Pharmacy Benefit Management (PBM) Market Analysis | 2023-2028

Market Insights

The pharmacy benefit management (PBM) market was estimated at USD 563.96 million in 2022 and is likely to grow at a CAGR of 5.29% during 2023-2028 to reach USD 770.99 million in 2028.

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Market Dynamics

Introduction

Pharmacy Benefit Management (PBM) is defined as companies that act as an intermediary between insurance companies, manufacturers, and pharmacies. Pharmacy benefit management helps to provide medical services and medications to employers at a low cost. The PBM managers negotiate with the drug makers to secure a discount on drug prices and pass the savings to insurers.

COVID-19 Impact 

The COVID-19 outbreak posed significant challenges to the healthcare system across geographies. It impacted the growth of the pharmacy benefit management (PBM) market positively. PBMs help patients stay at home and practice social distancing by providing reliable access to the needed prescription drugs conveniently. People moved out of their houses only for essential services due to fear of coronavirus infection and thus, added to the market growth.

Market Drivers

Surge in pharmaceutical expenses

The increasing prevalence of chronic diseases worldwide has led to a surge in pharmaceutical spending, with drug prices in the U.S. increasing by 4.0% in 2021 and individual prescription drug prices rising by 5%. This, coupled with an increasing number of prescriptions for chronic diseases, has heightened healthcare expenditures. The demand for services to reduce drug costs, manage spending, and aid market expansion is expected to continue.

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Restraining Factors

Transparency Issues in Profit Earnings

The global drug market is growing due to rising prescriptions and spending. However, transparency issues in pharmacy benefit management services, where revenue sources are often hidden, are causing a significant decrease in profit for manufacturers and insurance providers. This has led to a decrease in adoption rates and is expected to hinder market growth.

Key Players

The following are the key players in the pharmacy benefit management (PBM) market:

• CVS Health (The U.S),
• SS&C Technologies, Inc. (The U.S),
• UnitedHealth Group Incorporated (The U.S),
• Rite Aid Corporation (The U.S),
• Express Scripts Holding Company (The U.S),
• Benecard Services, LLC. (The U.S),
• CaptureRx (The U.S),
• Change Healthcare (The U.S),
• Anthem, Inc. (The U.S), and
• ProCare Rx (The U.S).

Segment Analysis

By Services Type

"Specialty pharmacy services segment accounted for the largest market share of more than 30% in 2022"

• Based on service, the market has been divided into specialty pharmacy services, drug formulary management, benefit plan design & consultation, and others.
• The specialty pharmacy services segment accounted for the largest market share of more than 30% in 2022.
• The segment growth can be attributed to increasing healthcare costs due to the prevalence of complex and chronic diseases.

Regional Analysis

"North America accounted for the largest share in 2022 and is projected to register significant growth during the review period"

• The market in North America accounted for the largest share in 2022 and is projected to register significant growth during the review period.
• The regional market growth can be attributed to the presence of an established healthcare industry and the increasing adoption of advanced healthcare solutions.
• The market in the Asia-Pacific region is projected to register the fastest growth rate on account of advancement in healthcare technologies in the developing countries.

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Research Methodology

• This strategic assessment report, from Stratview Research, provides a comprehensive analysis that reflects today’s functional pharmacy benefit management (PBM) market realities and future market possibilities for the forecast period.
• The report segments and analyzes the market in the most detailed manner to provide a panoramic view of the market.
• The vital data/information provided in the report can play a crucial role for market participants as well as investors in the identification of the low-hanging fruits available in the market as well as to formulate growth strategies to expedite their growth process.
• This report offers high-quality insights and is the outcome of a detailed research methodology comprising extensive secondary research, rigorous primary interviews with industry stakeholders, and validation and triangulation with Stratview Research’s internal database and statistical tools.
• More than 1,000 authenticated secondary sources, such as company annual reports, fact books, press releases, journals, investor presentations, white papers, patents, and articles, have been leveraged to gather the data.
• We conducted more than 15 detailed primary interviews with market players across the value chain in all four regions and industry experts to obtain both qualitative and quantitative insights.

Report Features

This report provides market intelligence in the most comprehensive way. The report structure has been kept such that it offers maximum business value. It provides critical insights into market dynamics and will enable strategic decision-making for existing market players as well as those willing to enter the market. The following are the key features of the report:

• Market structure: Overview, industry life cycle analysis, supply chain analysis.
• Market environment analysis: Growth drivers and constraints, Porter’s five forces analysis, SWOT analysis.
• Market trend and forecast analysis.
• Market segment trend and forecast.
• Competitive landscape and dynamics: Market share, Service portfolio, New Product Launches, etc.
• COVID-19 impact and its recovery curve
• Attractive market segments and associated growth opportunities.
• Emerging trends.
• Strategic growth opportunities for the existing and new players.
• Key success factors.

Market Segmentation

This report studies the market covering 12 years of trend and forecast. The report provides detailed insights into the market dynamics to enable informed business decision-making and growth strategy formulation based on the opportunities present in the market.

The pharmacy benefit management (PBM) market is segmented into the following categories:

By Services Type

• Specialty Pharmacy Services
• Drug Formulary Management
• Benefit Plan Design & Consultation
• Other

By Business Model Type

• Government Health Programs
• Employer-Sponsored Programs
• Health Insurance Management

By End-User Type

• Pharmacy Benefit Management Organization
• Mail Order Pharmacies
• Retail Pharmacies
• Inpatient Pharmacies
• Outpatient Pharmacies

By Region

• North America (Country Analysis: The USA, Canada, and Mexico)
• Europe (Country Analysis: Germany, France, The UK, Russia, and the Rest of Europe)
• Asia-Pacific (Country Analysis: China, India, Australia, South Korea, and the Rest of Asia-Pacific)
• Rest of the World (Country Analysis: Saudi Arabia, Brazil, and Others)

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Customization Options

Stratview Research offers one of the following free customization options to our respectable clients:

Company Profiling

• Detailed profiling of additional market players (up to three players)
• SWOT analysis of key players (up to three players)

Competitive Benchmarking

Benchmarking of key players on the following parameters: Product portfolio, geographical reach, regional presence, and strategic alliances

Custom Research: Stratview Research offers custom research services across sectors. In case of any custom research requirement related to market assessment, competitive benchmarking, sourcing and procurement, target screening, and others, please send your inquiry to [email protected].