The Pharmacy Benefit Management Market size was estimated at USD 553.49 billion in 2023 and is expected to reach USD 882.86 billion by 2031 at a CAGR of 6.01% during the forecast period of 2024-2031.
Pharmacy benefit management is an association of drug guides that manages, evaluates, and handles all topics related to healthcare and delivers drug program benefits to businesses. There are pharmacy benefit management companies among insurance providers, drugstore retailers, and drug manufacturers. They bargain with medication companies and retail pharmacies to control generic and branded medicine spending. Moreover, the increased prevalence of chronic diseases and rising healthcare expenditures in developed and developing countries are driving up demand for prescription drug cost management. This increases demand for these services on the global market.
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DRIVERS
Rise in healthcare expenditure
Increasing pharmaceutical expenses drive market growth
The rising frequency of chronic diseases among the world's population is driving up demand for treatment solutions. As a result, several large pharmaceutical corporations are focusing their efforts on producing high-priced branded drugs for the treatment of chronic disorders. This has resulted in a huge increase in pharmaceutical spending in recent years. Furthermore, a large increase in drug costs, combined with an increase in the number of prescriptions filed internationally, is increasing the health-care burden. This has resulted in growing demand for and acceptance of these services to lower drug costs and control pharmaceutical spending globally, as well as to aid market expansion over the study period.
RESTRAIN
A lack of transparency in profit revenues is to blame for limiting adoption.
Transparency concerns about business models are always a topic of worry in pharmaceutical benefit management services. These service revenue sources are rarely disclosed to insurance companies, retail pharmacy units, or drug manufacturers. As a result, a significant amount of medicine expenses is passed on to service providers. For example, according to a January 2022 research paper by Berkeley Research Group, more than half of overall spending on brand pharmaceuticals goes to the supply chain, including pharmacy benefit managers, rather than the drug manufacturers.
As a result, medication producers and insurance companies are seeing a huge drop in profits. As a result, the majority of insurance companies have abandoned the idea of partnering with PBMs, while those that have yet to do so are hesitant. As a result, the adoption rate of these services is decreasing, which is expected to impede market growth throughout the study period.
OPPORTUNITY
Increasing awareness
Increased awareness among pharmacists and healthcare providers about cost-cutting strategies and Pharmacy benefit management services is likely to give attractive potential for market expansion throughout the forecast period.
CHALLENGES
Transparency of the pricing model
Pharmacy benefit management contracts are frequently designed in ways that make complete transparency regarding fees and pricing challenging. Spread pricing regulations, "maximum allowable cost" (MAC) lists, and DIR fees all have a substantial impact on a claim's final cost. To prevent excessive financial risk, leaders should ensure they have the required competence to examine pharmacy benefit management contracts beyond standard due diligence.
The global pharmaceutical industry has had a varied reaction to Russia's invasion of Ukraine. Costs and price variations of APIs and raw materials continue to be key difficulties for pharmaceutical businesses and contract manufacturing organizations, which are currently compounded by the Ukraine crisis. Pharma firms may reduce the effects of API and raw material costs, as well as pricing and availability, using a unified supply chain platform that includes demand sensing capabilities, live market indices and projections to spot and leverage prices, and cost-cutting opportunities.
IMPACT OF ONGOING RECESSION
The ongoing recession impact on healthcare providers or on employment is number of strategies have been established in respect to health professionals, such as wage reduction, increased working hours, and reduced employee turnover. In Spain, these policies resulted in significant professional dissatisfaction, procurement issues, and restricted access to some specializations. In Portugal, higher pressure was observed through increasing working hours, which diminished job benefits. Younger healthcare workers were more inclined to relocate to countries with better working circumstances.
By Service
Retail pharmacy services
Specialty pharmacy services
Benefit plan design & consultation
Others
In 2022, the specialty pharmacy services segment is expected to held the highest market revenue of around 45-49% during the forecast period due to specialty pharmacies are developed to supply medications efficiently with exceptional handling, stockpiling, and distribution requirements utilizing established processes to address unusual or complicated medical diseases. The rising occurrence of rare and chronic diseases promotes demand for treatment options such as speciality medications. High-priced pharmaceuticals, on the other hand, must be affordable for the majority of patients. This boosts the demand for pharmacy benefit management services, cutting the cost of speciality medications to a manageable level. As a result, specialist pharmacy services, among other services, dominate the industry. Several market participants are participating in strategic efforts that contribute to market growth.
By End User
Healthcare Providers
Employers
In 2022, the healthcare providers segment is expected to dominate the market growth during the forecast period due to an increase in mergers and acquisitions of pharmacy benefit management services by insurance companies and healthcare providers. For example, First Medical Health Plan Inc and Abarca Health LLC created a three-year partnership to provide pharmacy benefit administration services. Furthermore, both developed and emerging nations are seeing an increase in the presence of health insurance corporations, which is considerably driving the expansion of the pharmacy benefit management services market.
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North America held a significant market share for USD 206.3 in 2022, due to leading pharmaceutical manufacturers, insurance companies, pharmacy benefit management service providers, and retail drugstore chains are headquartered in the United States. The increased adoption of health insurance among the US population has aided market expansion. Chronic diseases are more common than 50% in the United States. Because of increased insurance policy adoption rates and high healthcare expenditures, the market for pharmacy benefit management in North America is expanding. The number of health insurance companies in the region has increased significantly, which has supported the growth of the North American pharmacy benefit management market. Most patients in the United States rely on reimbursements to treat various disorders. Regional governments favorable reimbursement policies have also contributed to market growth.
Europe is witness to expand fastest CAGR rate during the forecast period due to the large number of patients covered by medical insurance, a favorable regulatory framework for pharmacy benefit managers, and the expanding number of pharmacy benefit administrators in European countries, all of these criteria are critical for regional supremacy. Several European industry participants are working on strategic measures to assist preserve market growth. Furthermore, the UK market for pharmacy benefit management services had the biggest market share, while the French market was the fastest-growing in the European region.
REGIONAL COVERAGE
North America
US
Canada
Mexico
Europe
Eastern Europe
Poland
Romania
Hungary
Turkey
Rest of Eastern Europe
Western Europe
Germany
France
UK
Italy
Spain
Netherlands
Switzerland
Austria
Rest of Western Europe
Asia Pacific
China
India
Japan
South Korea
Vietnam
Singapore
Australia
Rest of Asia Pacific
Middle East & Africa
Middle East
UAE
Egypt
Saudi Arabia
Qatar
Rest of Middle East
Africa
Nigeria
South Africa
Rest of Africa
Latin America
Brazil
Argentina
Colombia
Rest of Latin America
The major key players are Abarca Health LLC, CVS Health, Express Scripts, Humana Pharmacy Solutions, Magellan Rx Management, Anthem Inc., McKesson Corporation, Medimpact Healthcare, MeridianRx, OptumRx (UnitedHealth), Prime Therapeutics, Sea Rainbow, Vidalink, Centene Corporation, and Others.
In February 2022, Souther Scripts, known for its transparent pricing, has launched RxCompass, a product offering designed to help companies and their employees in the United States reduce the pharmacy benefit management services business faces high specialty pharmaceutical costs.
Centene Corporation, in January 2022, Centene Corporation acquired Magellan Health Inc in order to provide integrated healthcare solutions that promote overall health and create better health outcomes while being more economical pharmacy benefit management services.
In October 2021, a nonprofit partnership of approximately 40 firms was formed, including U.S. retailers Walmart (WMT.N) and Costco (COST.O), to develop a new company to provide pharmaceutical benefit management services to employers.
| Report Attributes | Details |
| Market Size in 2023 | US$ 553.49 Billion |
| Market Size by 2031 | US$ 882.86 Billion |
| CAGR | CAGR of 6.01% From 2024 to 2031 |
| Base Year | 2023 |
| Forecast Period | 2024-2031 |
| Historical Data | 2020-2022 |
| Report Scope & Coverage | Market Size, Segments Analysis, Competitive Landscape, Regional Analysis, DROC & SWOT Analysis, Forecast Outlook |
| Key Segments | • By Service (Retail pharmacy services, Specialty pharmacy services, Benefit plan design & consultation, and Others) • By End User (Healthcare Providers and Employers) |
| Regional Analysis/Coverage | North America (US, Canada, Mexico), Europe (Eastern Europe [Poland, Romania, Hungary, Turkey, Rest of Eastern Europe] Western Europe] Germany, France, UK, Italy, Spain, Netherlands, Switzerland, Austria, Rest of Western Europe]), Asia Pacific (China, India, Japan, South Korea, Vietnam, Singapore, Australia, Rest of Asia Pacific), Middle East & Africa (Middle East [UAE, Egypt, Saudi Arabia, Qatar, Rest of Middle East], Africa [Nigeria, South Africa, Rest of Africa], Latin America (Brazil, Argentina, Colombia Rest of Latin America) |
| Company Profiles | Abarca Health LLC, CVS Health, Express Scripts, Humana Pharmacy Solutions, Magellan Rx Management, Anthem Inc., McKesson Corporation, Medimpact Healthcare, MeridianRx, OptumRx (UnitedHealth), Prime Therapeutics, Sea Rainbow, Vidalink, Centene Corporation |
| Key Drivers | • Rise in healthcare expenditure • Increasing pharmaceutical expenses drive market growth |
| Market Opportunity | • A lack of transparency in profit revenues is to blame for limiting adoption. |
Ans: Pharmacy benefit management market is anticipated to expand by 7.4 % from 2023 to 2030.
Ans: Pharmacy benefit management market size was valued at USD 451.3 billion in 2022
Ans: Pharmacy benefit management market size was expected to grow USD 697.8 billion by 2030.
Ans: North America is dominating the pharmacy benefit management market.
Ans: Increasing pharmaceutical expenses drive market growth of pharmacy benefit management market.
TABLE OF CONTENTS
1. Introduction
1.1 Market Definition
1.2 Scope
1.3 Research Assumptions
2. Research Methodology
3. Market Dynamics
3.1 Drivers
3.2 Restraints
3.3 Opportunities
3.4 Challenges
4. Impact Analysis
4.1 Impact of the Russia-Ukraine War
4.2 Impact of Ongoing Recession
4.2.1 Introduction
4.2.2 Impact on major economies
4.2.2.1 US
4.2.2.2 Canada
4.2.2.3 Germany
4.2.2.4 France
4.2.2.5 United Kingdom
4.2.2.6 China
4.2.2.7 Japan
4.2.2.8 South Korea
4.2.2.9 Rest of the World
5. Value Chain Analysis
6. Porter’s 5 forces model
7. PEST Analysis
8. Pharmacy Benefit Management Market Segmentation, By Service
8.1 Retail pharmacy services
8.2 Specialty Pharmacy Services
8.3 Benefit plan design & consultation
8.4 Others
9. Pharmacy Benefit Management Market Segmentation, By End User
9.1 Healthcare Providers and
9.2 Employers
10. Regional Analysis
10.1 Introduction
10.2 North America
10.2.1 North America Pharmacy Benefit Management Market by Country
10.2.2North America Pharmacy Benefit Management Market by Service
10.2.3 North America Pharmacy Benefit Management Market by End User
10.2.4 USA
10.2.4.1 USA Pharmacy Benefit Management Market by Service
10.2.4.2 USA Pharmacy Benefit Management Market by End User
10.2.5 Canada
10.2.5.1 Canada Pharmacy Benefit Management Market by Service
10.2.5.2 Canada Pharmacy Benefit Management Market by End User
10.2.6 Mexico
10.2.6.1 Mexico Pharmacy Benefit Management Market by Service
10.2.6.2 Mexico Pharmacy Benefit Management Market by End User
10.3 Europe
10.3.1 Eastern Europe
10.3.1.1 Eastern Europe Pharmacy Benefit Management Market by Country
10.3.1.2 Eastern Europe Pharmacy Benefit Management Market by Service
10.3.1.3 Eastern Europe Pharmacy Benefit Management Market by End User
10.3.1.4 Poland
10.3.1.4.1 Poland Pharmacy Benefit Management Market by Service
10.3.1.4.2 Poland Pharmacy Benefit Management Market by End User
10.3.1.5 Romania
10.3.1.5.1 Romania Pharmacy Benefit Management Market by Service
10.3.1.5.2 Romania Pharmacy Benefit Management Market by End User
10.3.1.6 Hungary
10.3.1.6.1 Hungary Pharmacy Benefit Management Market by Service
10.3.1.6.2 Hungary Pharmacy Benefit Management Market by End User
10.3.1.7 Turkey
10.3.1.7.1 Turkey Pharmacy Benefit Management Market by Service
10.3.1.7.2 Turkey Pharmacy Benefit Management Market by End User
10.3.1.8 Rest of Eastern Europe
10.3.1.8.1 Rest of Eastern Europe Pharmacy Benefit Management Market by Service
10.3.1.8.2 Rest of Eastern Europe Pharmacy Benefit Management Market by End User
10.3.2 Western Europe
10.3.2.1 Western Europe Pharmacy Benefit Management Market by Country
10.3.2.2 Western Europe Pharmacy Benefit Management Market by Service
10.3.2.3 Western Europe Pharmacy Benefit Management Market by End User
10.3.2.4 Germany
10.3.2.4.1 Germany Pharmacy Benefit Management Market by Service
10.3.2.4.2 Germany Pharmacy Benefit Management Market by End User
10.3.2.5 France
10.3.2.5.1 France Pharmacy Benefit Management Market by Service
10.3.2.5.2 France Pharmacy Benefit Management Market by End User
10.3.2.6 UK
10.3.2.6.1 UK Pharmacy Benefit Management Market by Service
10.3.2.6.2 UK Pharmacy Benefit Management Market by End User
10.3.2.7 Italy
10.3.2.7.1 Italy Pharmacy Benefit Management Market by Service
10.3.2.7.2 Italy Pharmacy Benefit Management Market by End User
10.3.2.8 Spain
10.3.2.8.1 Spain Pharmacy Benefit Management Market by Service
10.3.2.8.2 Spain Pharmacy Benefit Management Market by End User
10.3.2.9 Netherlands
10.3.2.9.1 Netherlands Pharmacy Benefit Management Market by Service
10.3.2.9.2 Netherlands Pharmacy Benefit Management Market by End User
10.3.2.10 Switzerland
10.3.2.10.1 Switzerland Pharmacy Benefit Management Market by Service
10.3.2.10.2 Switzerland Pharmacy Benefit Management Market by End User
10.3.2.11 Austria
10.3.2.11.1 Austria Pharmacy Benefit Management Market by Service
10.3.2.11.2 Austria Pharmacy Benefit Management Market by End User
10.3.2.12 Rest of Western Europe
10.3.2.12.1 Rest of Western Europe Pharmacy Benefit Management Market by Service
10.3.2.12.2 Rest of Western Europe Pharmacy Benefit Management Market by End User
10.4 Asia-Pacific
10.4.1 Asia Pacific Pharmacy Benefit Management Market by Country
10.4.2 Asia Pacific Pharmacy Benefit Management Market by Service
10.4.3 Asia Pacific Pharmacy Benefit Management Market by End User
10.4.4 China
10.4.4.1 China Pharmacy Benefit Management Market by Service
10.4.4.2 China Pharmacy Benefit Management Market by End User
10.4.5 India
10.4.5.1 India Pharmacy Benefit Management Market by Service
10.4.5.2 India Pharmacy Benefit Management Market by End User
10.4.6 Japan
10.4.6.1 Japan Pharmacy Benefit Management Market by Service
10.4.6.2 Japan Pharmacy Benefit Management Market by End User
10.4.7 South Korea
10.4.7.1 South Korea Pharmacy Benefit Management Market by Service
10.4.7.2 South Korea Pharmacy Benefit Management Market by End User
10.4.8 Vietnam
10.4.8.1 Vietnam Pharmacy Benefit Management Market by Service
10.4.8.2 Vietnam Pharmacy Benefit Management Market by End User
10.4.9 Singapore
10.4.9.1 Singapore Pharmacy Benefit Management Market by Service
10.4.9.2 Singapore Pharmacy Benefit Management Market by End User
10.4.10 Australia
10.4.10.1 Australia Pharmacy Benefit Management Market by Service
10.4.10.2 Australia Pharmacy Benefit Management Market by End User
10.4.11 Rest of Asia-Pacific
10.4.11.1 Rest of Asia-Pacific Pharmacy Benefit Management Market by Service
10.4.11.2 Rest of Asia-Pacific APAC Pharmacy Benefit Management Market by End User
10.5 Middle East & Africa
10.5.1 Middle East
10.5.1.1 Middle East Pharmacy Benefit Management Market by Country
10.5.1.2 Middle East Pharmacy Benefit Management Market by Service
10.5.1.3 Middle East Pharmacy Benefit Management Market by End User
10.5.1.4 UAE
10.5.1.4.1 UAE Pharmacy Benefit Management Market by Service
10.5.1.4.2 UAE Pharmacy Benefit Management Market by End User
10.5.1.5 Egypt
10.5.1.5.1 Egypt Pharmacy Benefit Management Market by Service
10.5.1.5.2 Egypt Pharmacy Benefit Management Market by End User
10.5.1.6 Saudi Arabia
10.5.1.6.1 Saudi Arabia Pharmacy Benefit Management Market by Service
10.5.1.6.2 Saudi Arabia Pharmacy Benefit Management Market by End User
10.5.1.7 Qatar
10.5.1.7.1 Qatar Pharmacy Benefit Management Market by Service
10.5.1.7.2 Qatar Pharmacy Benefit Management Market by End User
10.5.1.8 Rest of Middle East
10.5.1.8.1 Rest of Middle East Pharmacy Benefit Management Market by Service
10.5.1.8.2 Rest of Middle East Pharmacy Benefit Management Market by End User
10.5.2 Africa
10.5.2.1 Africa Pharmacy Benefit Management Market by Country
10.5.2.2 Africa Pharmacy Benefit Management Market by Service
10.5.2.3 Africa Pharmacy Benefit Management Market by End User
10.5.2.4 Nigeria
10.5.2.4.1 Nigeria Pharmacy Benefit Management Market by Service
10.5.2.4.2 Nigeria Pharmacy Benefit Management Market by End User
10.5.2.5 South Africa
10.5.2.5.1 South Africa Pharmacy Benefit Management Market by Service
10.5.2.5.2 South Africa Pharmacy Benefit Management Market by End User
10.5.2.6 Rest of Africa
10.5.2.6.1 Rest of Africa Pharmacy Benefit Management Market by Service
10.5.2.6.2 Rest of Africa Pharmacy Benefit Management Market by End User
10.6 Latin America
10.6.1 Latin America Pharmacy Benefit Management Market by Country
10.6.2 Latin America Pharmacy Benefit Management Market by Service
10.6.3 Latin America Pharmacy Benefit Management Market by End User
10.6.4 Brazil
10.6.4.1 Brazil Pharmacy Benefit Management Market by Service
10.6.4.2 Brazil Africa Pharmacy Benefit Management Market by End User
10.6.5 Argentina
10.6.5.1 Argentina Pharmacy Benefit Management Market by Service
10.6.5.2 Argentina Pharmacy Benefit Management Market by End User
10.6.6 Colombia
10.6.6.1 Colombia Pharmacy Benefit Management Market by Service
10.6.6.2 Colombia Pharmacy Benefit Management Market by End User
10.6.7 Rest of Latin America
10.6.7.1 Rest of Latin America Pharmacy Benefit Management Market by Service
10.6.7.2 Rest of Latin America Pharmacy Benefit Management Market by End User
11. Company Profile
11.1 Abarca Health LLC
11.1.1 Company Overview
11.1.2 Financials
11.1.3 Product/Services Offered
11.1.4 SWOT Analysis
11.1.5 The SNS View
11.2 CVS Health
11.2.1 Company Overview
11.2.2 Financials
11.2.3 Product/Services Offered
11.2.4 SWOT Analysis
11.2.5 The SNS View
11.3 Express Scripts
11.3.1 Company Overview
11.3.2 Financials
11.3.3 Product/Services Offered
11.3.4 SWOT Analysis
11.3.5 The SNS View
11.4 Humana Pharmacy Solutions
11.4 Company Overview
11.4.2 Financials
11.4.3 Product/Services Offered
11.4.4 SWOT Analysis
11.4.5 The SNS View
11.5 Magellan Rx Management
11.5.1 Company Overview
11.5.2 Financials
11.5.3 Product/Services Offered
11.5.4 SWOT Analysis
11.5.5 The SNS View
11.6 Anthem Inc.
11.6.1 Company Overview
11.6.2 Financials
11.6.3 Product/Services Offered
11.6.4 SWOT Analysis
11.6.5 The SNS View
11.7 McKesson Corporation
11.7.1 Company Overview
11.7.2 Financials
11.7.3 Product/Services Offered
11.7.4 SWOT Analysis
11.7.5 The SNS View
11.8 Medimpact Healthcare
11.8.1 Company Overview
11.8.2 Financials
11.8.3 Product/Services Offered
11.8.4 SWOT Analysis
11.8.5 The SNS View
11.9 MeridianRx
11.9.1 Company Overview
11.9.2 Financials
11.9.3 Product/ Services Offered
11.9.4 SWOT Analysis
11.9.5 The SNS View
11.10 OptumRx (UnitedHealth)
11.10.1 Company Overview
11.10.2 Financials
11.10.3 Product/Services Offered
11.10.4 SWOT Analysis
11.10.5 The SNS View
11.11 Prime Therapeutics
11.11.1 Company Overview
11.11.2 Financials
11.11.3 Product/Services Offered
11.11.4 SWOT Analysis
11.11.5 The SNS View
11.12 Sea Rainbow
11.12.1 Company Overview
11.12.2 Financials
11.12.3 Product/Services Offered
11.12.4 SWOT Analysis
11.12.5 The SNS View
11.13 Vidalink
11.13.1 Company Overview
11.13.2 Financials
11.13.3 Product/Services Offered
11.13.4 SWOT Analysis
11.13.5 The SNS View
11.14 Centene Corporation
11.14.1 Company Overview
11.14.2 Financials
11.14.3 Product/Services Offered
11.14.4 SWOT Analysis
11.14.5 The SNS View
11.15 Others
12. Competitive Landscape
12.1 Competitive Benchmarking
12.2 Market Share Analysis
12.3 Recent Developments
12.3.1 Industry News
12.3.2 Company News
12.3.3 Mergers & Acquisitions
13. USE Cases and Best Practices
14. Conclusion
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