Pharmacy Benefit Management Market - Global Industry Size, Share, Trends, Opportunity, and Forecast, Segmented By Service (Specialty Pharmacy, Drug Formulatory Management, Benefit Plan Design and Consultation, Other Services), By Business Model (Government Health Programs, Employer-Sponsored Programs, Health Insurance Management), End-user (Pharmacy Benefit Management Organization, Mail Order Pharmacies, Retail Pharmacies, Other End-Users), By Region, By Competition, 2020-2030F

Market Overview

The Global Pharmacy Benefit Management Market, valued at USD 428.42 Billion in 2024, is projected to experience a CAGR of 7.21% to reach USD 650.55 Billion by 2030. Pharmacy Benefit Management (PBM) involves third-party administrators that manage prescription drug benefits for health insurers, employers, and government programs by negotiating drug prices, processing claims, and developing formularies to control costs and improve access to medications. Main drivers supporting market growth include the escalating global healthcare expenditure and rising prescription drug costs, alongside the increasing prevalence of chronic diseases that necessitate comprehensive medication management. Furthermore, expanding health insurance coverage contributes to greater prescription volumes and administrative complexity. According to the Canadian Institute for Health Information, in 2023, healthcare expenditure in Canada reached USD 344 billion.

A significant challenge that could impede market expansion is the persistent lack of transparency within PBM business practices. Stakeholders frequently express concerns regarding the opaque nature of profit generation, particularly concerning drug pricing mechanisms and rebate structures, which can foster distrust and complicate effective oversight.

Key Market Drivers

The escalating costs of prescription drugs represent a fundamental driver for the Global Pharmacy Benefit Management Market, necessitating sophisticated strategies to manage pharmaceutical expenditure. As drug prices continue to climb, health insurers, employers, and government programs increasingly rely on PBMs to negotiate discounts with manufacturers, establish cost-effective formularies, and implement utilization management programs. This demand for cost containment solutions positions PBMs as critical intermediaries in the healthcare supply chain, essential for mitigating financial burdens on payers and patients. According to the American Society of Health-System Pharmacists, in April 2025, U. S. prescription drug expenditures rose to $805.9 billion in 2024, representing an increase of 10.2% over the previous year. This substantial growth underscores the ongoing pressure to control costs, directly enhancing the value proposition of PBM services designed to optimize drug spending.

Complementing this, the rising prevalence of chronic diseases significantly expands the scope and complexity of medication management, thereby fueling the need for PBM interventions. Conditions such as diabetes, heart disease, and autoimmune disorders require sustained pharmacological treatments, often involving multiple, complex drug regimens that demand careful oversight for adherence and effectiveness. PBMs offer disease management programs and clinical support services that improve patient outcomes while striving for efficiency in medication delivery. According to the World Health Organization, in September 2025, noncommunicable diseases were responsible for at least 43 million deaths in 2021, accounting for 75% of non-pandemic-related deaths globally. The sheer volume and ongoing nature of medication needs associated with such widespread chronic conditions drive the need for organized pharmacy benefit administration. This growing patient population, coupled with the imperative for effective, cost-controlled care, translates directly into increased demand for comprehensive PBM solutions. In a demonstration of market activity, according to Drug Channels, in March 2025, Express Scripts commenced a five-year agreement in January 2024 to manage pharmacy benefits for approximately 20 million Centene beneficiaries.

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Key Market Challenges

The persistent lack of transparency within Pharmacy Benefit Management business practices presents a substantial impediment to market growth. Opaque profit generation, particularly concerning drug pricing mechanisms and rebate structures, cultivates significant distrust among various stakeholders. This environment complicates effective oversight and prompts increased scrutiny, leading to calls for more stringent regulation.

For instance, a survey by the National Association of Manufacturers in October 2024 revealed that over half of 188 polled companies were considering changing their PBM within three years, largely due to desires for more transparent contracts and pricing. This indicates a tangible reduction in client loyalty and an active search for alternative, more forthcoming service providers. Furthermore, the financial strain on crucial market participants is evident. According to a February 2024 National Community Pharmacists Association survey, 32 percent of independent pharmacy owners were contemplating closing their businesses in 2024, directly impacted by plunging prescription reimbursements influenced by PBM practices. Such instability among pharmacies, vital access points for patients, threatens the overall integrity and accessibility of the prescription drug supply chain, thereby hampering the expansion and smooth operation of the PBM market.

Key Market Trends

Advanced Technology and AI Integration represents a significant trend in the Global Pharmacy Benefit Management Market, transforming operational efficiencies and enhancing service delivery. PBMs are increasingly leveraging sophisticated digital tools and artificial intelligence to automate processes, optimize formulary design, and improve patient engagement. AHIP's 2024 Consumer Experience and Digital Health Forum notably featured "AI, Data Analytics and Interoperability" as a core track, underscoring the industry's strategic emphasis on these areas for evolving healthcare delivery. This technological shift allows for more precise identification of medication non-adherence risks and streamlined administrative functions. For example, OptumRx utilizes AI to predict patients at risk of medication nonadherence, triggering personalized interventions, and CVS Caremark deployed AI-driven prior authorization tools that reduced approval times from days to minutes. These advancements enhance the capability of PBMs to manage complex drug regimens more effectively and improve patient outcomes.

The shift to Value-Based Care and Outcomes is fundamentally reshaping how PBMs operate, moving beyond traditional fee-for-service models towards a focus on measurable health improvements. This trend incentivizes PBMs to develop programs that directly link pharmaceutical management to patient results and overall cost reduction. According to AHIP's 2024 annual survey, across all lines of business, value-based arrangements grew by nearly 4 percentage points from 41.3% in 2022 to 45.2% in 2023. This transition drives PBMs to integrate more deeply with healthcare providers and utilize clinical data to demonstrate the effectiveness of prescribed therapies. In a demonstration of this evolving landscape, CVS Health announced in November 2024 that its Aetna value-based care arrangements resulted in 49% more Medicare Advantage members achieving HbA1C control and 7% fewer hospitalizations compared to traditional fee-for-service models. This focus on outcomes strengthens the PBM's role as a strategic partner in achieving population health goals.

Segmental Insights

The Specialty Pharmacy segment is emerging as the fastest-growing area within the Global Pharmacy Benefit Management Market, driven by several critical factors. This rapid expansion is primarily due to the increasing prevalence of chronic and rare diseases, which necessitate the use of high-cost, complex specialty medications. Pharmacy Benefit Managers play a crucial role in managing the escalating costs associated with these innovative, often highly specialized, drugs. By providing tailored services such as adherence management and patient support, PBMs help payers ensure affordable access and optimal outcomes for patients requiring these advanced therapies, thereby fueling the segment's sustained growth.

Regional Insights

North America leads the Global Pharmacy Benefit Management market due to several distinct factors. The region benefits from a highly developed healthcare infrastructure and a high adoption rate of PBM services, driven by the escalating cost of prescription drugs and the consequent demand for effective cost-containment solutions. The presence of major PBM companies, often vertically integrated with health insurers, further solidifies its dominance, enabling extensive negotiations for drug pricing and formulary management on behalf of a large insured population. Regulatory frameworks, while under scrutiny for transparency, have historically shaped the PBM landscape, facilitating their intermediary role between insurers, drug manufacturers, and pharmacies.

Recent Developments

• In March 2025, OptumRx, a major pharmacy benefit manager, demonstrated its commitment to breakthrough research by integrating artificial intelligence (AI) into its operations. The company utilized AI-driven analytics to predict which patients were at a higher risk of medication nonadherence. This predictive capability allowed OptumRx to trigger personalized interventions, leading to a reduction in hospitalizations and an improvement in overall patient outcomes. This strategic adoption of AI aimed to streamline operations and enhance the effectiveness of medication management within the PBM sector.

• In July 2024, CVS Caremark, a leading pharmacy benefit manager and a CVS Health company, introduced its new TrueCost™ solution. This initiative was part of a renewed commitment to foster greater transparency, reduce drug costs, and deliver improved clinical care. The TrueCost™ solution aimed to align client and pharmacy reimbursement with specific costs, providing enhanced transparency and including additional dispensing fees for services rendered by pharmacists. This development was intended to strengthen pharmacy relations and promote lowest net cost prescription drugs for clients and members.

• In May 2024, Express Scripts announced a collaboration with CPESN USA, a network of independent pharmacies, as part of its IndependentRx Initiative. This partnership sought to enhance access to a broader range of care services, initially focusing on providing specialized support for Medicare beneficiaries living with diabetes and hypertension. Through this collaboration, CPESN pharmacies were integrated into the Express Scripts retail network to offer care coordination, medication management, and proactive interventions for at-risk patients, aiming to improve community-level care and support independent pharmacists.

• In January 2024, Express Scripts, a part of Cigna's Evernorth, commenced its strategic partnership with Centene to manage pharmacy benefits for approximately 20 million members. This collaboration aimed to improve the accessibility and affordability of prescription medications by leveraging Express Scripts' extensive pharmacy network. The partnership was a result of a competitive bidding process and was anticipated to foster better health outcomes through enhanced detection and care for members. This significant agreement underscored a continued focus on expanding Pharmacy Benefit Management (PBM) services to a broader population.

Key Market Players

• Optum, Inc.
• Centene Corporation (Envolve Health).
• CVS Health Corporation
• SS&C Technologies, Inc.
• Anthem, Inc..
• Elixir Rx Solutions, LLC.
• Express Scripts Holding Company
• Benecard Services, LLC.
• CaptureRx LLC

Report Scope:

In this report, the Global Pharmacy Benefit Management Market has been segmented into the following categories, in addition to the industry trends which have also been detailed below:

• Pharmacy Benefit Management Market, By Service:

o   Specialty Pharmacy

o   Drug Formulatory Management

o   Benefit Plan Design and Consultation

o   Other Services

• Pharmacy Benefit Management Market, By Business Model:

o   Government Health Programs

o   Employer-Sponsored Programs

o   Health Insurance Management

• Pharmacy Benefit Management Market, By End User:

o   Pharmacy Benefit Management Organization

o   Mail Order Pharmacies

o   Retail Pharmacies

o   Other

• Pharmacy Benefit Management Market, By Region:

o   North America

o   Europe

§  France

§  United Kingdom

§  Italy

§  Germany

§  Spain

o   Asia Pacific

o   South America

o   Middle East & Africa

Competitive Landscape

Company Profiles: Detailed analysis of the major companies presents in the Global Pharmacy Benefit Management Market.

Available Customizations:

Global Pharmacy Benefit Management Market report with the given market data, TechSci Research offers customizations according to a company's specific needs. The following customization options are available for the report:

Company Information

• Detailed analysis and profiling of additional market players (up to five).

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