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Emergence of Covid-19 is to Augment Growth of Pharmacy Benefit Management Market

Pharmacy benefit management (PBM) deals with administration of prescription drug programs for commercial health plans and self-insured employer plans. It also focuses on development and maintenance of pharmacy contracts, negotiation of discounts and rebates with drug manufacturers, and processing and payment of prescription drug claims. PBMs rely on various tools such as drug formulary, e-prescribing, manufacturer’s discount, pharmacy networks, mail-service pharmacies, disease management, drug utilization review, and pharmacy discount cards (for the uninsured) to manage the cost of prescription drugs and improve the customer value. Various prescription claim software/systems are available to manage these tools and the PBMs account. PBM also manage the prescription drug claims i.e. acts as a link between the payers and health insurers.

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Global Pharmacy Benefit Management Market – Drivers

Increasing prices of pharmaceutical drugs is expected to boost growth of the global pharmacy benefit management market. For instance, according to Milliman, an actuarial and consulting firm, prescription drug costs increased from 13.2% in 2001 to nearly 15.9% of the overall health spending for a family of four in 2015.

Third party administrators (TPAs) operate PBM. These TPAs act as a liaison between pharmacists, insurance providers (payers), and drug manufacturers. PBM aids in reducing drug prices through negotiations with drug manufacturers and retail pharmacies. PBM benefits patients who have enrolled in various health plans and those who are uninsured. Health plans and pharmacy benefit managers collaborate to offer drugs at low costs. Moreover, PBMs also help in management and planning the formulary as per customer needs. These advantages of PBM are also expected to boost growth of the global pharmacy benefit management market over the forecast period.

Global Pharmacy Benefit Management Market – Restraints

The demand for PBMs is expected to significantly increase, owing to development of expensive therapies for the treatment of chronic diseases such as cancer and hepatitis. However, PBM has been ineffective in controlling rapid increase in drug prices even with the presence of major players in the industry. Moreover, increasing focus of various governments to decrease drug prices such as the Affordable Care Act in the U.S. is also expected to hinder growth of the market.

Global Pharmacy Benefit Management Market Taxonomy

On the basis of the beneficiaries, the global pharmacy benefit management market is segmented into healthcare providers, employers, and drug manufacturers. Majority of the people in the U.S. receive healthcare benefits from their employers, which has led employers to opt for PBM services.

Global Pharmacy Benefit Management Market: Regional Analysis

On the basis of region, the global pharmacy benefit management market is segmented into North America, Latin America, Europe, Asia Pacific, Middle East, and Africa. The market in North America is majorly driven by high subscribers of Medicare prescription drug program. In the U.S., pharmacy benefit managers aid in deciding whether a generic or branded product would benefit the patient. Generics have a good profit margin, which can benefit the pharmacy benefit managers/management companies. Therefore, increasing number of drugs expected to expire in the near future is also boosting growth of the market in North America. For instance, patents for around 40 blockbuster brands worth US$ 155 billion are expected to expire by 2020. The market in Europe is expected to witness similar trends over the forecast period.

Key players in the market are focused on adopting M&A strategies to expand their product portfolio. For instance, in April 2012, Express Scripts acquired Medco Health Solutions for US$ 29.1 billion.

Major players are also focused on launching new pharmacy benefit programs to expand their product portfolio. For instance, in August 2019, Accredo, a specialty pharmacy, started a new, full-service pharmacy for residents of Hawaii who require additional clinical and administrative support for their complex treatments and medications. In July 2019, Aetna, a CVS Health company, started offering fully insured health care network options to its Preferred Product Organization (PPO), Exclusive Product Organization (EPO), and Health Maintenance Organization (HMO) product portfolios through Aetna Whole HealthSM – Southern California. In April 2019, Express Scripts, a pharmacy benefit management company, and Appriss Health, provider of prescription drug monitoring platform, developed a Prescription Drug Monitoring Program (PDMP) for the Military Health System (MHS).

Major Key Players Include In Pharmacy Benefit Management Market: Express Scripts, CVS Caremark, Prime Therapeutics, United Health / OptumRx, Catamaran Corporation, Humana Pharmacy Solutions and MedImpact

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• Current and future of Pharmacy Benefit Management Market outlook in the developed and emerging markets
• The segment that is expected to dominate the market as well as the segment which holds highest CAGR in the forecast period.
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• The latest developments, market shares, and strategies that are employed by the major market player

Main points in Pharmacy Benefit Management Market Report Table of Content

Chapter 1 Industry Overview
1.1 Definition
1.2 Assumptions
1.3 Research Scope
1.4 Market Analysis by Regions
1.5 Pharmacy Benefit Management Market Size Analysis from 2021 to 2027
11.6 COVID-19 Outbreak: Pharmacy Benefit Management Industry Impact

Chapter 2 Global Pharmacy Benefit Management Competition by Types, Applications, and Top Regions and Countries
2.1 Global Pharmacy Benefit Management (Volume and Value) by Type
2.3 Global Pharmacy Benefit Management (Volume and Value) by Regions

Chapter 3 Production Market Analysis
3.1 Global Production Market Analysis
3.2 Regional Production Market Analysis

Chapter 4 Global Pharmacy Benefit Management Sales, Consumption, Export, Import by Regions (2016-2021)
Chapter 5 North America Pharmacy Benefit Management Market Analysis
Chapter 6 East Asia Pharmacy Benefit Management Market Analysis
Chapter 7 Europe Pharmacy Benefit Management Market Analysis
Chapter 8 South Asia Pharmacy Benefit Management Market Analysis
Chapter 9 Southeast Asia Pharmacy Benefit Management Market Analysis
Chapter 10 Middle East Pharmacy Benefit Management Market Analysis
Chapter 11 Africa Pharmacy Benefit Management Market Analysis
Chapter 12 Oceania Pharmacy Benefit Management Market Analysis
Chapter 13 South America Pharmacy Benefit Management Market Analysis
Chapter 14 Company Profiles and Key Figures in Pharmacy Benefit Management Business
Chapter 15 Global Pharmacy Benefit Management Market Forecast (2021-2027)
Chapter 16 Conclusions
Research Methodology


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Last Updated: 14-Sep-2021