The escalating prices of pharmaceutical drugs have a significant impact on global healthcare expenditures. Out of all healthcare expenses, the cost of medication has seen the most substantial increase. Milliman, a consulting and actuarial firm, reports that prescription drug expenses for a family of four rose from 13.2% in 2001 to approximately 15.9% of total healthcare spending in 2015. This surge in drug prices and consumer spending on prescription medication has resulted in a growing demand for pharmacy benefit managers (PBMs). Third-party administrators (TPAs) run the pharmacy benefit management system, serving as intermediaries between drug manufacturers, insurance providers (payers), and pharmacists. Several reputed companies provide these services and work towards reducing drug prices by negotiating with retail pharmacies and drug manufacturers. Both patients who have enrolled in various health plans and those without insurance can take advantage of the pharmacy benefit management system. Health plans work together with pharmacy benefit managers to provide medications at a lower cost compared to retail pharmacies.
In addition, PBMs assist with formulary planning and management tailored to customer requirements, negotiating discounts and rebates with drug manufacturers, contracting with pharmacies, and processing prescription claims. To enhance the value for customers and control the cost of prescription drugs, PBMs employ a variety of tools, including pharmacy networks, mail-service pharmacies, drug formularies, e-prescribing, manufacturer discounts, disease management, drug utilization review, and pharmacy discount cards (for those without insurance). There are a variety of prescription claim software and systems available globally to manage these tools and PBM accounts.
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Taxonomy for the pharmacy benefit management market
The analysis of the global pharmacy benefit management market can focus on the recipients of these services, namely healthcare providers, employers, and drug manufacturers. In the United States, a significant portion of the population receives healthcare benefits through their employers. Consequently, employers are also looking to decrease their expenses and are considering pharmacy benefit management services. The providers of these services not only administer prescription drug claims but also serve as an intermediary between payers and health insurers.
In developed markets, the pharmacy benefit management market is characterized by a high level of concentration.
The analysis of the global pharmacy benefit management market is divided into five regions, namely Africa, Latin America, Asia Pacific, the Middle East, Europe, and North America. The concentration of PBM presence is primarily in the developed economies of Europe, and North America. The projected increase in subscribers for the Medicare prescription drug program in the United States is expected to drive the demand for PBMs. Additionally, pharmacy benefit managers assist in determining whether a generic or branded product would be more advantageous for the patient. The expiration of patents for approximately 40 blockbuster brands worth US$ 155 billion by 2020 is expected to provide favorable profit margins for generic products, which could benefit PBM or pharmacy benefit managers/management companies, thus favorably shaping the pharmacy benefit management market outlook. This favorable trend is also observed in the European pharmacy benefit management industry.
Obstacles faced in the Pharmacy Benefit Management Market
The demand for PBMs is expected to rise substantially due to the availability of expensive treatments and drugs for chronic illnesses like hepatitis and cancer. Despite the involvement of key competitors in the industry, PBMs have not been successful in controlling the rise in drug prices. Additionally, the profitability of this sector is expected to be significantly affected in the coming years due to the implementation of the Affordable Care Act and the ongoing efforts of governments to limit and regulate drug prices.
Some of the key players operating in the global pharmacy benefit management market include United Health/OptumRx, Express Scripts, Humana Pharmacy Solutions, CVS Caremark, MedImpact, Prime Therapeutics, and Catamaran Corporation. In April 2012, Express Scripts became a dominant player in the global pharmacy benefit management industry after acquiring Medco Health Solutions for US$ 29.1 billion. As competition intensifies, consolidation within the industry is anticipated to become a common occurrence in the coming years.
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Major participants in the market are directing their attention towards introducing fresh pharmacies and benefit schemes in order to broaden their market presence. As an example, in August 2019, Accredo, which is a specialty pharmacy, initiated a comprehensive pharmacy service for individuals residing in Hawaii who need supplementary clinical and administrative assistance for their intricate treatments and medicines.
Aetna, a CVS Health company, began providing fully insured healthcare network choices to its Preferred Product Organization (PPO), Exclusive Product Organization (EPO), and Health Maintenance Organization (HMO) product portfolios via Aetna Whole HealthSM – Southern California in July 2019, in a similar vein.
Express Scripts, a pharmacy benefit manager, partnered with Appriss Health, a provider of prescription drug monitoring platforms, to create a Prescription Drug Monitoring Program (PDMP) for the Military Health System (MHS) in April 2019.
Table of Content
Chapter 1 Industry Overview
1.3 Research Scope
1.4 Market Analysis by Regions
1.5 Pharmacy Benefit Management Market Size Analysis from 2023 to 2030
11.6 COVID-19 Outbreak: Pharmacy Benefit Management Industry Impact
Chapter 2 Global Pharmacy Benefit Management Competition by Types, Applications, and Top Regions and Countries
2.1 Global Pharmacy Benefit Management (Volume and Value) by Type
2.3 Global Pharmacy Benefit Management (Volume and Value) by Regions
Chapter 3 Production Market Analysis
3.1 Global Production Market Analysis
3.2 Regional Production Market Analysis
Chapter 4 Global Pharmacy Benefit Management Sales, Consumption, Export, Import by Regions (2017-2022)
Chapter 5 North America Pharmacy Benefit Management Market Analysis
Chapter 6 East Asia Pharmacy Benefit Management Market Analysis
Chapter 7 Europe Pharmacy Benefit Management Market Analysis
Chapter 8 South Asia Pharmacy Benefit Management Market Analysis
Chapter 9 Southeast Asia Pharmacy Benefit Management Market Analysis
Chapter 10 Middle East Pharmacy Benefit Management Market Analysis
Chapter 11 Africa Pharmacy Benefit Management Market Analysis
Chapter 12 Oceania Pharmacy Benefit Management Market Analysis
Chapter 13 South America Pharmacy Benefit Management Market Analysis
Chapter 14 Company Profiles and Key Figures in Pharmacy Benefit Management Business
Chapter 15 Global Pharmacy Benefit Management Market Forecast (2023-2030)
Chapter 16 Conclusions
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