US Pharmacy Benefit Management (PBM) Industry Report: 2011 Edition
PBM companies aim at merging retail pharmacy claims processing, formulary management and home delivery pharmacy services in order to develop and create an integrated product offering for payors. PBM is a high volume and low margin business.
The US prescription volume and expenditure has been increasing over the past years. The number of drugs coming into the US market is expected to speed up in future. More effective strategies are being developed by companies in response to pressures being put on health benefit providers with the intention to keep the medications affordable.
Demand of prescription drugs is expected to increase with the increase in average age of the American population. Medical beneficiaries have increased over the past decade and are expected to increase even further with the increase in aging population in the US. Over the past decade, the US health expenditure as percentage of Gross Domestic Product has also been increasing, thereby creating growth opportunities for PBM players. Life expectancy in the US has reached a new height due to which number of people with chronic condition has also risen.
The report analyzes the US Pharmacy Benefit Management Industry. Rising drug prices, increasing drug utilization and prevalence of chronic diseases are some of the drivers being discussed in the report. Mergers and acquisitions in the PBM industry in the past years have also been discussed.
The competition prevailing in the industry has been analyzed with market share of companies on the basis of source of dispensing. Trends in the industry have also been included focusing on key contract changes, contracts for renewals of the major players and market share of PBM companies adjusted on the basis of acquisitions and contract shifts. This report also profiles the major players of the PBM industry.
The US prescription volume and expenditure has been increasing over the past years. The number of drugs coming into the US market is expected to speed up in future. More effective strategies are being developed by companies in response to pressures being put on health benefit providers with the intention to keep the medications affordable.
Demand of prescription drugs is expected to increase with the increase in average age of the American population. Medical beneficiaries have increased over the past decade and are expected to increase even further with the increase in aging population in the US. Over the past decade, the US health expenditure as percentage of Gross Domestic Product has also been increasing, thereby creating growth opportunities for PBM players. Life expectancy in the US has reached a new height due to which number of people with chronic condition has also risen.
The report analyzes the US Pharmacy Benefit Management Industry. Rising drug prices, increasing drug utilization and prevalence of chronic diseases are some of the drivers being discussed in the report. Mergers and acquisitions in the PBM industry in the past years have also been discussed.
The competition prevailing in the industry has been analyzed with market share of companies on the basis of source of dispensing. Trends in the industry have also been included focusing on key contract changes, contracts for renewals of the major players and market share of PBM companies adjusted on the basis of acquisitions and contract shifts. This report also profiles the major players of the PBM industry.
1. PHARMACY BENEFIT MANAGEMENT
1.1 Who are PBM Managers
1.2 History of PBMs
1.3 Retail Dispensing Process & Flow of Funds
1.4 Mail Dispensing Process and Flow of Funds
2. US PHARMACY BENEFIT MANAGEMENT (PBM) MARKET
Retail Prescription Drug Spending
US Prescription Drugs – Generic Share
Top PBMs by Membership
Specialty Prescription
3. KEY TRENDS
3.1 Generic Dispensing Rate: Retail v/s Mail
3.2 PBM Mergers & Acquisitions
3.3 US Drug Distribution Market Share
3.4 Medicaid Pharmacy Program Savings
3.5 US Annual Pharmaceutical Sales Growth
3.6 US Healthcare Spending
3.7 Trends in Specialty Medicine
3.8 PBMs - Incremental Gross Profit from Generics
4. KEY DRIVERS
4.1 Aging US Demographics
4.2 Higher Life Expectancy
4.3 Increasing Drug Utilization
4.4 Increasing Prevalence of Chronic Diseases
4.5 Rising Drug Prices
4.6 US Healthcare Expenditures as a Percentage of GDP
4.7 US Prescription Volume and Expenditures
5. PBM MARKET - COMPETITIVE LANDSCAPE
Competitive Overview
Market Share - Retail
Market Share – Mail
Key Contract Changes
6. COMPANY PROFILES
6.1 Medco Health
Business Description
Key Strategies
Business Strategies
Deliver Earnings Growth
Investing in Clinical Innovation
6.2 CVS Caremark
Business Description
Key Strategies
Business Strategies
Programs to Improve Care & Control
Providing Diversity
Committed to Healthy Environment
6.3 Express Scripts
Business Description
Key Strategies
Business Strategies
Commitment to Fundamentals
Advances in Consumerology
List of Charts
History of PBMs
Retail Dispensing Process & Flow of Funds
Mail Dispensing Process & Flow of Funds
Generics’ Share of US Prescription Drug Market (1996–2009)
US Retail Prescription Drug Spending (2009–2017E)
Specialty Prescription Volume and Spending for Prime Therapeutics (2009)
Generic Dispensing Rate at Retail vs. Mail for Big Three PBMs (Q104–Q410)
US Drug Distribution Market Share (2010)
US Annual Pharmaceutical Sales Growth (2000–2009)
US Healthcare Expenditures Annual Growth Rate (2000-2009)
Trends in Specialty Medicine (2010)
PBMs - Incremental Gross Profit from Generics (2011E-2015E)
Medicare Enrollment (2000–2050E)
US Life Expectancy (2000-2035E)
Annual Change in Manufacturer Prices for Brand Name/General Drugs (2004–10)
US Healthcare Expenditures as a Percentage of GDP (2000–2013E)
US Prescription Volume and Expenditures (2000–2009)
PBM Total Market Share (2010)
PBM Retail Market Share (2010)
PBM Mail Market Share (2010)
Net Revenue of Medco Health Solutions (2006-2010)
Net Revenue of Medco Health Solutions- by Business Segment (2010)
Net Revenue of CVS (2006-2010)
Net Revenue of CVS- by Business segment (2010)
Revenue of Express Scripts (2006-2010)
1.1 Who are PBM Managers
1.2 History of PBMs
1.3 Retail Dispensing Process & Flow of Funds
1.4 Mail Dispensing Process and Flow of Funds
2. US PHARMACY BENEFIT MANAGEMENT (PBM) MARKET
Retail Prescription Drug Spending
US Prescription Drugs – Generic Share
Top PBMs by Membership
Specialty Prescription
3. KEY TRENDS
3.1 Generic Dispensing Rate: Retail v/s Mail
3.2 PBM Mergers & Acquisitions
3.3 US Drug Distribution Market Share
3.4 Medicaid Pharmacy Program Savings
3.5 US Annual Pharmaceutical Sales Growth
3.6 US Healthcare Spending
3.7 Trends in Specialty Medicine
3.8 PBMs - Incremental Gross Profit from Generics
4. KEY DRIVERS
4.1 Aging US Demographics
4.2 Higher Life Expectancy
4.3 Increasing Drug Utilization
4.4 Increasing Prevalence of Chronic Diseases
4.5 Rising Drug Prices
4.6 US Healthcare Expenditures as a Percentage of GDP
4.7 US Prescription Volume and Expenditures
5. PBM MARKET - COMPETITIVE LANDSCAPE
Competitive Overview
Market Share - Retail
Market Share – Mail
Key Contract Changes
6. COMPANY PROFILES
6.1 Medco Health
Business Description
Key Strategies
Business Strategies
Deliver Earnings Growth
Investing in Clinical Innovation
6.2 CVS Caremark
Business Description
Key Strategies
Business Strategies
Programs to Improve Care & Control
Providing Diversity
Committed to Healthy Environment
6.3 Express Scripts
Business Description
Key Strategies
Business Strategies
Commitment to Fundamentals
Advances in Consumerology
List of Charts
History of PBMs
Retail Dispensing Process & Flow of Funds
Mail Dispensing Process & Flow of Funds
Generics’ Share of US Prescription Drug Market (1996–2009)
US Retail Prescription Drug Spending (2009–2017E)
Specialty Prescription Volume and Spending for Prime Therapeutics (2009)
Generic Dispensing Rate at Retail vs. Mail for Big Three PBMs (Q104–Q410)
US Drug Distribution Market Share (2010)
US Annual Pharmaceutical Sales Growth (2000–2009)
US Healthcare Expenditures Annual Growth Rate (2000-2009)
Trends in Specialty Medicine (2010)
PBMs - Incremental Gross Profit from Generics (2011E-2015E)
Medicare Enrollment (2000–2050E)
US Life Expectancy (2000-2035E)
Annual Change in Manufacturer Prices for Brand Name/General Drugs (2004–10)
US Healthcare Expenditures as a Percentage of GDP (2000–2013E)
US Prescription Volume and Expenditures (2000–2009)
PBM Total Market Share (2010)
PBM Retail Market Share (2010)
PBM Mail Market Share (2010)
Net Revenue of Medco Health Solutions (2006-2010)
Net Revenue of Medco Health Solutions- by Business Segment (2010)
Net Revenue of CVS (2006-2010)
Net Revenue of CVS- by Business segment (2010)
Revenue of Express Scripts (2006-2010)
LIST OF TABLES
Top 50 PBMs by Membership (2010)
Selective Captive PBMs (2010)
Select PBM M&A Transactions (1993–2010)
Select PBM M&A Transactions in excess of US$100 million
Potential Medicaid Pharmacy Program Savings for Top 10 States (2012-2021)
Top 10 PBMs by Total Rx/ Year (2010)
PBM Market Share based on Reported Script Volume -Scripts in millions (2010)
PBM Market Share based on Acquisitions/Contract shifts (2010)
Key Contract Changes (2011)
Large Contracts for Renewal (2011)
Top 50 PBMs by Membership (2010)
Selective Captive PBMs (2010)
Select PBM M&A Transactions (1993–2010)
Select PBM M&A Transactions in excess of US$100 million
Potential Medicaid Pharmacy Program Savings for Top 10 States (2012-2021)
Top 10 PBMs by Total Rx/ Year (2010)
PBM Market Share based on Reported Script Volume -Scripts in millions (2010)
PBM Market Share based on Acquisitions/Contract shifts (2010)
Key Contract Changes (2011)
Large Contracts for Renewal (2011)
