The US Pharmacy Benefit Management (PBM) Market: Industry Analysis & Outlook (2016-2020)


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A pharmacy benefit manager (PBM) is a third-party administrator (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, and federal employee’s health benefits program in the US. Pharmacy benefit managers act as an intermediary between the payer and everyone else in the healthcare system. The healthcare system is very complex with many components working together to meet health needs. The pharmaceutical industry is growing rapidly owing to an increase in population and number of diseases. PBMs bring value through lower drug costs for insurers by negotiating with pharmacies and drug manufacturers.

The competition in the PBM market is quite concentrated with major market share divided between top three companies. The competition is expected to become severe in the future due to the emerging popularity of generics and biologics. The industry is also witnessing a lot of merger and acquisitions eyeing the growth in the market.

The key factors driving the growth of the US PBM market are increase in ageing population, increase in healthcare expenditure, improving economic conditions, increase in Life expectancy rate and rising use of drugs. Some of the noteworthy trends and developments of this industry are increasing trend towards consumerism, increasing trend of specialty drugs, increase in the medical enrollments, rising prevalence of narrow network, growth in retail prescriptions, mail order penetration and claims, increasing mix of insured individuals and drug prices trend. However, the expansion of the US PBM market is hindered by high cost of drugs, reimbursement rate pressure and legal regulations.

The report “The US Pharmacy Benefit Management (PBM) Market: Industry Analysis & Outlook (2016-2020)” provides an in-depth analysis of the market. The major trends, growth drivers as well as issues being faced by the industry are being presented in this report. The industry comprises large players such as CVS, Express Scripts, Optum Rx Humana. All these companies have been profiled in the present report highlighting their key financials and business strategies for growth.

Table of Content

1. PBM Overview
1.1 An Introduction
1.2 Types of PBM Services
1.3 PBM Managers Formulary Structure
1.4 PBM Timeline
1.5 Retail Dispensing Process & Flow of Funds
1.6 Mail Dispensing Process & Flow of Funds
 
2. Global Pharmaceutical Market Analysis
2.1 Global Pharmaceutical Market by Value
2.2 Global Pharmaceutical Market Forecast by Value
2.3 Global Pharmaceutical Market Share by Region
 
3. The US Pharmaceutical Market Analysis
3.1 The US Pharmaceutical Market
3.1.1 The US Pharmaceutical Market by Value
3.1.2 The US Pharmaceutical Market Forecast by Value
3.1.3 The US Annual Pharmaceutical Market Sales by Dispensing Channel
3.1.4 The US Pharmaceutical Market by Segments
3.1.5 The US Pharmaceutical Market Channel Type by Value
3.1.6 The US Pharmaceutical Market Types by Value
3.1.7 The US Pharmaceutical Market Share by Types
3.2 The US Prescription (Rx) Market
3.2.1 The US Prescription Market by Volume
3.2.2 The US Prescription Market Forecast by Volume
3.2.3 The US Prescription Market Volume by Category
3.2.4 The US Prescription Market Volume Forecast by Category
3.2.5 The US Prescription Market Share by Channel Type
3.2.6 The US Pharmaceutical Market Quarterly Prescriptions
3.2.7 The US Pharmaceutical Generic Market Quarterly Prescriptions
3.2.8 The US Pharmaceutical Branded Market Quarterly Prescriptions
3.2.9 The US Generic Market Penetration Rate
 
4. Market Dynamics
4.1 Growth Drivers
4.1.1 Growth in Ageing Population
4.1.2 Increasing Healthcare Expenditure
4.1.3 Improving Economic Conditions
4.1.4 Increasing Life Expectancy Rate
4.1.5 Rising Use of Drugs
4.2 Market Trends
4.2.1 Increasing Trend towards Consumerism
4.2.2 Growing Trend of Specialty Drugs
4.2.3 Rising Prevalence of Narrow Networks
4.2.4 Increase in the Medicare Enrollments
4.2.5 Drug Prices Trend
4.2.6 Growth in Retail Prescriptions
4.2.7 Declining Claims and Mail Order Penetration
4.2.8 Increasing Mix of Insured Individuals
4.3 Challenges
4.3.1 High Drug Prices
4.3.2 Reimbursement Rate Pressure
4.3.3 Legal Regulations
 
5. Competitive Landscape
5.1 The US PBM Market Share by Prescription Claim
5.2 The US PBM Market Share Forecast by Prescription Claim
5.3 The US PBM Market by Annual Script Volume
5.4 The US Specialty Pharmacy Market Share by Company
5.5 The US PBM Drug Cost Trend by Company
5.6 The US PBM Specialty Drug Cost Trend by Company
 
6. Company Profiles
6.1 Express Scripts
6.1.1 Business Overview
6.1.2 Financial Overview
6.1.3 Business Strategies
6.2 CVS Health
6.2.1 Business Overview
6.2.2 Financial Overview
6.2.3 Business Strategies
6.3 OptumRx
6.3.1 Business Overview
6.3.2 Financial Overview
6.3.3 Business Strategies
6.4 Humana
6.4.1 Business Overview
6.4.2 Financial Overview
6.4.3 Business Strategies

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