The Global Pharmacy Benefit Management (PBM) Market Size Was Worth USD 504.3 Billion in 2020, and It Is Projected to Grow to USD 692.0 Billion by 2026, at a CAGR of 5.5% Over The Forecast Period 2021 to 2026.
In the United States, prescription drug programs are managed by a third-party administrator. That third party is the administrator called pharmacy benefit management (PBM). They get the fund privately or are an integral part of government healthcare programs and healthcare companies. The development of formularies, pharmacy contracts and discounts with drug manufacturers are primarily managed by PBMs. It plays an important role in the payment processing of prescription drug claims. Their principal duty is to maintain the exceeding pharmaceutical cost and offer improved and effective health benefits to the end-users.
The term “pharmacy benefit management” (PBM) is an arrangement where a third-party administrator oversees prescription drug programs for health insurance companies as well as pharmacies, drug makers and other manufacturers. The system is responsible for significant functions at different levels of the supply chain for pharmaceutical products starting with financing and establishing guidelines for dispensing.
These PBM companies also provide generic substitutes for drugs, negotiate drug rebates with pharmacies and manufacturers and are involved in the development of drug formularies and management. In the end, they provide a wide range of services, including retail pharmacy services as well as drug formulary management, diseases management, benefits plan design and advice, as well as other services.
The market for pharmacy benefit management is driven by the rising demand for cost-management services because of the growing number of chronic illnesses and the rising costs of healthcare. Many consumers are turning toward PBM systems to gain access to medicines across several networks of pharmacies for retail.
In addition, the increasing presence of drugs that are similar in the market, with little differences in their APIs, has resulted in an increase in the cost sensitivity of these medications. This has meant that there is an increasing market to have PBM systems that provide drug formularies that cover all the drugs that are covered by their benefit plans. This is where the manufacturers are open to offering discounts. Additionally, the increasing incorporation with PBMs along with speciality pharmacies to provide greater expertise and connections to pharmaceutical companies for the establishment of contract agreements for the sale of drugs is also driving the growth of the market.
In addition, the increasing amount of alliances and partnerships between pharmacy benefit management companies together with health insurance providers to make it easier to afford and more personalize healthcare insurance is propelling the market globally for PBMs. Additionally, the introduction of more advanced benefits management solutions, such as drugs utilization programs and other pharmaceutical-medical-integrated products, will continue to propel the growth of the market in the coming years. In the near future. As per the IMARC, for the next five years, the Global Pharmacy Benefit Management (PBM) market will exhibit continuous growth.
Market Trend and Dynamics of the Global Pharmacy Benefit Management (PBM) Market:
Drivers and Restraints
Rapid improvements to the health infrastructure in emerging economies like China, India, Malaysia and Indonesia has produced a dramatic positive effect on the global market for pharmaceuticals. People working in the urban areas of these countries are demanding insurance coverage for their employers, and they are turning to PBMs to control their costs for employee benefits.
PBMs take care of negotiations with pharmaceutical companies byways to gain more cost-effective outcomes. They manage contracts with retail pharmacies and play a crucial function in approving and justifying reimbursement claims. A rising number of chronic diseases, as well as the increasing proportion of geriatrics across the globe’s population, and increasing awareness among consumers are just some of the factors that are increasing the demand in the marketplace for PBMs.
Market Potential
Mushrooming of medium and small companies and the increased focus of several government agencies to provide the minimum of medical services is likely to open up new opportunities in this industry soon.
With the rise of disposable income, the urban population are turning to insurance plans more than ever before as well as this means that the PBM market is set to expand. In addition, pharmacist benefit managers that collaborate in conjunction with pharmacies online are likely to grow in popularity in the future.
Based on product offerings that are offered, the market can be classified into formulary management for drugs, Benefit plan planning and consulting and speciality pharmacy services, Retail pharmacy service, as well as other services.
Competitive Landscape
Participants in those in the PBM market are reaching out to SMEs and government departments to use their experts’ teams and it is expected to remain an important method to increase their share over rivals. The expansion of the product line in response to the diverse needs of customers and the acquisition of mergers or companies are just a few alternatives to getting a dominant position among market players. Some of the most well-known brands include Catamar, Express Scripts, CVS Health, OptumRX and Prime Therapeutics.
The Key Market Segmentation of the Global Pharmacy Benefit Management (PBM) Market:
Global Pharmacy Benefit Management (PBM) Market can be divided into Service, Business Model, End-User, and Geographical landscapes, etc.
Pharmacy Benefit Management (PBM) Market Segmentation By Service:
- Specialty Pharmacy Services
- Drug Formulary Management
- Benefit Plan Design and Consultation
- Mail Order Service
- Other Services
Pharmacy Benefit Management (PBM) Market Segmentation By Business Model:
- Government Health Programs
- Employer-sponsored Programs
- Health Insurance Management
Pharmacy Benefit Management (PBM) Market Segmentation By End User:
- Pharmacy Benefit Management Organization
- Mail Order Pharmacies
- Retail Pharmacies
- Inpatient Pharmacies
- Outpatient Pharmacies
Pharmacy Benefit Management (PBM) Market Segmentation By Geographical Landscape:
- North America
- Europe
- Asia Pacific
- South America
- The Middle East and Africa
Major Key Players in the Global Pharmacy Benefit Management (PBM) Market Are:
- Cvs Health (CVS)
- Express Scripts
- Optumrx (UnitedHealth)
- Prime Therapeutics
- Medimpact Healthcare
- Humana Pharmacy Solutions
- Bc/bs
- Vidalink
- Magellan Health
- Sea Rainbow
- Cachet
The Covid-19 Impact Analysis:
The covid-19 outbreak brought significant problems for the health care system in all different regions. It affected the expansion of the pharmaceutical benefit management (PBM) market positively. PBMs enable patients to remain at home and perform social distancing by providing secure access to prescribed drugs quickly and easily. People were forced to leave their homes for the sole purpose of accessing vital services because of the concerns about coronavirus infections which, in turn, contributed to the growth of the market.
The Global Pharmacy Benefit Management (PBM) Market Report Highlights:
The growth of the global market is driven by the rising use of the number of chronic diseases, coupled with the growing geriatric population across different regions.
Based on Service, Global Pharmacy Benefit Management (PBM) Market can be divided into benefit plan design, drug formulary management, pharmacy service & consultation and others. The speciality pharmacy services segment was responsible for the most significant market share of over 30 percent in 2020.
Markets in North America accounted for the largest percentage in 2020 and is predicted to experience significant growth in the review time.
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