View Report Detail US Pharmacy Benefit Management Market Report ----------------------------------------2014
View Report Detail Executive Summary In the US, Pharmacy Benefit Management (PBM) deals with the management of prescription drug programs. It acts as an intermediary between health plans, drug companies, retail pharmacies and patients. Initially, PBMs used to process pharmaceutical claims for health plans. But nowadays in addition to this, PBMs have created more significant ‘pharmacy benefit’ by providing a system for reimbursement of drug claims, processing and cost control. The US prescription volume and pharmaceutical sales has witnessed an exceptional growth over the past few years and the same pattern is likely to continue in the near future. Therefore, through rebates from pharmaceutical manufacturers, price discounts from retails, and effective mail service pharmacies, the PBMs emphasis on enabling the plan sponsors and individuals to obtain prescribed drugs at lower prices. The PBM providers control drug spending and utilization by virtue of their advanced tools and techniques, encouraging use of generics and other lower-cost medications. In the US, there are some independent PBM’s while some are owned by managed care organizations and retail pharmacies. Today, the PBM industry has become more determined through a series of mergers and acquisitions. Some of the factors driving the growth of the PBM industry are: accelerating US aging population, increasing life expectancy rate and incidences of chronic and infectious diseases which further increase the healthcare expenditure and pharmaceutical sales in the US. The ongoing trends and development in the PBM industry include rising medicare enrollments and increased acceptance of specialty drugs. This report assesses the US PBM industry in terms of both market volume and market value. The increasing competition in the PBM industry has been analyzed on number of factors: revenue, dispensing specialty pharmaceuticals, claims and PDP lives. The top three companies having a vicious competition with each other and dominating the PBM industry are- Express Script, CVS Health and Catamaran. These players are being profiled in the report along with their key financials and strategies for growth.
The growing availability and rapid use of generic drugs continue to have a substantial moderating influence on prescription drug expenditures…… US Rx Market (2008-2018E)
The total Rx market increased with a CAGR of …% during the period spanning 2008-2013. During 2008-2013, the US annual prescription volume has exhibited positive growth.
Billion
The Rx market comprises of three segments- generic Rx, branded Rx and other. In 2013, the branded Rx market declined by …% and became …… million in 2013. On the other hand, generic Rx units were …….million, marking an increase of …%
2008 2009 2010 2011 2012 20132014E2015E2016E2017E2018E US Rx Market by Segment (2008-2013)
Million
%
US Annual Prescription Volume Growth (2008-2018E)
2008 2009 2010 2011 2012 20132014E2015E2016E2017E2018E
2008
2009
2010 Branded Rx
2011 Generic Rx
2012
2013
The changing lifestyle and rising consumer income level has resulted in overall increase in PBM industry…. Rx Market Share- by Segment (2014E) It is estimated that generic Rx will lead the Rx market in 2014 with …% Rx market share. In 2013, the US annual pharmaceutical sales have grown by ...% as compared to 2012. In 2013, an increasing trend was noticed in the utilization of mail delivery channel for dispensing specialty drugs with the decreasing utilization of retail channel over the past five years.
Branded Rx
Generic Rx
Other Utilization Rate of Dispensing Channel for Specialty Drugs (2009-2013)
%
%
US Annual Pharmaceutical Sales Growth (2007-2013)
2007
2008
2009
2010
2011
2012
2013
2009
2010 Retail C hannel
2011
2012
Mail delivery C hannel
2013
Express Script emerged as the largest market share holder in context of adjusted prescription volume… Market Share of PBM by Revenue
Express Script was the largest PBM with a share of … % of the total revenue followed by CVS Health with … % share. In terms of lives managed, the United Health Group Inc. represents a market share of …% thereby becoming the leader in the PBM Market Share by PDP Lives. Express Script emerged as the largest market share holder in context of adjusted prescription volume with …% market share.
Express Script Optum(UNH) Humana Pharmacy Solution Medimpact Healthcare Systems
CVS Health Catamaran Prime Therapeutics All Others Market Share of PBM by Adjusted Prescription Volume
Market Share of PBM by PDP Lives
United Health Group Inc. Humana Inc. Aetna Inc. Cigna
CVS Health Express Script WellCare Health Plans,Inc. Well Point,Inc.
Express Script
CVS Health
OptumRx
Catamaran
Human Pharmacy Solution
Prime Therapeutics
Medimpact
Envision Pharamaceutical Services
Others
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