1 Company overview
7.4.8.2 Service benchmarking
7.4.8.3 Strategic initiatives
7.4.9 Anthem
7.4.9.1 Company overview
7.4.9.2 Financial performance
7.4.9.3 Service benchmarking
7.4.9.4 Strategic initiatives??
1.1 Market Segmentation
1.2 Regional Scope
1.3 Estimates and Forecast Timeline
1.4 Research Objectives
1.4.1 Objective -
1.4.2 Objective -
1.4.3 Objective -
CHAPTER 2 METHODOLOGY
2.1 Research Methodology
2.2 Information Procurement
2.2.1 Purchased Database
2.2.2 GVR’s Internal Database
2.2.3 Secondary Sources
2.2.4 Primary Research
2.2.5 Details of Primary Research
2.3 Information or Data Analysis
2.3.1 Data Analysis Models
2.4 Market Formulation & Validation
2.5 Model Details
2.5.1 Commodity Flow Analysis
2.6 List of Secondary Sources
2.7 List of Abbreviations
CHAPTER 3 EXECUTIVE SUMMARY
3.1 Market Outlook
3.2 Segment Outlook
3.2.1 Business Model
3.2.2 End - use
3.3Competitive Insights
CHAPTER 4 MARKET VARIABLES, TRENDS & SCOPE
4.1 Market Lineage outlook
4.1.1 Parent market outlook
4.1.2 Ancillary/related market outlook
4.2 Market Dynamics
4.2.1 Market driver analysis
4.2.1.1 Vertical integration of key market players
4.2.1.2 Introduction of improved health benefit plans
4.2.1.3 Growing prevalence of chronic diseases in the U.S.
4.2.2 Market restraint analysis
4.2.2.1 Stringent regulations to cut back rebates
4.3 Penetration & Growth Prospect Mapping
4.4 Business Environment Analysis Tools
4.4.1 Porter’s Five Forces analysis
4.4.1.1 Competitive rivalry
4.4.1.2 Threat of new entrants
4.4.1.3 Bargaining power of buyers
4.4.1.4 Bargaining power of suppliers
4.4.1.5 Threat of substitutes
4.4.2 PESTEL Analysis
4.4.2.1 Political landscape
4.4.2.2 Economic and social landscape
4.4.2.3 Technological landscape
4.3 Impact of COVID - 19: Qualitative Analysis
CHAPTER 5 U.S. PHARMACY BENEFIT MANAGEMENT MARKET: BUSINESS MODEL ANALYSIS
5.1 U.S. Pharmacy Benefit Management Business Model Market Share Analysis, 2022 & 2030
5.2 U.S. Pharmacy Benefit Management Business Model Market: Segment Dashboard
5.3 Market Size & Forecasts and Trend Analyses, 2017 to 2030 for the Business Model Segment
5.3.1 Standalone PBM
5.3.1.1 Standalone PBM market, 2017 - 2030 (USD Billion)
5.3.2 Health Insurance Providers
5.3.2.1 Health insurance providers market, 2017 - 2030 (USD Billion)
5.3.3 Retail Pharmacy
5.3.3.1 Retail pharmacy market, 2017 - 2030 (USD Billion)
CHAPTER 6 U.S. PHARMACY BENEFIT MANAGEMENT MARKET: END - USE ANALYSIS
6.1 U.S. Pharmacy Benefit Management End - use Market Share Analysis, 2022 & 2030
6.2 U.S. Pharmacy Benefit Management End - use Market: Segment Dashboard
6.3 Market Size & Forecasts and Trend Analyses, 2017 to 2030 for the End - use Segment
6.3.1 Commercial
6.3.1.1 Commercial market, 2017 - 2030 (USD Billion)
6.3.2 Federal
6.3.2.1 Federal market, 2017 - 2030 (USD Billion)
CHAPTER 7 COMPETITIVE ANALYSIS
7.1 Recent Developments & Impact Analysis, by Key Market Participants
7.2 Competition Categorization (Key innovators, Market leaders, Emerging Players
7.3 Company Market Position Analysis
7.4 Company Profiles
7.4.1 CVS HEALTH
7.4.1.1 Company overview
7.4.1.2 Financial performance
7.4.1.3 Service benchmarking
7.4.1.4 Strategic initiatives
7.4.2 Elixir Rx Solutions LLC
7.4.2.1 Company overview
7.4.2.2 Service benchmarking
7.4.2.3 Strategic initiatives
7.4.3 Optum, Inc
7.4.3.1 Company overview
7.4.3.2 Financial performance
7.4.3.2 Service benchmarking
7.4.3.3 Strategic initiatives
7.4.4 Cigna
7.4.4.1 Company overview
7.4.4.2 Financial performance
7.4.4.2 Service benchmarking
7.4.4.3 Strategic initiatives
7.4.5 Change Healthcare
7.4.5.1 Company overview
7.4.5.2 Service benchmarking
7.4.5.3 Strategic initiatives
7.4.6 MedImpact
7.4.6.1 Company overview
7.4.6.2 Financial performance
7.4.6.3 Service benchmarking
7.4.6.4 Strategic initiatives
7.4.7 Prime Therapeutics LLC
7.4.7.1 Company overview
7.4.7.2 Service benchmarking
7.4.7.3 Strategic initiatives
7.4.8 HUB International Limited.
7.4.8.1 Company overview
7.4.8.2 Service benchmarking
7.4.8.3 Strategic initiatives
7.4.9 Anthem
7.4.9.1 Company overview
7.4.9.2 Financial performance
7.4.9.3 Service benchmarking
7.4.9.4 Strategic initiatives??
LIST OF TABLES
TABLE 1 List of secondary sources
TABLE 2 List of abbreviations
TABLE 3 U.S. U.S. pharmacy benefit management market, by business model, 2017 - 2030 (USD Billion)
TABLE 4 U.S. U.S. pharmacy benefit management market, by end-use, 2017 - 2030 (USD Billion)
TABLE 1 List of secondary sources
TABLE 2 List of abbreviations
TABLE 3 U.S. U.S. pharmacy benefit management market, by business model, 2017 - 2030 (USD Billion)
TABLE 4 U.S. U.S. pharmacy benefit management market, by end-use, 2017 - 2030 (USD Billion)
LIST OF FIGURES
FIG. 1 Market research process
FIG. 2 Information procurement
FIG. 3 Primary research pattern
FIG. 4 Market research approaches
FIG. 5 Value chain based sizing & forecasting
FIG. 6 QFD modeling for market share assessment
FIG. 7 Market formulation & validation
FIG. 8 Market outlook
FIG. 9 Pharmacy benefit management market segmentation
FIG. 10 Market trends & outlook
FIG. 11 Market driver relevance analysis (Current & future impact)
FIG. 12 Market restraint relevance analysis (Current & future impact)
FIG. 13 Penetration & growth prospect mapping
FIG. 14 U.S. pharmacy benefit management business model market share analysis, 2022 & 2030
FIG. 15 U.S. pharmacy benefit management business model market: Segment dashboard
FIG. 16 Standalone PBM market, 2017 - 2030 (USD Billion)
FIG. 17 Health insurance providers market, 2017 - 2030 (USD Billion)
FIG. 18 Retail pharmacy market, 2017- 2030 (USD Billion)
FIG. 19 U.S. pharmacy benefit management market end-use movement analysis, 2022 & 2030
FIG. 20 U.S. pharmacy benefit management end-use market: Segment dashboard
FIG. 21 Commercial market, 2017 - 2030 (USD Billion)
FIG. 22 Federal market, 2017- 2030 (USD Billion)
FIG. 23 Recent developments & impact analysis, by key market participants
FIG. 24 Strategy framework
FIG. 25 Competition Categorization
FIG. 26 Company market position analysis
FIG. 1 Market research process
FIG. 2 Information procurement
FIG. 3 Primary research pattern
FIG. 4 Market research approaches
FIG. 5 Value chain based sizing & forecasting
FIG. 6 QFD modeling for market share assessment
FIG. 7 Market formulation & validation
FIG. 8 Market outlook
FIG. 9 Pharmacy benefit management market segmentation
FIG. 10 Market trends & outlook
FIG. 11 Market driver relevance analysis (Current & future impact)
FIG. 12 Market restraint relevance analysis (Current & future impact)
FIG. 13 Penetration & growth prospect mapping
FIG. 14 U.S. pharmacy benefit management business model market share analysis, 2022 & 2030
FIG. 15 U.S. pharmacy benefit management business model market: Segment dashboard
FIG. 16 Standalone PBM market, 2017 - 2030 (USD Billion)
FIG. 17 Health insurance providers market, 2017 - 2030 (USD Billion)
FIG. 18 Retail pharmacy market, 2017- 2030 (USD Billion)
FIG. 19 U.S. pharmacy benefit management market end-use movement analysis, 2022 & 2030
FIG. 20 U.S. pharmacy benefit management end-use market: Segment dashboard
FIG. 21 Commercial market, 2017 - 2030 (USD Billion)
FIG. 22 Federal market, 2017- 2030 (USD Billion)
FIG. 23 Recent developments & impact analysis, by key market participants
FIG. 24 Strategy framework
FIG. 25 Competition Categorization
FIG. 26 Company market position analysis
