Overview


According to FutureWise analysis, the market for Pharmacy Benefit Management is expected to grow with a CAGR of 9.20% over the forecast period 2023-2031, and reach a market value of US$ 1116.1 billion by 2031.

U.S. Pharmacy Benefit Management (PBM) is a system that helps facilitate and manage prescribed medication benefits on behalf of health insurers, government programs, and employers. PBMs play a vital role in the healthcare industry by acting as intermediaries between pharmacies, drug manufacturers, and health insurance providers. PBMs negotiate with pharmaceutical manufacturers to secure discounts and rebates on prescription medications. These negotiated prices are often lower than what would be paid without the involvement of a PBM. PBMs also develop and maintain a list of preferred drugs, known as formularies. The formulary is a list of drugs protected by the insurance plan. Medications not on the formulary may require higher co-payments or may not be covered. Some PBMs offer services to educate patients about their medications, provide information about potential side effects, and help with medication adherence.

Pharmacy Benefit Management (PBM) in the US plays a crucial role in the healthcare system by acting as an intermediary between insurers, pharmaceutical manufacturers, and patients. One key aspect of PBM services is the management of Specialty Pharmacies and Retail Pharmacies. Specialty pharmacies focus on providing medications for complex, chronic, or rare conditions. These pharmacies have specialized knowledge infrastructure and often have direct relationships with pharmaceutical manufacturers to dispense high-cost, specialized medications. They offer various services, including medication counseling, adherence monitoring, and support for patients navigating the complexities of specialty drugs. On the other hand, retail pharmacies form the more familiar face of the pharmaceutical industry, with a widespread presence in communities nationwide. They serve as accessible points of care for everyday medication needs, offering a wide array of prescription and over-the-counter drugs. Retail Pharmacies also play a crucial role in patient education, counseling, and ensuring medication adherence.

FutureWise Market Research has published a report that provides an insightful analysis U.S. pharmacy benefit management market trends that are affecting the overall market growth. This report will provide a detailed analysis of market share, regional insights, and competitor analysis that includes stature of key manufacturers operational in this industry. According to the analysis conducted by FutureWise research analysts U.S. pharmacy benefit management market estimated to register a considerable growth rate over the forecast period. This report lists the market segments and potential prospects available across this industry, in addition providing crucial information on the total valuation currently held by the industry. Moreover, this report will assist key management individuals in an organisation to enhance their decisions pertaining to business expansion as well as strategic changes for increasing customer base.

  • CVS Health
  • Cigna
  • Optum, Inc.
  • MedImpact
  • Anthem
  • Change Healthcare
  • Prime Therapeutics LLC
  • HUB International Limited.
  • Elixir Rx Solutions LLC

(Note: The list of the major players will be updated with the latest market scenario and trends)

Recent Developments in U.S. Pharmacy Benefit Management Market:

  • In October 2021, an alliance of approximately 40 companies, which included major US retailers like Walmart (WMT.N) and Costco (COST.O), came together to establish a nonprofit partnership. This entity was formed with the aim of offering pharmacy benefit management services to employers.

The escalating incidence of chronic illnesses and the growing aging population in U.S. fuel the demand for prescription medications. This demographic shift necessitates a robust and efficient Pharmacy Benefit Management (PBM) infrastructure. PBMs play a crucial role in streamlining access to medications, ensuring cost-effective procurement, and optimizing prescription benefits. By leveraging their negotiating power with drug manufacturers and pharmacies, PBMs may help alleviate the financial burden of prescription drugs for both individuals and healthcare systems, thereby contributing significantly to improved overall healthcare outcomes. Moreover, the increasing costs of healthcare have driven a critical need for employers and payers to seek avenues for cost management. Here, Pharmacy Benefit Managers (PBMs) emerge as instrumental players in pursuing cost containment. Through strategic negotiations with drug manufacturers and pharmacies, PBMs exert the power to secure favorable pricing arrangements, driving down the overall expense of prescription medications. Additionally, the integration of technology in healthcare has propelled the service delivery. Innovations like electronic prescribing, telemedicine, and sophisticated data analytics offer PBMs a unique opportunity to elevate their services. This tech-driven approach not only streamlines prescription processes but also introduces greater efficiency and convenience, aligning with the growing needs of both healthcare providers and patients. However, the consolidation within the Pharmacy Benefit Management (PBM) sector and its integration with healthcare providers is reshaping the industry landscape, presenting a potential challenge. This consolidation creates a more competitive environment, posing barriers for smaller or emerging players to establish a foothold and gain market share. Moreover, the intricate nature of drug pricing, rebate negotiations, and formulary management poses a significant restraint for the U.S. pharmacy benefit management market. Navigating through these complexities demands a high level of expertise and resources. Furthermore, shifts in drug pricing strategies employed by pharmaceutical manufacturers may introduce considerable volatility, potentially impacting the profitability and stability of the U.S. pharmacy benefit management market.

By Business Model

  • Standalone PBM
  • Health Insurance Providers

By Service

  • Specialty Pharmacy
  • Retail Pharmacy

By End-user

  • Commercial
  • Federal

  • Tier 1 players- established companies in the market with a major market share
  • Tier 2 players
  • Emerging players which are growing rapidly
  • New Entrants

  • Growth prospects
  • SWOT analysis
  • Key trends
  • Key data-points affecting market growth

  • To provide with an exhaustive analysis on the U.S. Pharmacy Benefit Management Market By Business Model, By Service, and By End-user
  • To cater comprehensive information on factors impacting market growth (drivers, restraints, opportunities, and industry-specific restraints)
  • To evaluate and forecast micro-markets and the overall market
  • To record and evaluate competitive landscape, mapping- product launches, technological advancements, mergers and expansions

  • We have a flexible delivery model and you can suggest changes in the scope/table of content as per your requirement
  • The customization Mobility Care offered are free of charge with purchase of any license of the report
  • You can directly share your requirements/changes to the current table of content to: sales@futurewiseresearch.com

Table of Contents


  • 1.  Market Introduction
    •   1. Objectives of the Study 
        2. Market Definition 
        3. Market Scope 
           3.1. Years Considered for the Study
           3.2. Market Covered
        4. Currency 
        5. Limitations 
        6. Stakeholders 

  • 2.  Research Methodology
    •   1. Research Data 
           1.1. Secondary Data
              1.1.1. Key Data from Secondary Sources
           1.2 Primary Data
              1.2.1. Key Data from Primary Sources
        3. Market Size Estimation 
        4. Market Breakdown and Data Triangulation 
        5. Assumptions for the Study 

  • 3.  Executive Summary
    •   1. Market Outlook
        2. Segment Outlook
        3. Competitive Insights

  • 4.  U.S. Pharmacy Benefit Management Market Variables, Trends & Scope
    •   1. Market Lineage Outlook
        2. Penetration and Growth Prospect Mapping
        3. Industry Value Chain Analysis
        4. Cost Analysis Breakdown
        5. Application Overview
        6. Regulatory Framework
           6.1. Reimbursement Framework
           6.2. Standards and Compliances

  • 5.  Market Overview
    •   1. Market Dynamics
           1.1. Market Driver Analysis
              1.1.1. Increasing focus of U.S. Pharmacy Benefit Management Market Companies on Brand Protection
              1.1.2. Untapped Opportunities in Emerging Regions
           1.2. Market Restraint Analysis
              1.2.1. High Cost Associated with Implementation of Predictive Analysis
           1.3. Industry Challenges
              1.3.1. Presence of Ambiguous Regulatory Framework

  • 6.  U.S. Pharmacy Benefit Management Market Analysis Tools
    •   1. Industry Analysis - Porter’s
           1.1. Supplier Power
           1.2. Buyer Power
           1.3. Substitution Threat
           1.4. Threat from New Entrants
           1.5. Competitive Rivalry
        2. Pestel Analysis
           2.1. Political Landscape
           2.2. Environmental Landscape
           2.3. Social Landscape
           2.4. Application Landscape
           2.5. Legal Landscape
        3. Major Deals And Strategic Alliances Analysis
           3.1. Joint Ventures
           3.2. Mergers and Acquisitions
           3.3. Licensing and Partnership
           3.4. Application Collaborations
           3.5. Strategic Divestments
        4. Market Entry Strategies
        5. Case Studies

  • 7.  U.S. Pharmacy Benefit Management Market, By Business Model Historical Analysis and Forecast 2023-2031 (USD Million)
    •   1. Standalone PBM
        2. Health Insurance Providers

  • 8.  U.S. Pharmacy Benefit Management Market, By Service Historical Analysis and Forecast 2023-2031 (USD Million)
    •   1. Specialty Pharmacy
        2. Retail Pharmacy

  • 9.  U.S. Pharmacy Benefit Management Market, By End-user Historical Analysis and Forecast 2023-2031 (USD Million)
    •   1. Commercial
        2. Federal

  • 10.  Market Share Analysis and Competitive Landscape
    •   1. U.S. Landscape - Key Players, Revenue and Presence
        2. U.S. Share Analysis - Key Players (Tier 1, Tier 2, Tier 3)
        3. U.S. Emerging Companies
        4. U.S. - Market Share Analysis and Key Regional Players
        5. U.S. Key Player - Growth Matrix

  • 11.  Company Profiles (Competition Dashboard, Competitors Deep Dive, Products Offered and Financial Layouts)
    •   1. CVS Health
           1.1. Company Overview
           1.2. Product Portfolio
           1.3. SWOT Analysis
           1.4. Financial Overview
           1.5. Strategic Overview
        2. Cigna
           2.1. Company Overview
           2.2. Product Portfolio
           2.3. SWOT Analysis
           2.4. Financial Overview
           2.5. Strategic Overview
        3. Optum, Inc.
           3.1. Company Overview
           3.2. Product Portfolio
           3.3. SWOT Analysis
           3.4. Financial Overview
           3.5. Strategic Overview
        4. MedImpact
           4.1. Company Overview
           4.2. Product Portfolio
           4.3. SWOT Analysis
           4.4. Financial Overview
           4.5. Strategic Overview
        5. Anthem
           5.1. Company Overview
           5.2. Product Portfolio
           5.3. SWOT Analysis
           5.4. Financial Overview
           5.5. Strategic Overview
        6. Change Healthcare
           6.1. Company Overview
           6.2. Product Portfolio
           6.3. SWOT Analysis
           6.4. Financial Overview
           6.5. Strategic Overview
        7. Prime Therapeutics LLC
           7.1. Company Overview
           7.2. Product Portfolio
           7.3. SWOT Analysis
           7.4. Financial Overview
           7.5. Strategic Overview
        8. HUB International Limited.
           8.1. Company Overview
           8.2. Product Portfolio
           8.3. SWOT Analysis
           8.4. Financial Overview
           8.5. Strategic Overview
        9. Elixir Rx Solutions LLC
           9.1. Company Overview
           9.2. Product Portfolio
           9.3. SWOT Analysis
           9.4. Financial Overview
           9.5. Strategic Overview

  • 12.  Pre and Post COVID-19 Impact
    •  1. Positive influence on the healthcare industry
        2. The financial disruption of the manufacturing sector
        3. Impact of COVID-19 on emerging companies
        4. Significant mandates in the healthcare regulations initiated
      by administrations
        5. The overall economic slowdown of the developing and developed nations

  • 13.  FutureWise SME Key Takeaway Points for Client
    •   

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