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Market Overview of Global Pharmacy Benefit Management (PBM) market:
According to our latest research, the global Pharmacy Benefit Management (PBM) market looks promising in the next 5 years. As of 2022, the global Pharmacy Benefit Management (PBM) market was estimated at USD 589140.29 million, and it's anticipated to reach USD 832400.94 million in 2028, with a CAGR of 5.93% during the forecast years.
A pharmacy benefit manager (PBM) is a third-party administrator of prescription-drug programs for end payers, such as private insurers, and Benefit Plan Design and Consultation. With preferred formularies and exclusion lists, PBMs dictate which drugs consumers can receive from their plan without incurring additional out-of-pocket costs. They also leverage access to their formularies, and threats of exclusion, to negotiate rebates and discounts from the world's drug makers.
Limitations
Among the biggest limitations in the PBM landscape are the exclusionary networks that are often created by PBM partnerships. In these partnerships, preferred pharmacies accept discounts in exchange for the prospect of more business. While this may seem agreeable, participating pharmacies may be forced to pay direct and indirect remuneration fees (DIR fees), which can harm their financial bottom line and threaten the viability of independent brands.
Pharmacies that don't make the cut into these preferred networks often suffer in opportunities and associated volume performance. But pharmacies aren't the only ones who experience a negative impact - limited networks can harm patients when their prescribed drugs aren't available in conveniently-located pharmacies, which can lead to nonadherence and delays or failures to obtain treatment.
Opportunities
Major merger and acquisition activity have continued to increase the market share of the largest PBMs in the Pharmacy Benefit Management industry. Overall, rising total health expenditure and prescription drug use drove demand for industry services during the five-year period to 2018. Additionally, many brand-name drugs lost their patent exclusivity, giving more consumers access to lower-priced generic drugs. Over the five years to 2023, industry revenue is forecast to grow. PBMs will help cut healthcare costs by ensuring patient adherence, compliance and drug utilization. However, PBMs will endure mounting price pressures from insurers to keep prescription prices low, limiting industry revenue growth.
Region Overview:
In 2021, the share of the Pharmacy Benefit Management (PBM) market in North America stood at 94.35%.
Company Overview:
CVS Health Corporation is one of the major players operating in the Pharmacy Benefit Management (PBM) market, holding a share of 30.26% in 2020.
CVS Health Corporation
It operates through Pharmacy Services and Retail/LTC segments. The Pharmacy Services segment offers pharmacy benefit management solutions, such as plan design and administration, formulary management, Medicare Part D services, mail order, specialty pharmacy and infusion services, retail pharmacy network management services, prescription management systems, clinical services, disease management programs, and medical pharmacy management services.
Express Scripts Holding Company
The company's PBM segment offers clinical solutions; and specialized pharmacy care, home delivery and specialty pharmacy, retail network pharmacy administration, benefit design consultation, drug utilization review, drug formulary management, public exchange, administration of group purchasing organization, and digital consumer health and drug information services.
Segmentation Overview:
Among different product types, Retail Pharmacy Services segment is anticipated to contribute the largest market share in 2027.
Application Overview:
By application, the Non-mail Pharmacy Services segment occupied the biggest share from 2017 to 2022.
This report covers a research time span from 2018 to 2028, and presents a deep and comprehensive analysis of the global Pharmacy Benefit Management (PBM) market, with a systematical description of the status quo and trends of the whole market, a close look into the competitive landscape of the major players, and a detailed elaboration on segment markets by type, by application and by region.
Key Takeaways from the Global Pharmacy Benefit Management (PBM) Market Report:
Market Size Estimates: Pharmacy Benefit Management (PBM) market size estimation in terms of value and sales volume from 2018-2028
Market Trends and Dynamics: Pharmacy Benefit Management (PBM) market drivers, opportunities, challenges, and risks
Macro-economy and Regional Conflict: Influence of global inflation and Russia & Ukraine War on the Pharmacy Benefit Management (PBM) market
Segment Market Analysis: Pharmacy Benefit Management (PBM) market value and sales volume by type and by application from 2018-2028
Regional Market Analysis: Pharmacy Benefit Management (PBM) market situations and prospects in North America, Asia Pacific, Europe, Latin America, Middle East, Africa
Country-level Studies on the Pharmacy Benefit Management (PBM) Market: Revenue and sales volume of major countries in each region
Pharmacy Benefit Management (PBM) Market Competitive Landscape and Major Players: Analysis of 10-15 leading market players, sales, price, revenue, gross, gross margin, product profile and application, etc.
Trade Flow: Import and export volume of the Pharmacy Benefit Management (PBM) market in major regions.
Pharmacy Benefit Management (PBM) Industry Value Chain: Pharmacy Benefit Management (PBM) market raw materials & suppliers, manufacturing process, distributors, downstream customers
Pharmacy Benefit Management (PBM) Industry News, Policies & Regulations
Key players in the global Pharmacy Benefit Management (PBM) market are covered in Chapter 12:
Humana Pharmacy Solutions
Aetna Inc.
Cigna
Prime Therapeutics
MedImpact Holdings Inc.
CVS Health Corporation
UnitedHealth Group, Inc
Magellan Health Inc.
Express Scripts Holding Company
In Chapter 2 and Chapter 15.1, based on types, the Pharmacy Benefit Management (PBM) market from 2018 to 2028 is primarily split into:
Retail Pharmacy Services
Specialty Pharmacy Services
Benefit Plan Design and Consultation
Drug Formulary Management
Others
In Chapter 3 and Chapter 15.2, based on applications, the Pharmacy Benefit Management (PBM) market from 2018 to 2028 covers:
Mail-order Pharmacy Services
Non-mail Pharmacy Services
Geographically, the detailed analysis of consumption, revenue, market share and growth rate of the following regions are covered in Chapter 7, 8, 9, 10, 11, 15.3, 15.4:
North America (Covered in Chapter 7)
United States
Canada
Asia-Pacific (Covered in Chapter 8)
China
Japan
India
South Korea
Southeast Asia
Australia
Others
Europe (Covered in Chapter 9)
Germany
France
UK
Italy
Spain
Russia
Poland
Others
Latin America (Covered in Chapter 10)
Mexico
Brazil
Argentina
Others
Middle East and Africa (Covered in Chapter 11)
GCC Countries
Africa
Others
The data of this research report is mainly obtained from industry associations, magazines, press releases, national customs, annual reports of enterprises, expert interviews, paid databases and other channels with authority. It also provides scientific forecasts of the industry's core development indicators through professional analysis and forecasting models.
In short, whatever role you take in this industry value chain, this report will help you or your company to acquire a systematic and in-depth understanding of the industry.
Chapter Outline
This report consists of 16 chapters. Below is a brief guideline to help you quickly grasp the main contents of each chapter:
Chapter 1 starts the report with an overview of the Pharmacy Benefit Management (PBM) market, as well as the definitions of the target market and the subdivisions. Through the presented global market size, regional market sizes, and segment market shares, you will be able to draw an overall and comprehensive picture of the market situation. Meanwhile, the research method and data source will be shared in this chapter.
Chapter 2 and Chapter 3 breaks down the market by different types and applications, with historic data presented in metrics of sales volume, revenue, market share and growth rate.
Chapter 4 elaborates on market dynamics and future trends in the industry, which contains an in-depth analysis of market drivers, opportunities, challenges, and risks. Other essential factors that will have a major impact on the market, i.e., industry news and policies in recent years, global inflation, and regional conflict, are also taken into consideration.
Chapter 5 compares the sales volume and revenue of the major regions across the globe, which enables the readers to understand the regional competitive pattern.
Chapter 6 is the analysis of the trade flow. Import volume and export volume are revealed on a regional level.
Chapters 7-11 focus on country-level studies. Data from the major countries in each region are provided, showing the current development of the industry in different countries. Besides, you will also find qualitative trends analysis under global inflation under each of the 6 regions.
Chapter 12 first up presents the competitive landscape by displaying and comparing the revenues, sales volumes, and market shares of the top players in the market, followed by a company-by-company analysis of all the major market participants with introductions of their products, product applications, company profiles, and business overview. In addition, their competitiveness is manifested through numbers of sales volume, revenue, price, gross and gross margin.
Chapter 13 looks into the whole market industrial chain, ranging from the upstream key raw materials and their suppliers to midstream distributors and downstream customers, with influences of global inflation taken into consideration.
Chapter 14 is perfect for those who wish to develop new projects in the industry. This chapter sheds a light on industry entry barriers and gives suggestions on new project investments.
Chapter 15 forecasts the future trend of the market from the perspective of different types, applications, and major regions.
Chapter 16 is the conclusion of the report which helps the readers sum up the main findings and insights.
Years considered for this report:
Historical Years: 2018-2022
Base Year: 2022
Estimated Year: 2023
Forecast Period: 2023-2028