The U.S. pharmacy benefits management market size is projected to reach USD 744.6 billion by 2026, according to a new report by., exhibiting a CAGR of 9.2% during the forecast period. Increasing vertical integration of key market players, rising prevalence of chronic disease, and shrinking FDA generic-approval backlog are some of the primary growth stimulants for the market.
Vertical integration of pharmacy benefits management (PBM) organizations with health insurance companies are poised to result in increased control of PBMs over distribution systems. This will lead to rise in rebates, ultimately increasing the cost of drug list prices. Moreover, it will result in a monopoly of certain market player, concentrating sales and revenue generation.
The business of insuring and administering employee benefit programs in the country, especially, health care programs, is heavily regulated by federal and state laws and administrative agencies, such as the Department of Health and Human Services (HHS), State Departments of Insurance, Centers for Medicare & Medicaid Services (CMS), Internal Revenue Services, and Departments of Labor.
All PBM businesses in the U.S. must include home delivery and specialty pharmacies licensed as pharmacies in the states of establishment. Several states in the country regulate the scope of prescription (Rx) drug coverage and delivery channels to receive drugs for managed care organizations (MCOs), insurers, and Medicaid care plans. Certain home delivery and specialty pharmacies must be registered with the U.S. Drug Enforcement Administration (DEA) and individual state controlled substance authorities.
Further key findings from the study suggest:
• Based on business model, the market has been segmented into standalone PBM, health insurance providers, and retail pharmacy. Of these, PBMs associated with health insurers are likely to witness the fastest growth over the forecast period
• Rise in mergers and partnerships between market players is expected to result in an increased demand for PBM systems
• OptumRx and Express Scripts (merged with Cigna in December 2018) are among the key players merged or acquired by large health insurance providers
• Based on end use, the market has been divided into commercial and federal. Commercial PBM systems dominated the market and are estimated to maintain their dominance through 2026 owing to a large number of covered patients
• CVS Health; Aetna; Express Scripts; Cigna; OptumRx, Inc.; Walgreens Booth Alliance; MedImpact Healthcare Systems, Inc.; Anthem; and Rite Aid are some of the key players in the market.
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Table of Contents
Chapter 1 Methodology and Scope
1.1 Market Segmentation & Scope
1.1.1 Business Model
220.127.116.11 Standalone PBM
18.104.22.168 Health Insurance Providers
22.214.171.124 Retail Pharmacy
1.1.2 END USE
1.1.3 Estimates And Forecast Timeline
1.2 Research Methodology
1.3 Information Procurement
1.3.1 Purchased Database:
1.3.2 Gvr’s Internal Database
1.3.3 Secondary Sources:
1.3.4 Primary Research
1.4 Information or Data Analysis
1.5 Market Formulation & Validation
Chapter 2 Executive Summary
2.1 Market Outlook
2.2 Segment Outlook
Chapter 3 Market Variables, Trends & Scope
3.1 Market Segmentation
3.2 User Perspective Analysis
3.2.1 Consumer Behavior Analysis
3.2.2 Market Influencer Analysis
3.3 Market Dynamics
3.3.1 Market Driver Analysis
126.96.36.199 Vertical Integration Of Key Market Players
188.8.131.52 Introduction Of Improved Health Benefit Plans
184.108.40.206 Growing Prevalence Of Chronic Diseases In The U.S.
3.3.2 Market Restraint Analysis
220.127.116.11 Stringent regulations to cut back rebates
3.4 Penetration & Growth Prospect Mapping
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