Pharmacy Benefit Management in the US - Industry Market Research Report

In Good Health: Industry Consolidation Will Continue As Companies Seek to Increase Market Share and Expand Services

Businesses in the Pharmacy Benefit Management (PBM) industry act as intermediaries between healthcare payers and the rest of the US healthcare system. They help process prescription claims, negotiate rebates, develop drug formularies and review drug usage rates. Historically, PBMs have served as third-party administrators of prescription drug programs. The role of PBMs has expanded to include programs that lower prescription costs, like offering drug formularies that feature lower cost therapeutic categories. Rising drug prices, particularly specialty drugs, have incited health insurers to turn to PBMs for cost management services. As drug manufacturers consolidated, PBMs have followed suit to strengthen their bargaining power. Moreover, as healthcare shifts toward value-added care, PBMs have sought to expand their solutions to address the entire patient journey.

This industry includes operators that provide pharmacy benefit management services. Industry operators are third-party administrators of government and employer-sponsored prescription drug programs. They are primarily responsible for processing and paying prescription drug claims.

This report covers the scope, size, disposition and growth of the industry including the key sensitivities and success factors. Also included are five year industry forecasts, growth rates and an analysis of the industry key players and their market shares.