THE PHARMACY BENEFIT MANAGEMENT (PBM) MARKET IN THE US WAS VALUED AT USD 446.28 BILLION IN 2021 AND IS EXPECTED TO REACH USD 616.47 BILLION BY 2027, GROWING AT A CAGR OF 5.53%.

The U.S. Pharmacy Benefit Management Market Size, Share, & Trends Analysis Report by

  • Health Plan: Commercial Health Plans, Medicare, Medicaid, and Others
  • Services: Specialty Pharmacy Services, Retail Pharmacy Networks, Mail-Order Pharmacy Services, Claims Processing, Formulary Management, Drug Utilization Review, Price, Discount, & Rebate Negotiations, and Disease Management & Adherence Initiatives
  • Business Model: Insurance Companies and Retail Pharmacies and Pure Play PBMS

Industry Analysis Report, Regional Outlook, Growth Potential, Price Trends, Competitive Market Share & Forecast 2022–2027. 

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212 Pages

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35 Tables

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81 Charts

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1 Regions

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1 Countries

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26 Companies

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3 Market Segment

US PHARMACY BENEFIT MANAGEMENT MARKET REPORT SCOPE

Report Attribute Details
MARKET SIZE (2027) USD 616.47 Billion
Market Size (2021) USD 446.28 Billion
CAGR (2022-2027) 5.53%
Base Year 2021
Forecast Year 2022-2027
Market Segments Health Plan, Services, and Business Model

MARKET INSIGHTS

The US pharmacy benefit management (PBM) market was valued at USD 446.28 billion in 2021 and is expected to reach USD 616.47 billion by 2027, growing at a CAGR of 5.53% during the forecasted period. 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.

Rise in Biologics & Biosimilars Approvals in the U.S.

  • An increase in approvals and commercial availability of branded biologics and biosimilars in the U.S. caught the attention of PBMs as they are costly and require the need for negotiation with drug developers in terms of pricing and discounts.
  • As drug developers prioritize commercializing a wide range of branded biologics, PBMs and payers are backing increasing usage of branded biologics as they receive discounts & rebates on these therapies, thereby increasing their prescription volume and revenue.
  • Over the last two decades, a transformation has occurred in treating many chronic and highly complex diseases like autoimmune disorders, cancer, and diabetes.
  • The market penetration of biologics such as mAbs, cell therapies, and vaccines has been increasing at a significant rate in the pharma industry due to the introduction of new biologics and their increased adoption, especially in developed economies.
  • The biopharmaceuticals market is witnessing a significant increase in revenue, and many new drugs have been approved in the last few years. The market also addresses unmet drug demand for some challenging diseases such as cancer and autoimmune diseases.
  • In 2020, the US FDA approved 53 new molecular entities (NMEs), 13 or 25% biologics. This level of NME organic approval is in line with recent years. In 2019, 21% of NME approvals by CDER were biologics.
  • PBMs particularly influence cancer, where a broad majority of branded biologics are prescribed as they play a significant role in treating the most complex and end-stage cancers.

Favorable Healthcare Reforms & Growing Adoption of Insured People in the U.S.

  • As of March 2010, 29 million members were eligible to enroll in the Medicare part-D plan. CMS chooses PBM to support Medicare Advantage Predictive Drugs (MA-PD) and prescription drug plans. The number of Medicare members is expected to increase to 77 million by 2030. The pharmacy benefit management market vendors have an important opportunity to target a large customer base under the proposal for healthcare reform. There are significant changes to the plan structure of Medicare Part D.
  • In 2018, it was estimated that nearly 92% of the population were insured. The movement to secure the right to medical care is gradually progressing.
  • S. Pharmacy Benefit Management market has an excellent opportunity to re-enter the Medicare Part-D industry and increase its market share. By allowing them to adapt to new policies and provide equivalent planning to meet consumer needs
  • The Biden-Harris administration has reduced health care costs, increased access to insurance, and made it possible for almost anyone who purchases personal or family health insurance through the PBM market to receive tax credits to reduce insurance premiums.
  • The American Rescue Plan has reduced medical costs for most Marketplace consumers and increased registrations at these record levels. HealthCare.gov consumers have reduced their average monthly premiums by 23% compared to the 2021 registration period before the end of the American Rescue program.

U.S. Pharmacy Benefit Management Market Scenario

Due to multiple parties and a lack of openness, the drug system in the United States is exceedingly complicated. There's often a lack of choice because the drugs that get the attention are chosen by individuals in the pharmaceutical industry, not by customers. But consumers are becoming more conscious of how they engage in prescription drug and health plan purchases. There is a need to optimize health and create a choice. This leads to space for operators that build models and enable higher visibility, choice, and transparency in the prescription drug marketplace.

U.S. Pharmacy Benefit Management Market Segmentations

The US PBM market is segmented based on health plans, services, and business models.

Pharmacy benefit managers started managing prescription claims for insurers, which began in the late 1960s. However, their role has expanded, and their functions have gone beyond. Due to coverage expansions under the Affordable Care Act (ACA) and Medicare Part D, PBMs have evolved from just processing claims to negotiating product discounts and providing a full range of services during the last decade. Furthermore, rising prescription medication costs prompted self-insured organizations and health plans to hire a third party to help them better control their spending. They now offer clinical, administrative, and value-added services that help in the clinical management of patients.

Approximately 266+ million U.S. customers are protected by health plans in the U.S. Premiums fund private health plans, and taxes are used to finance current health insurance for government-sponsored health systems. Many big and small employers assume a direct risk of employees' medical costs. Prescription subsidies are a big part of most of these health plans, driving the demand in the pharmacy benefit management market. While most organizations and governments involved in health plan provisions depend on pharmacy benefit management, fee-for-service (FFS) Medicaid programs do not largely depend on PBMs. PBMs partner with their clients to determine how pharmacy benefits will be managed by figuring out co-pay tiers, utilization management, making formulary decisions, and finalizing pharmacy channels.

Pure play PBMs include independent PBMs and insurance companies. Retail pharmacies include healthcare companies that have primarily invested in the insurance business or are principally known for their retail pharmacy operations and own or have acquired PBMs. Over the past couple of years, PBMs have focused on optimizing core functions, adopting value-based strategies, and investing in analytics and digital tools. Primary PBM services, especially transaction-based ones, are becoming commoditized, pushing for the development of new models and solutions to control profits pools in the U.S. Pharmacy benefit management market. Further, the force of convergence and vertical integration has driven the need for more diversity in terms of ideas and strategies.

Insights by Services

  • Specialty Pharmacy Services
  • Retail Pharmacy Services
  • Mail-order Pharmacy Services
  • Formulary Management
  • Drug Utilization Review
  • Price, Discount, & Rebate Negotiations
  • Disease Management & Adherence Initiatives

Insights by Health Plans

  • Commercial Health Plans
  • Medicare
  • Medicaid
  • Others

Insights by Business Model

  • Insurance Companies & Retail Pharmacies
  • Pure Play PBMs

Frequently Asked Questions

HOW BIG IS THE US PHARMACY BENEFIT MANAGEMENT MARKET?

The U.S. pharmacy benefit management market was valued at USD 446.28 billion in 2021 and is expected to reach USD 616.47 billion by 2027, growing at a CAGR of 5.53%.

WHAT IS A PBM INDUSTRY?

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.

WHAT ARE THE LATEST TRENDS IN THE U.S. PHARMACY BENEFIT MANAGEMENT MARKET?

Increased adoption of e-prescription & mail-order pharmacies and growing approvals of biologics & biosimilars from the FDA are the latest trends in the U.S. pharmacy benefit management market.

WHAT IS THE FUTURE PREDICTION OF THE U.S. PHARMACY BENEFIT MANAGEMENT MARKET?

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

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The U.S. pharmacy benefit management market was valued at USD 446.28 billion in 2021 and is expected to reach USD 616.47 billion by 2027, growing at a CAGR of 5.53%.

The following factors are likely to contribute to the growth of the U.S. pharmacy benefit management market during the forecast period:

  • Favorable Healthcare Reforms
  • Growing Adoption of Healthcare Plans by U.S. Residents
  • Prevalence of Fraud, Waste, & Abuse in Healthcare
  • Increase in Demand for Personalized Medicines

Base Year: 2021

Forecast Year: 2022-2027

The study considers a detailed scenario of the present U.S. pharmacy benefit management market and its market dynamics for 2022−2027. 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.

Key Company Profiles

  • CVS Health
    • Business Overview
    • Product Offerings
    • Key Strengths
    • Key Strategies
    • Key Opportunity
  • Cigna
  • UnitedHealth Group

Key Companies to Watch

  • Humana Pharmacy Solutions
    • Business Overview
    • Product Offerings
    • Key Strengths
    • Key Strategies
    • Key Opportunity
  • Medimpact
  • Prime Therapeutics

Other Prominent Vendors

  • Abarca Health
    • Business Overview
    • Service offerings
    • Key Strengths
    • Key Strategies
  • 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

Segmentation by Health Plan

  • Commercial Health Plans
  • Medicare
  • Medicaid
  • Others

Segmentation by Services

  • Specialty Pharmacy Services
  • Retail Pharmacy Networks
  • Mail-Order Pharmacy Services
  • Claims Processing
  • Formulary Management
  • Drug Utilization Review
  • Price, Discount, & Rebate Negotiations
  • Disease Management & Adherence Initiatives

Segmentation by Business Model

  • Insurance Companies and Retail Pharmacies
  • Pure Play PBMS

1 RESEARCH METHODOLOGY

2 RESEARCH OBJECTIVES

3 RESEARCH PROCESS

4 SCOPE & COVERAGE

4.1 MARKET DEFINITION

4.1.1 INCLUSIONS

4.1.2 EXCLUSIONS

4.1.3 MARKET ESTIMATION CAVEATS

4.2 BASE YEAR

4.3 SCOPE OF THE STUDY

4.4 MARKET SEGMENTATION

4.4.1 MARKET SEGMENTATION BY SERVICE

4.4.2 MARKET SEGMENTATION BY HEALTH PLAN

4.4.3 MARKET SEGMENTATION BY BUSINESS MODEL

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

14.3.1 THREAT OF NEW ENTRANTS

14.3.2 BARGAINING POWER OF SUPPLIERS

14.3.3 BARGAINING POWER OF BUYERS

14.3.4 THREAT OF SUBSTITUTES

14.3.5 COMPETITIVE RIVALRY

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

15.4.1 MARKET OVERVIEW

15.4.2 MARKET SIZE & FORECAST

15.5 MEDICAID

15.5.1 MARKET OVERVIEW

15.5.2 MARKET SIZE & FORECAST

15.6 OTHERS

15.6.1 MARKET OVERVIEW

15.6.2 MARKET SIZE & FORECAST

16 SERVICES

16.1 MARKET SNAPSHOT & GROWTH ENGINE

16.2 MARKET OVERVIEW

16.3 SPECIALTY PHARMACY SERVICES

16.3.1 MARKET OVERVIEW

16.3.2 MARKET SIZE & FORECAST

16.4 RETAIL PHARMACY NETWORKS

16.4.1 MARKET OVERVIEW

16.4.2 MARKET SIZE & FORECAST

16.5 MAIL-ORDER PHARMACY SERVICES

16.5.1 MARKET OVERVIEW

16.5.2 MARKET SIZE & FORECAST

16.6 CLAIMS PROCESSING

16.6.1 MARKET OVERVIEW

16.6.2 MARKET SIZE & FORECAST

16.7 FORMULARY MANAGEMENT

16.7.1 MARKET OVERVIEW

16.7.2 MARKET SIZE & FORECAST

16.8 DRUG UTILIZATION REVIEW

16.8.1 MARKET OVERVIEW

16.8.2 MARKET SIZE & FORECAST

16.9 PRICE, DISCOUNT & REBATE NEGOTIATIONS

16.9.1 MARKET OVERVIEW

16.9.2 MARKET SIZE & FORECAST

16.10 DISEASE MANAGEMENT & ADHERENCE INITIATIVES

16.10.1 MARKET OVERVIEW

16.10.2 MARKET SIZE & FORECAST

17 BUSINESS MODEL

17.1 MARKET SNAPSHOT & GROWTH ENGINE

17.2 MARKET OVERVIEW

17.3 INSURANCE COMPANIES & RETAIL PHARMACIES

17.3.1 MARKET OVERVIEW

17.3.2 MARKET SIZE & FORECAST

17.4 PURE PLAY PBMS

17.4.1 MARKET OVERVIEW

17.4.2 MARKET SIZE & FORECAST

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

19.1.1 BUSINESS OVERVIEW

19.1.2 SERVICE OFFERINGS

19.1.3 KEY STRENGTHS

19.1.4 KEY STRATEGIES

19.1.5 KEY OPPORTUNITY

19.2 CIGNA

19.2.1 BUSINESS OVERVIEW

19.2.2 SERVICE OFFERINGS

19.2.3 KEY STRENGTHS

19.2.4 KEY STRATEGIES

19.2.5 KEY OPPORTUNITY

19.3 UNITEDHEALTH GROUP

19.3.1 BUSINESS OVERVIEW

19.3.2 SERVICE OFFERINGS

19.3.3 KEY STRENGTH

19.3.4 KEY STRATEGIES

19.3.5 KEY OPPORTUNITY

20 KEY COMPANIES TO WATCH

20.1 HUMANA PHARMACY SOLUTIONS

20.1.1 BUSINESS OVERVIEW

20.1.2 SERVICE OFFERINGS

20.1.3 KEY STRENGTHS

20.1.4 KEY STRATEGIES

20.1.5 KEY OPPORTUNITY

20.2 MEDIMPACT

20.2.1 BUSINESS OVERVIEW

20.2.2 SERVICE OFFERINGS

20.2.3 KEY STRENGTHS

20.2.4 KEY STRATEGIES

20.2.5 KEY OPPORTUNITIES

20.3 PRIME THERAPEUTICS

20.3.1 BUSINESS OVERVIEW

20.3.2 SERVICE OFFERINGS

20.3.3 KEY STRENGTHS

20.3.4 KEY STRATEGIES

21 OTHER PROMINENT VENDORS

21.1 ABARCA HEALTH

21.1.1 BUSINESS OVERVIEW

21.1.2 SERVICE OFFERINGS

21.1.3 KEY STRENGTHS

21.1.4 KEY STRATEGIES

21.2 ANTHEM

21.2.1 BUSINESS OVERVIEW

21.2.2 SERVICE OFFERINGS

21.2.3 KEY STRATEGIES

21.2.4 KEY STRENGTHS

21.3 ASCELLAHEALTH

21.3.1 BUSINESS OVERVIEW

21.3.2 SERVICE OFFERINGS

21.3.3 KEY STRENGTHS

21.3.4 KEY STRATEGIES

21.4 BENECARD PBF

21.4.1 BUSINESS OVERVIEW

21.4.2 SERVICE OFFERINGS

21.4.3 KEY STRENGTHS

21.4.4 KEY STRATEGIES

21.5 CAPTURERX

21.5.1 BUSINESS OVERVIEW

21.5.2 SERVICE OFFERINGS

21.5.3 KEY STRENGTHS

21.5.4 KEY STRATEGIES

21.6 CENTENE

21.6.1 BUSINESS OVERVIEW

21.6.2 SERVICE OFFERINGS

21.6.3 KEY STRENGTHS

21.6.4 KEY STRATEGIES

21.7 CHANGE HEALTHCARE

21.7.1 BUSINESS OVERVIEW

21.7.2 SERVICE OFFERINGS

21.7.3 KEY STRENGTHS

21.7.4 KEY STRATEGIES

21.8 CITIZENS RX

21.8.1 BUSINESS OVERVIEW

21.8.2 SERVICE OFFERINGS

21.8.3 KEY STRENGTHS

21.8.4 KEY STRATEGIES

21.9 ENVISIONRXOPTIONS

21.9.1 BUSINESS OVERVIEW

21.9.2 SERVICE OFFERINGS

21.9.3 KEY STRENGTHS

21.9.4 KEY STRATEGIES

21.10 EXCELERA

21.10.1 BUSINESS OVERVIEW

21.10.2 SERVICE OFFERINGS

21.10.3 KEY STRENGTHS

21.10.4 KEY STRATEGIES

21.11 MAGELLAN RX MANAGEMENT

21.11.1 BUSINESS OVERVIEW

21.11.2 SERVICE OFFERINGS

21.11.3 KEY STRENGTHS

21.11.4 KEY STRATEGIES

21.12 MEDALISTRX

21.12.1 BUSINESS OVERVIEW

21.12.2 SERVICE OFFERINGS

21.12.3 KEY STRENGTH

21.12.4 KEY STRATEGIES

21.13 MAXORPLUS

21.13.1 BUSINESS OVERVIEW

21.13.2 SERVICE OFFERINGS

21.13.3 KEY STRENGTHS

21.13.4 KEY STRATEGIES

21.14 NAVITUS HEALTH SOLUTIONS

21.14.1 BUSINESS OVERVIEW

21.14.2 SERVICE OFFERINGS

21.14.3 KEY STRENGTH

21.14.4 KEY STRATEGY

21.15 PERFORMRX

21.15.1 BUSINESS OVERVIEW

21.15.2 SERVICE OFFERINGS

21.15.3 KEY STRENGTHS

21.15.4 KEY STRATEGIES

21.16 PROCARE RX

21.16.1 BUSINESS OVERVIEW

21.16.2 SERVICE OFFERINGS

21.16.3 KEY STRENGTHS

21.16.4 KEY STRATEGIES

21.17 RXADVANCE

21.17.1 BUSINESS OVERVIEW

21.17.2 SERVICE OFFERINGS

21.17.3 KEY STRENGTHS

21.17.4 KEY STRATEGIES

21.18 RITE AID

21.18.1 BUSINESS OVERVIEW

21.18.2 SERVICE OFFERINGS

21.18.3 KEY STRENGTHS

21.18.4 KEY STRATEGIES

21.19 WELLDYNERX

21.19.1 BUSINESS OVERVIEW

21.19.2 SERVICE OFFERINGS

21.19.3 KEY STRENGTHS

21.19.4 KEY STRATEGIES

21.20 WALGREENS BOOTS ALLIANCE

21.20.1 BUSINESS OVERVIEW

21.20.2 SERVICE OFFERINGS

21.20.3 KEY STRENGTHS

21.20.4 KEY STRATEGIES

22 REPORT SUMMARY

22.1 KEY TAKEAWAYS

22.2 STRATEGIC RECOMMENDATIONS

23 QUANTITATIVE SUMMARY

23.1 MARKET BY HEALTH PLANS

23.2 MARKET BY SERVICES

23.3 MARKET BY BUSINESS MODEL

24 APPENDIX

24.1 ABBREVIATIONS

LIST OF EXHIBITS

EXHIBIT 1 SEGMENTATION OF PHARMACY BENEFIT MANAGEMENT (PBM) MARKET IN US

EXHIBIT 2 MARKET SIZE CALCULATION APPROACH 2021

EXHIBIT 3 ROLE OF PBMS IN PROVIDING SERVICES & FLOW OF FUNDS FOR PRESCRIPTION DRUGS

EXHIBIT 4 PRESCRIPTION DRUG EXPENDITURES 2011−2027 ($ BILLION)

EXHIBIT 5 NUMBER OF DRUG APPROVALS IN PIPELINE FOR 2020

EXHIBIT 6 PBMS RESPONSE TOWARDS COVID-19

EXHIBIT 7 US MEDICATION NON-ADHERENCE STATISTICS 2019

EXHIBIT 8 IMPACT OF INCREASED ADOPTION OF E-PRESCRIPTION & MAIL ORDER PHARMACY

EXHIBIT 9 HER ADOPTION RATE IN US

EXHIBIT 10 IMPACT OF GROWING FDA APPROVALS OF BIOLOGICS & BIOSIMILARS

EXHIBIT 11 NUMBER OF BIOLOGICS APPROVED BY US FDA IN 2000−2010 & 2011−2020

EXHIBIT 12 PERCENTAGE SHARE OF BIOLOGICS APPROVED BY US FDA 2016−2021

EXHIBIT 13 IMPACT OF MARKET ENTRY OF PAYERS THROUGH M&AS

EXHIBIT 14 IMPACT OF ENTRY OF DIGITAL HEALTH SOLUTIONS IN PBM INDUSTRY

EXHIBIT 15 IMPACT OF FAVORABLE HEALTHCARE REFORMS

EXHIBIT 16 AVERAGE MONTHLY PREMIUMS FOR 16 NATIONAL PART D STANDALONE DRUG PLANS

EXHIBIT 17 IMPACT OF GROWING ADOPTION OF HEALTHCARE PLANS BY US RESIDENTS

EXHIBIT 18 STANDALONE DRUG PLANS & MEDICARE ADVANTAGE DRUG PLANS

EXHIBIT 19 MEDICAID SPENDING BY US RESIDENTS

EXHIBIT 20 IMPACT OF PREVALENCE OF FRAUD, WASTE & ABUSE IN HEALTHCARE

EXHIBIT 21 OVERVIEW OF FRAUD, WASTE & ABUSE IN US 2019

EXHIBIT 22 IMPACT OF INCREASED DEMAND FOR PERSONALIZED MEDICINES

EXHIBIT 23 IMPACT OF PBMS MORE SUSCEPTIBLE TO LAWSUITS & GOVERNMENT SCRUTINY

EXHIBIT 24 IMPACT OF LACK OF TRANSPARENCY IN SERVICES BY PBMS

EXHIBIT 25 IMPACT OF DECLINING GROWTH FROM GENERICS

EXHIBIT 26 SHARE OF GENERIC VERSUS BRANDED DRUG PRESCRIPTIONS DISPENSED IN US 2008−2018

EXHIBIT 27 IMPACT OF LEGAL UNCERTAINTY & IMPENDING LIMITATIONS ON PBM TOOLS

EXHIBIT 28 THE CASE FOR PBMS

EXHIBIT 29 PHARMACY BENEFIT MANAGEMENT MARKET IN US 2021–2027 ($ BILLION)

EXHIBIT 30 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY HEALTH PLANS: MARKET SHARE 2021 & 2027

EXHIBIT 31 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY SERVICES: MARKET SHARE 2021 & 2027

EXHIBIT 32 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY BUSINESS MODEL: MARKET SHARE 2021 & 2027

EXHIBIT 33 FIVE FORCES ANALYSIS 2021

EXHIBIT 34 INCREMENTAL GROWTH BY HEALTH PLANS 2021 & 2027

EXHIBIT 35 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY HEALTH PLANS: INCREMENTAL GROWTH

EXHIBIT 36 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY HEALTH PLANS: ABSOLUTE GROWTH

EXHIBIT 37 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY COMMERCIAL HEALTH PLANS: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 38 US PHARMACY BENEFIT MANAGEMENT MARKET BY COMMERCIAL HEALTH PLANS 2021–2027 ($ BILLION)

EXHIBIT 39 US PHARMACY BENEFIT MANAGEMENT MARKET IN US BY MEDICARE: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 40 US PHARMACY BENEFIT MANAGEMENT MARKET BY MEDICARE 2021–2027 ($ BILLION)

EXHIBIT 41 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY MEDICAID: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 42 US PHARMACY BENEFIT MANAGEMENT MARKET BY MEDICAID 2021–2027 ($ BILLION)

EXHIBIT 43 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY OTHERS: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 44 US PHARMACY BENEFIT MANAGEMENT MARKET BY OTHERS 2021–2027 ($ BILLION)

EXHIBIT 45 INCREMENTAL GROWTH BY SERVICES 2021 & 2027

EXHIBIT 46 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY SERVICES: INCREMENTAL GROWTH

EXHIBIT 47 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY SERVICES: ABSOLUTE GROWTH

EXHIBIT 48 STATISTICS ON SPECIALTY DRUGS IN US 2019

EXHIBIT 49 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY SPECIALTY PHARMACY SERVICES: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 50 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY SPECIALTY PHARMACY SERVICES 2021–2027 ($ BILLION)

EXHIBIT 51 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY RETAIL PHARMACY NETWORKS: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 52 PBMS WITH NETWORK PHARMACY

EXHIBIT 53 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY RETAIL PHARMACY NETWORKS 2021–2027 ($ BILLION)

EXHIBIT 54 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY MAIL-ORDER PHARMACY SERVICES: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 55 MAIL-ORDER PHARMACY SERVICES SAVE MONEY

EXHIBIT 56 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY MAIL-ORDER PHARMACY SERVICES  2021–2027 ($ BILLION)

EXHIBIT 57 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY CLAIMS PROCESSING: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 58 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY CLAIMS PROCESSING2021–2027 ($ BILLION)

EXHIBIT 59 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY FORMULARY MANAGEMENT: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 60 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY FORMULARY MANAGEMENT 2021–2027 ($ BILLION)

EXHIBIT 61 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY DRUG UTILIZATION REVIEW: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 62 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY DRUG UTILIZATION REVIEW 2021–2027 ($ BILLION)

EXHIBIT 63 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY PRICE, DISCOUNT & REBATE NEGOTIATIONS: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 64 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY PRICE, DISCOUNT & REBATE NEGOTIATIONS 2021–2027 ($ BILLION)

EXHIBIT 65 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY DISEASE MANAGEMENT & ADHERENCE INITIATIVES: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 66 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY DISEASE MANAGEMENT & ADHERENCE INITIATIVES 2021–2027 ($ BILLION)

EXHIBIT 67 INCREMENTAL GROWTH BY BUSINESS MODEL 2021 & 2027

EXHIBIT 68 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY BUSINESS MODEL: INCREMENTAL GROWTH

EXHIBIT 69 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY INSURANCE COMPANIES & RETAIL PHARMACIES: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 70 US PHARMACY BENEFIT MANAGEMENT MARKET BY INSURANCE COMPANIES & RETAIL PHARMACIES 2021–2027 ($ BILLION)

EXHIBIT 71 US PHARMACY BENEFIT MANAGEMENT MARKET IN US BY PURE PLAY PBMS: INCREMENTAL & ABSOLUTE GROWTH

EXHIBIT 72 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY PURE PLAY PBMS 2021–2027 ($ BILLION)

EXHIBIT 73 COMPETITIVE ANALYSIS OF KEY VENDORS: PHARMACY BENEFIT MANAGEMENT MARKET IN US

EXHIBIT 74 PHARMACY BENEFIT MANAGEMENT MARKET IN US: KEY VENDORS RANKING 2021

EXHIBIT 75 KEY VENDOR CAPABILITIES COMPARISON IN US PHARMACY BENEFIT MANAGEMENT MARKET

EXHIBIT 76 CVS HEALTH: TOTAL REVENUE 2019–2021 ($ MILLION)

EXHIBIT 77 CVS HEALTH REVENUE SHARE BY BUSINESS SEGMENTS 2019–2021 (%)

EXHIBIT 78 CIGNA: TOTAL REVENUE 2019–2021 ($ MILLION)

EXHIBIT 79 CIGNA: REVENUE BY BUSINESS SEGMENT 2021 (%)

EXHIBIT 80 UNITEDHEALTH GROUP: TOTAL REVENUE 2019–2021 ($ MILLION)

EXHIBIT 81 UNITEDHEALTH GROUP: REVENUE BY BUSINESS PLATFORM 2020 (%)

LIST OF TABLES

TABLE 1 KEY CAVEATS

TABLE 2 CURRENCY CONVERSION 2015−2021

TABLE 3 PBMS PARTICIPATION WITH OTHER PLAYER PHARMACEUTICAL ECOSYSTEM

TABLE 4 CVS HEALTH: MAJOR SERVICE OFFERINGS

TABLE 5 CIGNA: MAJOR SERVICE OFFERINGS

TABLE 6 UNITEDHEALTH GROUP: MAJOR SERVICE OFFERINGS

TABLE 7 HUMANA PHARMACY SOLUTIONS: MAJOR SERVICE OFFERINGS

TABLE 8 MEDIMPACT: MAJOR SERVICE OFFERINGS

TABLE 9 PRIME THERAPEUTICS: MAJOR SERVICE OFFERINGS

TABLE 10 ABARCA HEALTH: MAJOR SERVICE OFFERINGS

TABLE 11 ANTHEM: MAJOR SERVICE OFFERINGS

TABLE 12 ASCELLAHEALTH: MAJOR SERVICE OFFERINGS

TABLE 13 BENECARD PBF: MAJOR SERVICE OFFERINGS

TABLE 14 CAPTURERX: MAJOR SERVICE OFFERINGS

TABLE 15 CENTENE: MAJOR SERVICE OFFERINGS

TABLE 16 CHANGE HEALTHCARE: MAJOR SERVICE OFFERINGS

TABLE 17 CITIZENS RX: MAJOR SERVICE OFFERINGS

TABLE 18 ENVISIONRXOPTIONS: MAJOR SERVICE OFFERINGS

TABLE 19 EXCELERA: MAJOR SERVICE OFFERINGS

TABLE 20 MAGELLAN RX MANAGEMENT: MAJOR SERVICE OFFERINGS

TABLE 21 MEDALISTRX: MAJOR SERVICE OFFERINGS

TABLE 22 MAXORPLUS: MAJOR SERVICE OFFERINGS

TABLE 23 NAVITUS HEALTH SOLUTIONS: MAJOR SERVICE OFFERINGS

TABLE 24 PERFORMRX: MAJOR SERVICE OFFERINGS

TABLE 25 PROCARE RX: MAJOR SERVICE OFFERINGS

TABLE 26 RXADVANCE: MAJOR SERVICE OFFERINGS

TABLE 27 RITE AID: MAJOR SERVICE OFFERINGS

TABLE 28 WELLDYNERX: MAJOR SERVICE OFFERINGS

TABLE 29 WALGREENS BOOTS ALLIANCE: MAJOR SERVICE OFFERINGS

TABLE 30 PHARMACY BENEFIT MANAGEMENT MARKET THE US BY HEALTH PLANS 2021−2027 ($ BILLION)

TABLE 31 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY HEALTH PLANS 2021−2027 (%)

TABLE 32 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY SERVICES 2021−2027 ($ BILLION)

TABLE 33 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY SERVICES 2021−2027 (%)

TABLE 34 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY BUSINESS MODEL 2021−2027 ($ BILLION)

TABLE 35 PHARMACY BENEFIT MANAGEMENT MARKET IN US BY BUSINESS MODEL 2021−2027 (%)

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