Pharmacy Benefit Management Market to Grow with a CAGR of 7.39% through 2028

Increasing prescription drug utilization is expected to drive the United States Pharmacy Benefit Management Market growth in the forecast period, 2024-2028.

 

According to TechSci Research report, “Pharmacy Benefit Management Market – United States Industry Size, Share, Trends, Competition Forecast & Opportunities, 2028”, the United States Pharmacy Benefit Management Market stood at USD 469.12 billion in 2022 and is anticipated to grow with a CAGR of 7.39% in the forecast period, 2024-2028.  As healthcare expenditures continue to soar, stakeholders across the industry are seeking ways to contain costs without compromising the quality of care. PBMs play a pivotal role in this quest by negotiating with pharmaceutical manufacturers to secure favorable pricing for prescription medications. Through their purchasing power and ability to leverage formulary management strategies, PBMs can optimize drug utilization and ensure that cost-effective alternatives, such as generic drugs, are prioritized. This cost containment function is vital in a healthcare landscape where affordability is a persistent concern for both consumers and payers.

The increasing prevalence of chronic diseases is another significant driver propelling the PBM market forward. Chronic conditions, such as diabetes, cardiovascular diseases, and respiratory disorders, are on the rise in the United States. The management of these long-term health issues often involves the consistent use of prescription medications. PBMs, with their expertise in negotiating drug prices and managing pharmacy networks, are essential in ensuring that patients with chronic conditions have access to the medications they need. The demand for comprehensive and cost-effective solutions for managing chronic diseases has spurred the growth of PBMs, positioning them as key players in the healthcare ecosystem.

Technological advancements and the integration of digital solutions represent another crucial driver of growth in the U.S. PBM market. PBMs are increasingly leveraging data analytics, artificial intelligence, and digital platforms to enhance their operations and improve patient outcomes. These technologies enable PBMs to streamline processes, optimize drug formularies, and identify cost-saving opportunities.

 

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The United States Pharmacy Benefit Management Market is segmented into Business Model, End-use, Distribution Channel, Regional Distribution, And Company.

Based on the Business Model, Standalone PBM model emerged as the dominant segment in the United States market for United States Pharmacy Benefit Management Market in 2022. the standalone PBM model offers specialization and expertise in the management of prescription drug benefits. By focusing exclusively on pharmacy-related services, standalone PBMs can dedicate their resources, technology, and personnel to optimizing drug benefits, negotiating with pharmaceutical manufacturers, and implementing cost-effective strategies. This specialization allows standalone PBMs to stay abreast of the complex and rapidly evolving pharmaceutical landscape, ensuring that they can adapt quickly to industry changes and emerging trends. Additionally, the standalone PBM model provides flexibility and neutrality in its operations. Independent PBMs are not tied to specific health insurance plans or pharmacy chains, allowing them to work with a diverse range of clients, including health plans, employers, and government programs. This flexibility enables them to tailor their services to the unique needs of each client, fostering a more personalized and adaptable approach to prescription drug benefit management.

Based on the End-use, Contraceptives emerged as the dominant segment in the United States market for United States Pharmacy Benefit Management Market in 2022. the commercial sector encompasses a wide array of employers and private companies that provide healthcare benefits to their employees. With a large portion of the U.S. population covered by employer-sponsored health plans, the demand for efficient and cost-effective prescription drug benefit management is substantial. Commercial enterprises, ranging from small businesses to large corporations, turn to PBMs to navigate the complexities of pharmaceutical pricing, formulary management, and drug utilization. The need for these services has become even more pronounced as healthcare costs continue to rise, prompting employers to seek solutions that balance employee health outcomes with cost containment. Moreover, the commercial sector's reliance on PBMs is driven by the desire to enhance employee satisfaction and well-being. Providing comprehensive and well-managed prescription drug benefits is a crucial component of employee healthcare packages.

Mid-West emerged as the dominant player in the United States Pharmacy Benefit Management Market in 2022, holding the largest market share.The Midwest is home to a diverse range of industries, including manufacturing, agriculture, technology, and healthcare. Robust economic activity in the region could lead to higher employment rates and, consequently, increased demand for healthcare services, including prescription drug benefits managed by PBMs. The Midwest hosts major healthcare institutions, hospital systems, and medical research centers. These institutions often have a significant influence on the demand for healthcare services and prescription medications, driving the need for effective PBM services. State-specific healthcare policies and regulations can influence the demand for PBM services. If the Midwest has a favorable regulatory environment that encourages the use of PBMs, it could contribute to the region's dominance.

 

Major companies operating in United States Pharmacy Benefit Management Market are:

• Elixir Rx Solutions LLC
• CVS Health
• Cigna Health
• Optum, Inc.
• MedImpact Healthcare Systems
• Anthem Biosciences Pvt. Ltd.
• Change Healthcare
• Prime Therapeutics LLC
• HUB International Limited.

 

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 “The United States Pharmacy Benefit Management (NGS) market is poised for significant growth in the coming years. Anticipated to be driven by factors such as the rising healthcare costs, increasing prevalence of chronic diseases, and advancements in pharmaceuticals, PBMs play a crucial role in optimizing prescription drug benefits. The demand for cost-effective solutions, coupled with the emphasis on patient-centric care models and the integration of technology like data analytics and artificial intelligence, positions PBMs at the forefront of healthcare innovation. Additionally, as regulatory landscapes evolve and stakeholders prioritize transparency, PBMs are expected to adapt, contributing to the market's expansion.” said Mr. Karan Chechi, Research Director with TechSci Research, a research-based management consulting firm.

“United States Pharmacy Benefit Management Market Segmented By Business Model (Standalone PBM, Health Insurance Providers, Retail Pharmacy), By End-use (Commercial, Federal) Region and Competition, Opportunity, and Forecast, 2018-2028”, has evaluated the future growth potential of United States Pharmacy Benefit Management Market and provides statistics & information on market size, structure and future market growth. The report intends to provide cutting-edge market intelligence and help decision makers take sound investment decisions. Besides, the report also identifies and analyzes the emerging trends along with essential drivers, challenges, and opportunities in United States Pharmacy Benefit Management Market.

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