Pharmacy Benefit Management Market Size & Share, by Service (Specialty Pharmacy Services, Drug Formulary Management, Benefit Plan Design & Consultation, Other Services); Business Model (Government Health Programs, Employer-Sponsored Programs, Health Insurance Management); End-user (Pharmacy Benefit Management Organization, Mail Order, Retail, Inpatient, Outpatient Pharmacies) - Global Supply & Demand Analysis, Growth Forecasts, Statistics Report 2023-2033

  • Report ID: 4547
  • Published Date: Feb 24, 2023
  • Report Format: PDF, PPT

Global Pharmacy Benefit Management Market Definition

The pharmacy benefit management (PBM) is a set of businesses that act as mediators for insurance companies, pharmacies, and medication manufacturers. PBMs are in charge of procuring reduced prescription costs for insurers and insurance corporations. They achieve this through consultation with pharmacies and medicine producers. Insurance firms are subsequently given the reductions, and the profits are obtained by slightly increasing drug prices or keeping a portion of rebates.

This service helps customers or employers to get the medications at the possible lowest price. The PBM managers negotiate for discounts with drug producers and contract pharmacies. They also provide programs to the members to maintain and improve their health conditions, which they monitoring very closely. A formulary is developed where a prescription drug list is evaluated by doctors or pharmacists based on effectiveness and cost.

The drugs that are not on the list of the formulary are sold at their original price without any discount. Insurance companies hire PBMs to manage their costs during medical claims. The drug manufacturer reduces the cost of the drugs for these insurance companies as they are promoting their drug products to millions of people. The competition in this field is very high, as they play a huge role in price negotiation. 

Global Pharmacy Benefit Management Market: Key Insights

Base Year

2022

Forecast Year

2023-2033

CAGR

~6%

Base Year Market Size (2022)

~ USD 500 Billion

Forecast Year Market Size (2033)

~ USD 700 Billion

Regional Scope

  • North America (U.S., and Canada)
  • Latin America (Mexico, Argentina, Rest of Latin America)
  • Asia-Pacific (Japan, China, India, Indonesia, Malaysia, Australia, Rest of Asia-Pacific)
  • Europe (U.K., Germany, France, Italy, Spain, Russia, NORDIC, Rest of Europe)
  • Middle East and Africa (Israel, GCC North Africa, South Africa, Rest of the Middle East and Africa)

Global Pharmacy Benefit Management Market Size, Forecast, and Trend Highlights Over 2023 - 2033

The global pharmacy benefit management market is estimated to garner a revenue of USD 700 Billion by the end of 2033 by growing at a CAGR of ~6% over the forecast period, i.e., 2023 – 2033. Further, the market generated a revenue of USD 500 Billion in the year 2022. Rising healthcare expenditure and a radical upsurge in the prevalence of various types of chronic diseases are estimated to boost market growth during the forecast period. The national healthcare expenditure of the U.S. raised to 9.7%, i.e., to 4.1 trillion in 2020. Chronic diseases include diabetes, hypertension, stroke, heart disease, cancer, arthritis, obesity, oral disorders, and respiratory diseases. All these last more than one year and may lead to hospitalization and death eventually. Chronic diseases usually occur in the aged population, as they are immune compromised. These types of diseases affect the quality of life and require continuous medication intake as the only remedy, and it is anticipated to increase the growth of the global pharmacy benefit management market.

Pharmacy-Benefit-Management-Market-overview. Get more information on this report:Download Sample PDF

 Pharmacy benefit management aids to provide medical services and drugs at the cheapest price to employers through insurance companies. More customers are attracted to PBM services to increase their access to many pharmaceuticals and retail pharmacies. Further, the availability of many drugs with the same composition of APIs in the market makes it difficult for the manufacturers and consumers owing to the slightest difference in prices of these drugs. Besides this, the adoption of ML (machine learning) and AI (artificial intelligence) in dispensing pharmacies to reduce manual errors is expected to fuel the growth of the market. For instance, as per observations, out of 100,000 prescriptions, a hospital pharmacist makes an overall average of 5 errors.

Global Pharmacy Benefit Management Market: Growth Drivers and Challenges

Growth Drivers

  • Surge in Need to Reduce Medication Errors that Occur Owing to Badly Written Prescriptions – Medication errors occur in preparation, distribution, dispensing, and administration. Furthermore, the medication errors take place on account of the negligence of manufacturers, formulators, pharmacists, doctors or nurses, or any medical person or caretaker. It cause serious damage to the body and may lead to poisoning and death in some cases. Therefore, there is a strong need to prevent medication errors, and it is expected to boost the market growth in the upcoming years. For instance, every year, in the U.S. about 7000 to 9000 people die on account of medication errors.

  • Rising Regionalization of Pharmacies to Increase More Approach to the People – As of 2022, the number of pharmacies and drug stores in the U.S. reached 28,000. In addition, in 2018, more than 800 pharmacies in the U.S. had specialty accreditations, such as independent and small regional pharmacies.

  • Increase in Aged Population with Rising Longevity – From 2020 and 2050, it is predicted to be 427 million more people who are 80 years of age or older than there are today around the globe.

  • Rise in Labor Costs that Rises the Investment Cost – As per estimates, civilian wages and salaries are increased to 5.3% by 2022 in the U.S.

Challenges

  • Stringent Government Regulations Stringent government regulations are estimated to play a significant restraint as PBMs. Now, they have a dominant role in determining not just what prescriptions patients get, and also how much consumers, pharmacists, and health plans spend for those drugs. Many critics charge that PBMs add significant costs to the healthcare system rather than saving it money. As an intermediary, they add levels of complexity and expenditures with no return for the government.
  • No Transparency in the Earnings
  • Lack of Awareness about Online Facilities

Market Segmentation

The global pharmacy benefit management market is segmented and analyzed for demand and supply by service into specialty pharmacy services, drug formulary management, benefit plan design & consultation, and other services. Out of which, specialty pharmacy services are anticipated to hold the largest market size by the end of 2033 on the back of the rising prevalence of complex and chronic diseases that require a profound time to be treated. For instance, more than 50% of Americans had at least one chronic condition and more than 27% of U.S adults had multiple chronic conditions in 2020. The instance of two or more chronic conditions is a rising issue across the world. More people, especially the old age population, are suffering from these multimorbidity disorders. In addition, the combination of diseases increases the risk of death for these people. Increasing longevity is also the reason for the incidence of chronic disorders. The incidence of diabetes leads to lower immunity, reduced healing power, and higher chances of the occurrence of diseases such as hypertension, heart disorders, and renal failure.

The global pharmacy benefit management market is also segmented and analyzed for demand and supply by end-user into pharmacy benefit management organization, mail order, retail, inpatient, and outpatient pharmacies. Amongst these segments, the retail pharmacies segment is expected to garner a significant share, as it is the fastest-growing industry around the world. Moreover, the increasing availability of credit for people impacts their purchasing capacity of the customers. Therefore, retail pharmacists build customer relationships which makes them rely more on retail stores. Trust is built between them as direct human contact gives more confidence to the consumer while purchasing medicines from the such pharmacy. Also, retail pharmacies deliver medicines immediately and without delay in front of the consumer. This increases the loyal customer rate in retail pharmacies. The number of retail pharmacies in the U.S. in 2021 was about 60,000 out of a total count of 67,000 pharmacy facilities, as per the estimations.

Our in-depth analysis of the global pharmacy benefit management market includes the following segments:

                          By Service

  • Specialty Pharmacy Services
  • Drug Formulary Management
  • Benefit Plan Design & Consultation
  • Other Services

                           By Business Model

  • Government Health Programs
  • Employer-Sponsored Programs
  • Health Insurance Management

 

                              By End-User

  • Pharmacy Benefit Management Organization
  • Mail Order Pharmacies
  • Retail Pharmacies
  • Inpatient Pharmacies
  • Outpatient Pharmacies

Global Pharmacy Benefit Management Market Regional Synopsis

The North America pharmacy benefit management market, amongst the market in all the other regions, is projected to hold the largest market share by the end of 2033. The growth of the market can be attributed majorly to the account of elevating penetration of online pharmacies. For instance, as per the estimations, the number of adults who use web-based prescription filling notably has increased from 6% in 2009 to 12% in 2018 in the United States. Furthermore, escalating adoption of advanced healthcare solutions along with the existence of a well-established health industry are some other growth factors that are propelling the market growth in the region. The rising modernization and digitalization of everything improved the healthcare industry a lot. The increasing penetration of e-commerce software and platform in every sector also impacts the growth of the market segment. Moreover, pharmacists are responsible for the proper dispensing of drugs, as any small error in drug dispensing will lead to several complications. Sometimes the handwritten prescriptions of doctors can be unreadable, and on the other hand, the online prescription is clearly visible with a good font. Also, all the drug-related information, such as dosage, administration route, therapeutic use, contraindications, and side effects, is available on online platforms. All these help any nonmedical person to understand the condition of their help. The increasing advantage of online prescriptions impacts the growth of the market in the region during the forecast periods as per the market analysis.

pharmacy-Benefit-Management-Market-regional.

Top Featured Companies Dominating the Global Pharmacy Benefit Management Market

  • CVBS Health Corporation
    • Company Overview
    • Business Strategy
    • Key Product Offerings
    • Financial Performance
    • Key Performance Indicators
    • Risk Analysis
    • Recent Development
    • Regional Presence
    • SWOT Analysis
  • SS&C Technologies Holdings Inc.
  • UnitedHealth Group
  • Rite Aid Corporation
  • Express Scripts Holding Company
  • Benecard Services, LLC.
  • CAPTURERX LLC
  • Change Healthcare
  • Anthem Insurance Companies, Inc. 
  • ProCare Rx


In-the-news

In the News

  • CVS Health Corporation designed a Vendor Benefit Management service to help the customers of CVS Caremark Pharmacy Benefit Management and announced its availability to manage, contract, and implement their choice of health benefit solutions in the digital and non-digital platforms.

  • Rite Aid Corporation’s subsidiary Elixir announced the introduction of a specialty generic enhancement to the clients of copay solutions to provide them with specific specialty medications at USD 0 copay to save USD 40,000 every year.

 


Author Credits:  Radhika Gupta, Shivam Bhutani


  • Report ID: 4547
  • Published Date: Feb 24, 2023
  • Report Format: PDF, PPT

Key Questions Answered in the Report

1) What are the major factors driving the growth of the pharmacy benefit management market?

Ans: Surge in the need to reduce medication errors and the rising regionalization of pharmacies are the major factors driving the growth of the pharmacy benefit management market.

2) What would be the CAGR of pharmacy benefit management market over the forecast period?

Ans: The market is anticipated to attain a CAGR of ~6% over the forecast period, i.e., 2023 – 2033.

3) What are the challenges affecting the pharmacy benefit management market growth?

Ans: Stringent government regulations and no transparency in the earnings are the challenges affecting the market growth.

4) Which region will provide more business opportunities for growth of pharmacy benefit management market in future?

Ans: The market in North America region is projected to hold the largest market share by the end of 2033 and provide more business opportunities in the future.

5) Who are the major players dominating the pharmacy benefit management market?

Ans: The major players in the market are CVS Health Corporation, SS&C Technologies Holdings Inc., UnitedHealth Group, Rite Aid Corporation, Express Scripts Holding Company, Benecard Services, LLC., CaptureRx Inc., Change Healthcare, Anthem Insurance Companies Inc., Procare Rx.

6) How are the company profiles selected?

Ans: The company profiles are selected based on the revenues generated from the product segment, geographical presence of the company which determine the revenue generating capacity as well as the new products being launched into the market by the company.

7) What are the segments in the pharmacy benefit management market?

Ans: The market is segmented by service, business model, end-user, and by region.

8) Which segment captures the largest market size in service in the pharmacy benefit management market?

Ans: The specialty pharmacy services segment is anticipated to garner the largest market size by the end of 2033 and display significant growth opportunities.

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