Global Pharmacy Benefit Management Services Market, By Type (Commercial Health Plans, Self-Insured Employer Plans, Medicare Part D Plans, Federal Employees Health Benefits Program, State Government Employee Plans), Business Model (Government Health Programs, Employer-Sponsored Programs, and Health Insurance Management), Application (Mail-Order Pharmacy Services, Non-Mail Pharmacy Services), Service (Retail Pharmacy Services, Specialty Pharmacy Services, Benefit Plan Design and Consultation, Network-Pharmacy Claims Processing, Home Delivery Pharmacy Care, Drug Utilization Review, Drug Formulary Management, Medical and Drug Data Analysis Services, Others), End-User (Healthcare Providers, Employers, Drug Manufacturers, Others) – Industry Trends and Forecast to 2030.
Pharmacy Benefit Management Services Market Analysis and Size
The global pharmacy benefit management services market is driven by the rising healthcare costs and the need to control prescription drug expenses, leading healthcare payers and employers to rely on pharmacy benefit management services for cost-effective medication management. With a focus on expanding pharmacy networks, managing specialty drugs, and improving medication adherence, pharmacy benefit management services play a pivotal role in optimizing drug utilization. However, regulatory challenges, the demand for pricing transparency, and industry consolidation pose restraints, while opportunities lie in telehealth integration, personalized medicine, value-based care models, and global expansion as pharmacy benefit management services adapt to an evolving healthcare landscape.
Data Bridge Market Research analyses that the pharmacy benefit management services market which was USD 560.93 billion in 2022, is expected to reach USD 630.35 billion by 2030, and is expected to undergo a CAGR of 6.30% during the forecast period of 2023 to 2030. “Government health programs” dominates the business model segment of the global pharmacy benefit management services market owing to a rising government initiatives to increase awareness about pharmacy benefit management services. In addition to the insights on market scenarios such as market value, growth rate, segmentation, geographical coverage, and major players, the market reports curated by the Data Bridge Market Research also include depth expert analysis, patient epidemiology, pipeline analysis, pricing analysis, and regulatory framework.
Pharmacy Benefit Management Services Market Scope and Segmentation
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Report Metric
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Details
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Forecast Period
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2023 to 2030
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Base Year
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2022
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Historic Years
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2021 (Customizable to 2015-2020)
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Quantitative Units
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Revenue in USD Million, Volumes in Units, Pricing in USD
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Segments Covered
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Type (Commercial Health Plans, Self-Insured Employer Plans, Medicare Part D Plans, Federal Employees Health Benefits Program, State Government Employee Plans), Business Model (Government Health Programs, Employer-Sponsored Programs, and Health Insurance Management), Application (Mail-Order Pharmacy Services, Non-Mail Pharmacy Services), Service (Retail Pharmacy Services, Specialty Pharmacy Services, Benefit Plan Design & Consultation, Network-Pharmacy Claims Processing, Home Delivery Pharmacy Care, Drug Utilization Review, Drug Formulary Management, Medical & Drug Data Analysis Services, Others), End-User (Healthcare Providers, Employers, Drug Manufacturers, Others)
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Countries Covered
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U.S., Canada, Mexico, Germany, Italy, U.K., France, Spain, Netherlands, Belgium, Switzerland, Turkey, Russia, Rest of Europe, Japan, China, India, South Korea, Australia, Singapore, Malaysia, Thailand, Indonesia, Philippines, Rest of Asia-Pacific, Brazil, Argentina, Rest of South America, South Africa, Saudi Arabia, U.A.E., Egypt, Israel, Rest of Middle East and Africa
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Market Players Covered
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Cigna (U.S.), CVS Health (U.S.), UnitedHealth Group (U.S.), Anthem, Inc. (U.S.), Centene Corporation (U.S.), DST Systems, Inc. (U.S.), Kaiser Foundation Health Plan, Inc. (U.S.), Magellan Health, Inc. (U.S.), McKesson Corporation(U.S.), MedImpact Direct, LLC. (U.S.), Micro Merchant Systems, Inc. (U.S.), Prime Therapeutics LLC (U.S.), Rite Aid Corp. (U.S.), TrialCard Incorporated (U.S.) and Walgreens Boots Alliance, Inc (U.S.)
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Market Opportunities
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Market Definition
Pharmacy benefit management services provide several medical facilities to patients. They are run by third party administrators (TPAs) who act as link between pharmacists, insurance companies, and claimers of insurance and drug manufacturers. They help in reducing the price of drugs, manage prescriptions, plan the best health plans for patients by offering discounts and rebates. They offer medicines at affordable prices as compared to those sold by retail pharmacists.
Global Pharmacy Benefit Management Services Market Dynamics
Drivers
- Increasing in Chronic Diseases
The growing prevalence of chronic diseases worldwide, such as diabetes, cardiovascular diseases, and cancer, has led to an increased demand for prescription medications. PBMS play a crucial role in ensuring access to necessary medications while controlling costs for both patients and healthcare payers.
- Expansion of Health Insurance Coverage
Efforts to expand health insurance coverage, particularly in regions such as U.S. with the implementation of the Affordable Care Act (ACA), have increased the number of individuals with access to prescription drug benefits. This has boosted the demand for PBM services to efficiently manage and administer these benefits.
- Growth of Special Pharmaceuticals
The growth of specialty pharmaceuticals, which are used to treat complex and rare conditions, is a significant driver for PBMs. These drugs often come with high price tags and require specialized handling and distribution. PBMs assist in the management of specialty drug benefits, including prior authorizations, patient support programs, and cost containment strategies.
- Growing Investment for Healthcare Facilities
Surging focus towards improving the condition of healthcare facilities and improving the overall healthcare infrastructure another important factor fostering the growth of the market. Rising number of partnerships and strategic collaborations between the public and private players pertaining to funding and application of new and improved technology is further creating lucrative market opportunities.
Opportunities
- Rising Demand for Specialty Pharmacy Services
With the increasing prevalence of complex and rare diseases, there is a growing demand for specialty pharmaceuticals. PBMs have an opportunity to expand their services to effectively manage specialty drug benefits. This includes providing support for prior authorizations, patient education, adherence monitoring, and cost-effective distribution of specialty drugs.
- Value-Based Care Models
The shift toward value-based care, which emphasizes outcomes and patient satisfaction over fee-for-service models, creates an opportunity for PBMs to align their services with these new payment models. PBMs can work with healthcare providers to develop value-based contracts that reward positive patient outcomes and cost-effective medication management.
Restraints/Challenges
- Complex Process of Regulatory
The PBM industry operates in a heavily regulated environment, subject to changing government policies and regulations. Compliance with these regulations can be complex and costly. In addition, changes in healthcare legislation can impact PBM operations and profitability.
- Pricing Pressures of Drugs
The constant pressure to reduce drug prices and healthcare costs can limit the profit margins for PBMs. Negotiating favourable pricing with pharmaceutical manufacturers while maintaining quality care can be a delicate balancing act.
- Rising Costs of Prescription Drug
One of the primary challenges for PBMs is the continuous increase in prescription drug costs. Pharmaceutical manufacturers often release expensive specialty drugs and medications, which can significantly inflate healthcare expenditures. PBMs must find ways to manage these costs while ensuring patient access to necessary medications.
- Constant Challenges of Drug Formularies Management
PBMS manage drug formularies, which are lists of preferred medications for specific health plans. Balancing cost-effective options with providing the best care for patients is a constant challenge. Ensuring that formularies are updated to include new, effective treatments can also be complex.
This global pharmacy benefit management services market report provides details of new recent developments, trade regulations, import-export analysis, production analysis, value chain optimization, market share, impact of domestic and localized market players, analyses opportunities in terms of emerging revenue pockets, changes in market regulations, strategic market growth analysis, market size, category market growths, application niches and dominance, product approvals, product launches, geographic expansions, technological innovations in the market. To gain more info on the global pharmacy benefit management services market contact Data Bridge Market Research for an Analyst Brief, our team will help you take an informed market decision to achieve market growth.
Recent Developments
- In October 2022, Omnicell, Inc., a provider of medication management and adherence tools for health systems and pharmacies, launched Specialty Pharmacy Services, a comprehensive offering designed to help health systems launch and/or optimize a fully managed, hospital-owned specialty pharmacy
- In March 2022, ProdigyRx, a pharmacy benefits manager, launched its business operations that offer PBM services and clinical solutions for workers compensation insurers, third-party administrators, and self-insured/administered employers
Global Pharmacy Benefit Management Services Market Scope
The global pharmacy benefit management services market is segmented on the basis of type, business model, application, service and end-user. The growth amongst these segments will help you analyse meagre growth segments in the industries and provide the users with a valuable market overview and market insights to help them make strategic decisions for identifying core market applications.
Type
- Commercial Health Plans
- Self-Insured Employer Plans
- Medicare Part D Plans
- Federal Employees’ Health Benefits Program
- State Government Employee Plans
Business Model
- Government Health Programs
- Employer-Sponsored Programs
- Health Insurance Management
Application
- Mail-Order Pharmacy Services
- Non-Mail Pharmacy Services
Service
- Retail Pharmacy Services
- Specialty Pharmacy Services
- Benefit Plan Design and Consultation
- Network-Pharmacy Claims Processing
- Home Delivery Pharmacy Care
- Drug Utilization Review
- Drug Formulary Management
- Medical and Drug Data Analysis Services
- Others
End-User
- Healthcare Providers
- Employers
- Drug Manufacturers
- Others
Global Pharmacy Benefit Management Services Market Regional Analysis/Insights
The global pharmacy benefit management services market is analysed and market size insights and trends are provided by country, type, business model, application, service and end-user as referenced above.
The countries covered in the global pharmacy benefit management services market report are U.S., Canada, Mexico, Germany, Italy, U.K., France, Spain, Netherlands, Belgium, Switzerland, Turkey, Russia, Rest of Europe, Japan, China, India, South Korea, Australia, Singapore, Malaysia, Thailand, Indonesia, Philippines, Rest of Asia- Pacific, Brazil, Argentina, Rest of South America, South Africa, Saudi Arabia, U.A.E., Egypt, Israel, Rest of Middle East and Africa
Latin America dominates the global pharmacy benefit management services market due to rise in the government health programs and health insurance companies combining and utilizing various resources in the market to provide member-healthcare benefits in this region.
Asia-Pacific (APAC) is expected to witness a significant growth in the global pharmacy benefit management services market during the forecast period of 2023 to 2030 due to the surge in demand for advanced technologies in pharmacy benefit management services.
The country section of the report also provides individual market impacting factors and changes in regulation in the market domestically that impacts the current and future trends of the market. Data points like down-stream and upstream value chain analysis, technical trends and porter's five forces analysis, case studies are some of the pointers used to forecast the market scenario for individual countries. Also, the presence and availability of global brands and their challenges faced due to large or scarce competition from local and domestic brands, impact of domestic tariffs and trade routes are considered while providing forecast analysis of the country data.
Healthcare Infrastructure Growth Installed Base and New Technology Penetration
The global pharmacy benefit management services market also provides you with detailed market analysis for every country growth in healthcare expenditure for capital equipment, installed base of different kind of products for global pharmacy benefit management services market, impact of technology using life line curves and changes in healthcare regulatory scenarios and their impact on the global pharmacy benefit management services market. The data is available for historic period 2015-2020.
Competitive Landscape and Global Pharmacy Benefit Management Services Market Share Analysis
The global pharmacy benefit management services market competitive landscape provides details by competitor. Details included are company overview, company financials, revenue generated, market potential, investment in research and development, new market initiatives, global presence, production sites and facilities, production capacities, company strengths and weaknesses, product launch, product width and breadth, application dominance. The above data points provided are only related to the companies' focus related to global pharmacy benefit management services market.
Some of the major players operating in the global pharmacy benefit management services market are:
- Cigna (U.S.)
- CVS Health (U.S.)
- UnitedHealth Group (U.S.)
- Anthem, Inc. (U.S.)
- Centene Corporation (U.S.)
- DST Systems, Inc. (U.S.)
- Kaiser Foundation Health Plan, Inc. (U.S.)
- Magellan Health, Inc. (U.S.)
- McKesson Corporation(U.S.)
- MedImpact Direct, LLC. (U.S.)
- Micro Merchant Systems, Inc. (U.S.)
- Prime Therapeutics LLC (U.S.)
- Rite Aid Corp. (U.S.)
- TrialCard Incorporated (U.S.)
- Walgreens Boots Alliance, Inc. (U.S.)
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