According to a report, “U.S. Pharmacy Benefit Management Market Size, Share & Trends Analysis Report By Business Model (Standalone, Health Insurance Providers, Retail Pharmacy), By End Use (Commercial, Federal), And Segment Forecasts, 2019 － 2026”, the rise in healthcare expenditure led by a significant rise in cases of chronic diseases is expected to pump the market growth in the coming years. In addition, the demand for pharmacy management services is mainly due to the rise in health insurance companies in the U.S.
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.
The healthcare industry in the U.S. remains influenced due to the vertical integration of pharmacy benefits management organizations with health insurance companies. This is expected to increase the cost of drugs and is more likely to result in gaining a huge market share in terms of revenue. All PBM businesses in the U.S. must include home delivery and specialty pharmacies licensed as pharmacies in the states of the 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.
U.S. Pharmacy Benefit Management Market Report Highlights:
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 during 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.
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Grand View Research has segmented the U.S. pharmacy benefits management (PBM) market based on business model and end use:
Business Model Outlook (Revenue, USD Billion, 2015 －2026)
Health Insurance Providers
End Use Outlook (Revenue, USD Billion, 2015 － 2026)
List of Key Players for U.S. Pharmacy Benefit Management Market:
Walgreens Booth Alliance;
MedImpact Healthcare Systems, Inc.;
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