U.S. Pharmacy Benefit Management (PBM) Market Size, Revenue, Shares, And Forecast 2026 | Grand View Research, Inc
“The U.S. pharmacy benefit management market size was valued at USD 368.3 billion in 2018. It is expected to expand at a CAGR of 9.2% over the forecast period.�
The U.S. pharmacy benefits management market size is projected to reach USD 744.6 billion by 2026, according to a new report by Grand View Research, Inc., 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.
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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.
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) Standalone PBMs
Health Insurance Providers
Retail Pharmacy
End Use Outlook (Revenue, USD Billion, 2015 - 2026) Commercial
Federal
Browse Related Category Reports @ www.grandviewresearch.com/industry/healthcare-it Table of Content of U.S. Pharmacy Benefit Management (PBM) Market Chapter 1 Methodology and Scope 1.1 Market Segmentation & Scope 1.1.1 Business Model 1.1.1.1 Standalone PBM 1.1.1.2 Health Insurance Providers 1.1.1.3 Retail Pharmacy 1.1.2 END USE 1.1.2.1 Commercial 1.1.2.2 Federal
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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 1.6 Model Details 1.6.1 Commodity Flow Analysis (Model 1) 1.6.2 Volume Price Analysis (Model 2) 1.7 List of Secondary Sources 1.8 List of Primary Sources 1.9 List of Abbreviations 1.10 Objectives 1.10.1 Objective - 1: 1.10.2 Objective - 2: 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 3.3.1.1 Vertical Integration Of Key Market Players 3.3.1.2 Introduction Of Improved Health Benefit Plans 3.3.1.3 Growing Prevalence Of Chronic Diseases In The U.S. 3.3.2 Market Restraint Analysis
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3.3.2.1 Stringent regulations to cut back rebates 3.4 Penetration & Growth Prospect Mapping 3.4.1 Penetration & Growth Prospect Mapping Analysis 3.5 Business Environment Analysis Tools 3.5.1 Porter’s Five Forces Analysis 3.5.1.1 Bargaining power of buyers: High 3.5.1.2 Bargaining power of suppliers: Moderate 3.5.1.3 Competitive rivalry: High 3.5.1.4 Threat of new entrants: Low 3.5.1.5 Threat of substitutes: High 3.5.2 Pestel Analysis 3.5.2.1 Political & Legal Landscape 3.5.2.2 Economic Landscape 3.5.2.3 Social Landscape 3.5.2.4 Technological Landscape 3.5.2.5 Environmental Landscape 3.6 Supply Chain Analysis 3.7 Regulatory Framework Chapter 4 U.S. Pharmacy Benefits Management Market: Business Model Analysis 4.1 U.S. Pharmacy Benefits Management Business Model Market Share Analysis, 2018 & 2026 4.2 U.S. Pharmacy Benefits Management Business Model Market: Segment Dashboard: 4.3 Market Size & Forecasts and Trend Analyses, 2015 to 2026 for the Business Model Segment 4.3.1 Standalone PBM 4.3.1.1 Standalone PBM Market, 2015 - 2026 (USD Billion) 4.3.2 Health Insurance Providers 4.3.2.1 Health Insurance Providers Market, 2015 - 2026 (USD Billion) 4.3.3 Retail Pharmacy 4.3.3.1 Retail Pharmacy Market, 2015 - 2026 (USD Billion) Chapter 5 U.S. Pharmacy Benefits Management Market: End Use Analysis 5.1 U.S. Pharmacy Benefits Management End Use Market Share Analysis, 2018 & 2026 5.2 U.S. Pharmacy Benefits Management End Use Market: Segment Dashboard 5.3 Market Size & Forecasts and Trend Analyses, 2015 to 2026 for the End Use
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5.3.1 CommerciaL 5.3.1.1 Commercial PBM market, 2015 - 2026 (USD Billion) 5.3.2 Federal 5.3.2.1 Federal PBM market, 2015 - 2026 (USD Billion) Chapter 6 Competitive Analysis 6.1 Recent Developments & Impact Analysis, by Key Market Participants 6.2 Strategic Framework/ Competition Categorization (Key innovators, Market leaders, emerging players 6.3 Vendor Landscape 6.3.1 List Of Key Distributors And Channel Partners 6.3.2 Strategy Mapping 6.3.3 Major Deals & Strategic Alliances AnalysiS 6.4 U.S. Pharmacy Benefits Management (PBM) Market: Market Position Analysis (Based on Regional Presence and Recent Updates) 6.5 Company Profiles 6.5.1 CVS HEALTH 6.5.1.1 Company overview 6.5.1.2 Financial performance 6.5.1.3 Service benchmarking 6.5.1.4 Strategic initiatives 6.5.1.5 SWOT analysis 6.5.2 AETNA 6.5.2.1 Company overview 6.5.2.2 Financial performance 6.5.2.3 Service benchmarking 6.5.2.4 Strategic initiatives 6.5.2.5 SWOT analysis 6.5.3 EXPRESS SCRIPTS HOLDING COMPANY 6.5.3.1 Company overview 6.5.3.2 Financial performance 6.5.3.3 Service benchmarking 6.5.3.4 Strategic initiatives 6.5.3.5 SWOT analysis
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6.5.4 CIGNA 6.5.4.1 Company overview 6.5.4.2 Financial performance 6.5.4.3 Service benchmarking 6.5.4.4 Strategic initiatives 6.5.4.5 SWOT analysis 6.5.5 OPTUMRX, INC. 6.5.5.1 Company overview 6.5.5.2 Financial performance 6.5.5.3 Service benchmarking 6.5.5.4 Strategic initiatives 6.5.5.5 SWOT analysis 6.5.6 WALGREENS BOOTS ALLIANCE, INC. 6.5.6.1 Company overview 6.5.6.2 Service benchmarking 6.5.6.3 Strategic initiatives 6.5.6.5 SWOT analysis 6.5.7 ANTHEM 6.5.7.1 Company overview 6.5.7.2 Financial performance 6.5.7.3 Service benchmarking 6.5.7.4 Strategic initiatives 6.5.7.5 SWOT analysis 6.5.8 MEDIMPACT HEALTHCARE SYSTEMS, INC. 6.5.8.1 Company overview 6.5.8.2 Financial performance 6.5.8.3 Service benchmarking 6.5.8.4 Strategic initiatives 6.5.8.5 SWOT analysis 6.5.9 RITE AID 6.5.9.1 Company overview 6.5.9.2 Financial performance
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6.5.9.3 Service benchmarking 6.5.9.4 Strategic initiatives 6.5.9.5 SWOT analysis
About Us: Grand View Research, Inc. is a U.S. based market research and consulting company, registered in the State of California and headquartered in San Francisco. The company provides syndicated research reports, customized research reports, and consulting services. To help clients make informed business decisions, the company offers market intelligence studies ensuring relevant and fact-based research across a range of industries including technology, chemicals, materials, healthcare and energy.
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