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United States Pharmacy Benefit Management Market Outlook & Forecasts Report 2022-2027 Featuring Key Companies and Future Players Such as Humana Pharmacy Solutions, Medimpact, & Prime Therapeutics -

DUBLIN--(BUSINESS WIRE)--The "Pharmacy Benefit Management Market in the US - Industry Outlook & Forecast 2022-2027" report has been added to's offering.

The U.S. pharmacy benefit management market is expected to grow at a CAGR of 5.53% during 2022-2027

The study considers a detailed scenario of the present U.S. pharmacy benefit management market and its market dynamics. It covers a detailed overview of several industry growth enablers, restraints, and trends. The report offers both the demand and supply aspects of the market. It profiles and examines leading companies and other prominent ones operating in the market.


The PBM industry refers to companies that act as intermediaries between insurance companies, pharmacies, and pharmaceutical companies. PBM is responsible for reducing insurers and their drug costs. They achieve this by negotiating with pharmacies and pharmaceutical companies. The pharmacy benefit management systems entered the pharmaceutical industry in the 1960s to meet the needs of employer-based health benefits. They soon became an important stakeholder in the entire pharmaceutical supply chain.

Pharmacy costs represent almost 32% of the total health care spending, and this expenditure is expected to grow more than two times during the forecast period. Currently, pharmacy benefit management plays a major role and acts as an intermediary between payers, drug manufacturers, and pharmacies.

Since PBMs play a significant role in influencing out-of-pocket costs and patient access to medications owing to their management tools, formulary power, and price concessions. They are in a position of power to pass savings to customers. According to PBM lobby groups, between 2020 to 2029, PBM tools will reduce consumer and plan sponsors' spending by more than $1 trillion.

There is a growing criticism of PBMs with claims that they are driving up costs of drug prices, making huge gains via pharmacy spreads, rebates from manufacturers, and fees from the supply chain. This is being spurred by the opaqueness of the true cost of drugs to PBMs owing to the rules of engagement between manufacturers and PBMs.

The future of PBMs is going to be dictated by the implementation of state and national-level policies in terms of their revenue streams and business practices in the pharmaceutical space.

U.S. Pharmacy Benefit Management Market Segmentations

Based on services, specialty pharmacy services are the major contributor in the pharmacy benefit management market in the US, and it is likely to witness high incremental growth of $48.24 billion during the forecast period.

Based on health plans, commercial health plans are the major contributor in the pharmacy benefit management market in the US, and it is likely to witness high absolute growth of 34.69% during the forecast period.


The presence of prominent market players, increasing favorable healthcare reforms, rising e-prescription, and growing adoption of healthcare plans by us residents are the primary factors for the significant market share in the country.

Key Company Profiles

  • CVS Health
  • Cigna
  • UnitedHealth Group

Key Companies to Watch

  • Humana Pharmacy Solutions
  • Medimpact
  • Prime Therapeutics

Other Prominent Vendors

  • Abarca Health
  • AscellaHealth
  • BeneCard PBF
  • CaptureRx
  • Centene
  • Change Healthcare
  • Citizens Rx
  • EnvisionRxOptions
  • Excelera
  • Magellan Rx Management
  • MedalistRx
  • MaxorPlus
  • Navitus Health Solutions
  • PerformRx
  • ProCare Rx
  • RxAdvance
  • Rite Aid
  • WellDyneRx
  • Walgreens Boots Alliance

Key Topics Covered:

1 Research Methodology

2 Research Objectives

3 Research Process

4 Scope & Coverage

4.1 Market Definition

4.2 Base Year

4.3 Scope of the Study

4.4 Market Segmentation

5 Report Assumptions & Caveats

5.1 Key Caveats

5.2 Currency Conversion

5.3 Market Derivation

6 Market at a Glance

7 Introduction

7.1 Us Economy & Healthcare Industry Landscape

7.2 Pharmacy Benefit Management

7.2.1 Role of PBMs in Money Spent on Prescription Drugs

7.2.2 Reforms to Regulate PBMs

8 Pharmaceutical Ecosystem

8.1 Overview

8.2 Evolution of PBM Ownership

8.2.1 PBM Services Over Time

8.2.2 PBMs & Other Players in Pharmaceutical Ecosystem

9 Impact of Covid-19 on PBM Market

9.1 Overview

9.1.1 PBMs Covid-19 Response Strategies

10 Gaps in Information & Care in Us Healthcare Industry

10.1 Overview

11 Market Opportunities & Trends

11.1 Increased Adoption of E-Prescription & Mail Order Pharmacy

11.2 Growing FDA Approvals of Biologics & Biosimilars

11.3 Market Entry of Payers Through M&As

11.4 Entry of Digital Health Solutions in PBM Industry

12 Market Growth Enablers

12.1 Favorable Healthcare Reforms

12.2 Growing Adoption of Healthcare Plans by Us Residents

12.3 Prevalence of Fraud, Waste & Abuse in Healthcare

12.4 Increased Demand for Personalized Medicines

13 Market Restraints

13.1 PBMs More Susceptible to Lawsuits & Government Scrutiny

13.2 Lack of Transparency in Services by PBMs

13.3 Declining Growth from Generics

13.4 Legal Uncertainty & Impending Limitations on PBM Tools

14 Market Landscape

14.1 Market Overview

14.2 Market Size & Forecast

14.2.1 Insight by Health Plans

14.2.2 Insights by Services

14.2.3 Insight by Business Model

14.3 Five Forces Analysis

15 Health Plans

15.1 Market Snapshot & Growth Engine

15.2 Market Overview

15.3 Commercial Health Plans

15.3.1 Market Overview

15.3.2 Market Size & Forecast

15.4 Medicare

15.5 Medicaid

15.6 Others

16 Services

16.1 Market Snapshot & Growth Engine

16.2 Market Overview

16.3 Specialty Pharmacy Services

16.4 Retail Pharmacy Networks

16.5 Mail-Order Pharmacy Services

16.6 Claims Processing

16.7 Formulary Management

16.8 Drug Utilization Review

16.9 Price, Discount & Rebate Negotiations

16.10 Disease Management & Adherence Initiatives

17 Business Model

17.1 Market Snapshot & Growth Engine

17.2 Market Overview

17.3 Insurance Companies & Retail Pharmacies

17.4 Pure Play PBMs

18 Competitive Landscape

18.1 Competition Overview

18.2 Market Share Analysis

18.2.1 Cvs Health

18.2.2 Cigna

18.2.3 Unitedhealth Group

18.2.4 Humana Pharmacy Solutions

18.2.5 Medimpact

18.2.6 Prime Therapeutics

19 Key Company Profiles

19.1 CVS Health

19.2 Cigna

19.3 Unitedhealth Group

20 Key Companies to Watch

20.1 Humana Pharmacy Solutions

20.2 Medimpact

20.3 Prime Therapeutics

For more information about this report visit

Laura Wood, Senior Press Manager
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Editor Details

  • Company:
    • Businesswire
Last Updated: 15-Jul-2022