U.S. PHARMACY BENEFIT MANAGEMENT MARKET SIZE TO REACH USD 700 BILLION BY 2025, GROWING AT A CAGR OF 7% DURING THE FORECAST PERIOD

U.S. Pharmacy Benefit Management Market Size, Share, Industry Analysis by Health Plans (Commercial Health Plan, Self-insured Employer Plan, Medical Part D Plans, Managed Medicaid Programs, and Others), Services (Specialty, Pharmacy Services, Retail Pharmacy Services, Mail-order Pharmacy Services, Benefit Plan Design & Administration, Formulary Management, Clinical Programs & Services, and Others), Business Model (Insurance Companies & Retail Pharmacies, and Pure Play PBMs), Industry Insights, Price Trends, Growth Potential, Competitive Landscape, and Forecast 2020-2025

GET ACTIONABLE INSIGHTS ON HOW COVID-19 IS IMPACTING YOUR BUSINESS
Enquire Now Download Free Sample

Most Exhaustive Report

200 Pages

32 Tables

52 Charts

3 Regions

1 Countries

21 Companies

1 Market Segment

U.S. PHARMACY BENEFIT MANAGEMENT MARKET REPORT SCOPE

Report Attribute Details
MARKET SIZE (REVENUE) USD 700 BILLION (2025)
CAGR 7% (2020-2025)
Base Year 2019
Forecast Year 2020-2025
Market Segments Health Plans (Commercial Health Plan, Self-insured Employer Plan, Medical Part D Plans, Managed Medicaid Programs, and Others), Services (Specialty, Pharmacy Services, Retail Pharmacy Services, Mail-order Pharmacy Services, Benefit Plan Design & Administration, Formulary Management, Clinical Programs & Services, and Others), Business Model (Insurance Companies & Retail Pharmacies, and Pure Play PBMs)
Geographic Analysis North America
Countries Covered United States

U.S. PHARMACY BENEFIT MANAGEMENT MARKET-INDUSTRY INSIGHTS

The U.S. pharmacy benefit management (PBM) market size is to reach USD 700 billion by 2025, growing at a CAGR of 7% during 2020-2025. The complexity of the American drug system and increasing awareness of consumers toward prescription drug and health plan purchases will drive the U.S pharmacy benefits market growth. The easy claiming process offered by the pharmacy benefit management companies has increased the volume of total pharmacy claims thereby driving the market growth. PBMS is working on maximizing clinical outcomes by depending on technology. For instance, Magellan Rx Management does this through patient rewards by partnering with AiCure and introducing an AI platform that records and identifies behavioral data, audio, and video.

Some of the segments in the market are witnessing a lot of dynamism and a faster trajectory. As drug prices used to treat complex or rare conditions become more demanding for payers, patients, and providers, it is driving the specialty pharmacy segment upward.

SNIPPETS

  • The specialty pharmacy services segment is expected to witness an incremental growth of over $51 billion by 2025.
  • The healthcare plan segment is projected to observe an incremental growth of over $81 billion on account of the growing adoption of employer-sponsored health insurance plans.
  • With the annual healthcare waste accounts for $935 billion, PBMs, which are increasingly turning to data and evidence-based approaches, can go a long way to correct the wrong practices in the healthcare industry.

U.S. PHARMACY BENEFIT MANAGEMENT MARKET - INDUSTRY TRENDS

 Consumers' inclination towards digital health tools and shifting to outcome-based contracts will remain an emerging trend in the market. In a bid to curb the rising costs of health care, much of the US healthcare system has been moving from focusing on volume via fee-for-service to value via value/outcome-based payments over the last decade, offering a huge opportunity in the market.

Growth in FDA approvals for orphan and specialty drugs, and shift towards individualized medicines are among the major growth enables of the market. FDA is approving drugs that have never received the approved designation or been used in clinical practice in the US for promoting patient care and are mostly specialty drugs that come with staggering costs. From the top-down, the focus is on encouraging advancements in healthcare and new therapies for patients. In addition, the number of biosimilars that are on the pipeline is growing, fostering cost-saving opportunities for players and payers alike and driving the market growth. Orphan drugs are finding their moment in the spotlight. The number of manufacturers entering the market with competing products has risen.

U.S. PHARMACY BENEFIT MANAGEMENT MARKET SEGMENTATION

This research report includes a detailed segmentation by

  • Services
  • Health Plan
  • Business Model

In 2019, specialty and retail pharmacy services segment occupied more than 40% of the U.S. pharmacy benefit management market share. Specialty pharmacy is witnessing strong growth, driven by increased dynamism in payer access and data systems. Specialty drugs account for almost two-thirds of the revenues for specialty dispensing activities and is growing continuously. In 2019, Prime Therapeutics launched Specialty Monitor powered by Artemetrx, an integrated self-service data solution that provides specific pharmacy and medical benefits insights specific to specialty drugs. Overall, 73% of employers spend 15% or more of their healthcare budgets on pharmacy benefits, and this can go up to 28%, and specialty drugs are driving this segment. Specialty pharmacy services are thus a lucrative segment in the U.S. pharmacy benefit management market.

Approximately 266+ million US consumers are covered by health plans in the US. Premiums fund private health insurers, and taxes are used to fund current health insurance for government-sponsored health systems. Prescription benefits are a big part of most of these health plans, driving the need for a pharmacy benefit manager. Large employers are being driven to use PBM services. Healthcare costs for large employers are touted to rise by almost 7% in 2020. Drugs that treat auto-immune conditions are growing at the fastest rate in commercial health plans, driving demand for management services that deal with them. The pharmacy benefit management market in the US by commercial health plans is expected to reach USD 268 billion by 2025. The enrollment in Medicare Part D plans has grown 2X times over the last 15 years.

The U.S. pharmacy benefit management market by insurance companies and retail pharmacies is growing at a CAGR of 7% during the forecast period. In 2019, more than 52% medium to large employers in the US had either carved out or intended to carve out pharmacy benefits by 2020 in a desperate attempt to stem rising costs. Self-funded products and direct contracts with PBMs are growing as plan sponsors look to discounts and rebates to pull them out of their expensive drug expenditures. This has proven advantageous for independent PBMs. Paired with client dissatisfaction with large PBMs, such factors have initiated a demand for independent PBMs.

U.S. PHARMACY BENEFIT MANAGEMENT MARKET SHARE INSIGHTS

The PBM industry is highly concentrated with CVS Caremark, Express Scripts, and OptumRX, accounting for more than 70% of claims volume. The U.S. pharmacy benefit management (PBM) market share has changed considerably in the last couple of years, where acquisitions led the market to where it is today, occupied mostly by a couple of giants. PBMs are expected to witness a more competitive and challenging atmosphere due to increased consumer pressure, political pressure, legal scrutiny and due to the forces of new, innovative players in the health care space. Express Scripts is a leading vendor in the market. It serves more than 100 million customers and has around 3,000 clients. The Cigna and Express Scrips merger has resulted in expanded specialty services, integrated medical, pharmacy and behavioral management capabilities, advanced analytics, and higher cost affordability and clinical quality.

Frequently Asked Questions

U.S. pharmacy benefit management market size is to reach USD 700 billion by 2020.
The market is growing at a CAGR of over 7% during 2020–2025.
The leading segments are: Health Plans (Commercial Health Plan, Self-insured Employer Plan, Medical Part D Plans, Managed Medicaid Programs, Other), Services (Specialty, Pharmacy Services, Retail Pharmacy Services, Mail-order Pharmacy Services, Benefit Plan Design & Administration, Formulary Management, Clinical Programs & Services, Others) Business Model (Insurance Companies & Retail Pharmacies, Pure Play PBMs )
CVS Caremark, Express Scripts, OptumRx, and Humana Pharmacy Solutions are the leading vendors in the market.
Download Free Sample
Read More

Select a license type that suits your business needs

Single User Licence
$3500.00
  • Report accessible by one user only
  • Free 10% or 3 days of customization
  • Free post-sale service assistance
  • Continuous support through email
Best Value Tag
5 User Licence
$4000.00
  • Report accessible by 5 users within the organization
  • Free 15% or 4.5 days of customization
  • Free post-sale service assistance
  • Continuous support through email and telephone
  • Free analyst hour
  • Free Upgrade: If an updated report published within 180 days of purchase, you will get the revised report free of charge
Corporate Licence
$5000.00
  • Free Datasheet worth $1500
  • Report accessible by the entire organization
  • Free 20% or 6 days of customization
  • Free post-sale service assistance
  • Continuous support through email and telephone
  • Direct access to lead analysts
  • Free analyst hour
  • Free Upgrade: If an updated report published within 180 days of purchase, you will get the revised report free of charge
Datasheet Licence
$1500.00
  • Report accessible by 1 user only
  • Free 15% or 32 hours of customization
  • Free post-sale service assistance
  • Direct access to lead analysts

Select a license type that suits your business needs

Best Value Tag
Coming Soon
  • Stay tuned with us.

YOU CAN GET A FREE SAMPLE OF THIS REPORT!

Fill out your details & get your free sample

Our Clients

Licence Types What are these?

Our Clients Speak

"The report by Arizton was spot on. It not only gave us insight into the pro audio market, we used it to raise funds for our company. The data proved (to the VC we pitched to) that the market was large enough for our company to not only survive but also grow."

Erik Young
CEO, Co-founder
Audink Inc., DBA Audios
SPEAK WITH OUR ANALYST

Want to know more about the report or any specific requirement?

Click to Email +1-312-235-2040

Why Arizton?

  • 100% Customer Satisfaction
  • 24x7 availability – we are always there when you need us
  • 200+ Fortune 500 Companies trust Arizton's report
  • 80% of our reports are exclusive and first in the industry
  • 100% more data and analysis
  • 1000+ reports published till date