Pharmacy Benefit Management Market (By Service: Specialty Pharmacy Services, Benefit Plan Design & Administration, Formulary Management, Pharmacy Claims Processing, Others; By Service Provider: Retail Pharmacies, Insurance Companies, Standalone Pharmacy Benefit Management Providers; By Business Model: Government Health Programs, Employer-sponsored Programs, Health Insurance Management) - Global Industry Analysis, Size, Share, Growth, Trends, Regional Outlook, and Forecast 2022 – 2030


The global pharmacy benefit management market size was valued at US$ 467.58 billion in 2021 and it is expected to hit US$ 757.05 billion by 2030 with a registered CAGR of 5.5% from 2022 to 2030.

Pharmacy Benefit Management Market Size 2021 to 2030

Market Overview

Pharmacy benefit manager (PBM) specializes as a third-party supervisor. Pharmacy benefit management is an association of drug guides which manages, examines, and manages all the topics in relation with healthcare, and offers advantages of drug programs to the employers.  Moreover, it aids in offering management with medical services as well as biologic medications at lowered costs. The cost deduction is attained over refunds with drug producers, coming in agreements with pharmacies, concocting, and remunerating prescription drug alleges and by employing with self-protected associations and government plans. This benefit management liberates the list of medication drugs which involve all drugs enfolded by the name of its advantageous plans, at which point producers are available to provide rebates. PBM is able to be varied and bendable starting from a little, to enormous in size. A few of the sectors of the pharmacy benefit manager involve checking clinical lineups for a vast populace, low price therapeutic alternates, medication therapy management programs & details regarding tablet splitting, and services of mail order.

Report Scope of the Pharmacy Benefit Management Market

Report Coverage Details
Market Size by 2030 USD 757.05 Billion
Growth Rate from 2022 to 2030

CAGR of 5.5%

Largest Market Asia Pacific
Fastest Growing Region North America
Base Year 2021
Forecast Period 2022 to 2030
Segments Covered Service, Service Provider, Business Model, Region
Companies Mentioned CVS Health, SS&C Technologies, Inc., Anthem Inc., Medimpact, Express Scripts Holding Company, Benecard Services, LLC, CaptureRx Inc., Change Healthcare, OptumRx, Inc., Cigna

 

Growth Factors

Pharmacy benefit management refers to the group of companies that act as the middlemen between the insurance companies and drug manufacturers and pharmacies for the purpose of securing lower drug costs for the insurance companies and insurers. The significantly rising prevalence of various chronic diseases among the global population is a primary driver of the global pharmacy benefit management market. The most prominent diseases that constitutes maximum deaths includes cancer, cardiovascular diseases, respiratory diseases, and diabetes. The si8gnificantly rising healthcare costs and healthcare expenditure in the developed and developing nations is boosting the growth of the global pharmacy benefit management market. The rising prevalence of chronic diseases and rising healthcare expenditure is augmenting the demand for the prescription drugs across the globe. This is boosting the demand for the pharmacy benefits management services across the globe.

Furthermore, the rising drug prices across the globe is resulting in increased healthcare spending which is a prominent factor behind the rising demand for the pharmacy benefit management services among the healthcare insurance providers. The rising healthcare expenditure owing to the rising adoption of the expensive drugs for rare diseases is supporting the market growth significantly. The growing penetration of the health insurance providers and rising consumer awareness regarding the benefits of health insurances is expected to boost the demand for the pharmacy benefit management services among the health insurance providers across the globe. The rapid adoption of the pharmacy benefit management services among the drug manufacturers, retail pharmacies, and health insurance providers is shifting the preferences of the service providers towards the advanced workflows that utilizes machine learning technologies. The introduction of the artificial intelligence and machine learning technologies in the pharmacy benefit management services is expected to offer various growth opportunities to the market players.

Growing Advocacy of Machine Learning to Make Regular Workflow

The growing adoption of benefit management services amid the pharmacy links, drug producers, as well as insurance suppliers are changing their propensities of the service suppliers from traditional flow of the work to develop workflow by employing machine learning. As a consequence, associations can offer an exquisite supply chain, speedy mail order delivery and feed to a vast number of coverage and merchandise pharmacy links inside the time limit.

For example, a key player in the U.S., CapitalRx is using artificial intelligence (AI), and machine learning procedures to lower manmade error and lowering in time for the processing of claim. Hence, the implementation of AI and ML technology into the flow of work is harnessing associations to steer down the cost of medical and rise the efficacy of the procedures of coverage.

Service Insights

Based on service, the specialty pharmacy segment accounted largest revenue share of 34% in 2021. The rapidly rising prevalence of rare and chronic diseases among the population is boosting the demand for the specialty drugs. The high prices of the specialty drugs are unaffordable by the majority of the patients across the globe. Therefore, the low affordability of the patients owing to the high prices of the drugs is a major factor behind the burgeoning demand for the pharmacy benefit management services to reduce the prices of these specialty drugs and make it affordable to the patients. These factors has led to the dominance of the specialty pharmacy segment in the global pharmacy benefit management market.

Pharmacy Benefit Management Market Share, By Service, 2021 (%)

The benefit plan design and administration is anticipated to be the most opportunistic segment during the forecast period. The rising number of patients across the globe, opting for the medical insurance claims is fueling the growth of this segment. As per the India Express, people opting for medical insurance policy have increased from 30% in March 2020 to 80% in March 2021. Therefore, the rising number of people who opts for medical claims across the globe is expected to boost the growth of this segment significantly during the forecast period.

Service Provider Insights

Based on service provider, the insurance companies segment dominated the global pharmacy benefit management market in 2021. The rising number of acquisitions and mergers between the insurance companies and the pharmacy benefit management service providers is the major factor behind the dominance of this segment in the global pharmacy benefit management market. For instance, First Medical Health Plan, Inc. and Abarca Health LLC entered into a partnership for pharmacy benefit management services for three years. Moreover, the rising penetration of the health insurance companies across the developed and developing nations is further fueling the growth of the market significantly.

On the other hand, the retail pharmacy is expected to be the fastest-growing segment during the forecast period. The growing number of retail pharmacy units across the globe coupled with the rising penetration of the online pharmacies is expected to boost the growth of this segment. The rising penetration of internet, rising adoption of smartphones, and growing popularity of e-commerce among the consumers is fueling the growth of the online retail pharmacies, which is expected to boost the growth of the retail pharmacy segment in the forthcoming years. According to the International Telecommunications Union, about 64% of the global population had access to the internet and this number is expected to grow rapidly. The online pharmacies offers quick home delivery, convenient payment options, huge discounts, and easy refund and replacements. This is a major factor behind the augmenting demand for the online retail pharmacies. This is further expected to boost the growth of this segment in the global pharmacy benefit management market.

Region Insights

North America dominated the global pharmacy benefit management market in 2021. US PBM market was valued t US$ 450 billion in 2021 from US$ 426.5 billion in 2020. US is the home to leading pharmaceutical manufacturers, leading insurance providers, leading pharmacy benefit management service providers, and leading retail pharmacy chains. The increased adoption of the health insurances among the US population has supported the market growth. It is estimated that more than half of the US population is suffering from one or more chronic diseases. The high healthcare expenditure and increased adoption of the insurance po0licies has led to the growth of the North America pharmacy benefit management market. As per the Centers for Medicare and Medicaid Services, the total healthcare expenditure in US increased to US$4.1 trillion or an increase of 9.7% in 2020 as compared to the previous year. The huge penetration of the health insurance providers in the region has led to the growth of the North America pharmacy benefit management market. Most of the patients in US depends on the reimbursements for receiving treatment for various diseases. The favorable reimbursement policies of the government have also supported the market growth in North America.

Pharmacy Benefit Management Market Share, By Region, 2021 (%)

Asia Pacific is expected to witness a significant growth rate during the forecast period. This is attributed to the rising adoption of the healthcare insurances among the population. The rising prevalence of chronic diseases and rising healthcare expenditure in the region is supporting the market growth. Moreover, the rising penetration of several pharmacy benefit management service providers in the region is expected to boost the growth of the market in the foreseeable future.

COVID Impact Analysis

The effect of the COVID-19 pandemic was positive on the global pharmacy benefit management market. Various prominent players reported a considerable growth in their net sales. However, the net sales of market players functioning in this market hit back to the pre-pandemic stage by 2021, owing to the accomplishment of jab drives in most of the nations coupled with the accessibility of a huge range of medicine at a reduced cost.

Key Market Developments

  • In January 2022, Centene Corporation completed the acquisition of Magellah Health, Inc. to offer integrated healthcare solutions with better results at lower costs.
  • In May 2020, Anthem, Inc. introduced its innovative pharmacy benefit manager named IngenioRx. It uses digital first approach and clinical expertise to personalize the experiences of the members. This strategy aimed at increasing revenue and customer reach.

Key Industry Players

The market is domineered by some of the major market players like OptumRx Inc., Cigna, and CVS Health. Few of the factors contributing to the market predominance include steady focus on the inorganic plans of growth, involving acquisition and partnership of other market players for the expansion of the brand presence globally. For example, Diplomat, which offers infusion services and specialty pharmacy was acquired by OptumRx Inc. in the year 2019 with a goal to reduce the overall cost of care and extend its product range.

To the contrary, key market players, containing Anthem Inc., Medimpact, among others are concentrating on unveiling new attributes and solutions enlarge their offerings and attract more consumers. For example, Medimpact, in the year 2020 unveiled a new solution to merge prescript discount card saving with a conventional plan. Another market players functioning in the market are SS&C Technologies Inc., Express Scripts Holding Company, and others.

Some of the prominent players:

  • CVS Health
  • SS&C Technologies, Inc.
  • Anthem Inc.
  • Medimpact
  • Express Scripts Holding Company
  • Benecard Services, LLC
  • CaptureRx Inc.
  • Change Healthcare
  • OptumRx, Inc.
  • Cigna

Segments Covered in the Report

(Note*: We offer report based on sub segments as well. Kindly, let us know if you are interested)

By Service

  • Specialty Pharmacy Services
  • Benefit Plan Design & Administration
  • Formulary Management
  • Pharmacy Claims Processing
  • Others

By Service Provider

  • Retail Pharmacies
  • Insurance Companies
  • Standalone Pharmacy Benefit Management Providers

By Business Model

  • Government Health Programs
  • Employer-sponsored Programs
  • Health Insurance Management

By Geography

  • North America
    • U.S.
    • Canada
  • Europe
    • U.K.
    • Germany
    • France
  • Asia-Pacific
    • China
    • India
    • Japan
    • South Korea
    • Malaysia
    • Philippines
  • Latin America
    • Brazil
    • Rest of Latin America
  • Middle East & Africa (MEA)
    • GCC
    • North Africa
    • South Africa
    • Rest of the Middle East & Africa

Frequently Asked Questions

What is the current size of pharmacy benefit management market?
The global pharmacy benefit management market size was reached at US$ 467.58 billion in 2021 and it is anticipated to rake US$ 757.05 billion by 2030.
The global pharmacy benefit management market is expected to drive growth at a CAGR of 5.5% from 2022 to 2030.
The major players operating in the pharmacy benefit management market are CVS Health, SS&C Technologies, Inc., Anthem Inc., Medimpact, Express Scripts Holding Company, Benecard Services, LLC, CaptureRx Inc., Change Healthcare, OptumRx, Inc., and Cigna.
The rapidly growing prevalence of various chronic diseases such as cancer, cardiovascular diseases, respiratory diseases, and diabetes are expected to boost the growth of the global pharmacy benefit management market during the forecast period.
North America region will lead the global pharmacy benefit management market over the forecast period 2022 to 2030.
  • Report Code:1770
  • Category:Healthcare
  • No. of Pages:150+
  • Format:PDF/PPT/Excel
  • Status:Published

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