Pharmacy Benefit Management Market Size Report, Industry Share, Analysis, Growth, 2032

Global Pharmacy Benefit Management Market: Industry Analysis

The global Pharmacy Benefit Management Market size was valued at USD 611.78 Billion in 2023 and is predicted to reach USD 1350.82 Billion by the end of 2032. The market is expected to grow with a CAGR of 9.2% during the forecast period. The report analyzes the global Pharmacy Benefit Management Market's growth drivers, restraints, and impact on demand during the forecast period. It will also help navigate and explore the arising opportunities in the Pharmacy Benefit Management industry.

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Global Pharmacy Benefit Management Market: Overview

The pharmacy benefit manager acts as a third-party administrator. Pharmacy benefit management is an administration of prescription drug programs that monitors, administers, and handles all the issues concerned with healthcare and facilitates drug benefit programs for the organization’s employers. It aids in providing the medical services and prescribed medicines at low costs to the employers.

The cost reduction is done with the help of rebates from various drug manufacturers, undergoing contracts with various pharmacies, processing & compensating the prescribed drug claims, and working with government programs & self-insured companies.

The pharmacy benefit management (PBM) calls out the lists of the prescription drugs which enclose all the drugs covered in the plans where the manufacturers are liable to offer discounts. The pharmacy benefit management can be varied from flexible and diverse programs ranging from the big to small in size. Some of the applications of the pharmacy benefit manager include medication therapy programs, assessing the clinical programs for the huge populations, less expensive therapeutic alternatives, awareness regarding tablet splitting, and mail order service.

Global Pharmacy Benefit Management Market: Growth Factors

One of the factors that are driving the global pharmacy benefit management market is the urgent need to eliminate or reduce medication errors. It is raising healthcare expenditure costs across the globe. Also, the rising consumer spending on prescription drugs is soaring the demand for pharmacy benefit management. The PBM helps in managing and planning the formulary concerning the customer wants, negotiating discounts, different rebates from drug manufacturers, processing the claims concerned with the prescription, and contracting with different pharmacies.

To improve the customer value and reduce the cost of prescription drugs, different tools are adopted by the PBMs like pharmacy discount cards, drug utilization review, disease management, manufacturer’s discount, e-prescribing, drug formulary, mail-service pharmacies, pharmacy networks, and many more.

Key Insights

• As per the analysis shared by our research analyst, the global Pharmacy Benefit Management Market is estimated to grow annually at a CAGR of around 9.2% over the forecast period (2024-2032).
• In terms of revenue, the global Pharmacy Benefit Management Market size was valued at around USD 611.78 Billion in 2023 and is projected to reach USD 1350.82 Billion by 2032.
• Based on the service, In the Pharmacy Benefit Management (PBM) market, specialty pharmacy services are currently the most dominant segment. This growth is driven by the increasing prevalence of complex, chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis, which require specialized medications and management. Specialty pharmacies offer expertise in handling these high-cost therapies, providing patient support programs, prior authorization assistance, and clinical care management, making them a critical and expanding part of PBM services.
• Based on the business model, In terms of business model segmentation, the standalone PBM segment is the most dominant. Standalone PBMs operate independently from insurers and healthcare providers, allowing them to focus solely on optimizing drug benefit programs. Their independence helps them negotiate better drug prices, manage formularies efficiently, and provide more customized services to their clients, which include employers, insurers, and government programs.
• Based on the end-user, Among end-users, the healthcare providers segment holds the dominant share of the PBM market. Healthcare providers, including hospitals and clinics, increasingly rely on PBMs to manage medication therapies, reduce prescription drug costs, and ensure better clinical outcomes for patients. This collaboration allows providers to focus more on patient care while PBMs handle the complex administrative and operational aspects of pharmaceutical benefits.
• Based on the region, Geographically, North America, particularly the United States, is the most dominant region in the Pharmacy Benefit Management market. The strong presence of major PBM players, high healthcare spending, an advanced insurance framework, and a growing demand for cost-effective medication management solutions contribute significantly to North America's leading position in the global market.

Global Pharmacy Benefit Management Market: Report Scope

Global Pharmacy Benefit Management Market: Segmentation

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The global pharmacy benefit management market can be segmented into service, business model, end-user, and region. All the segments have been analyzed based on present and future trends and the market is estimated from 2024 to 2032.

By service, the market can be segmented into mail order service, benefit plan design & consultation, drug formulary management, specialty pharmacy services, and others. The specialty pharmacy services segment holds hegemony over others as the market consolidates with growing acquisitions and mergers.

By business model, the market can be segmented into health insurance management, employer-sponsored programs, and government health programs.

By end-user, the market can be segmented into outpatient pharmacies, inpatient pharmacies, retail pharmacies, mail-order pharmacies, pharmacy benefit management organizations, and others. The inpatient pharmacies can further be segmented into long term care facilities and acute care settings. The outpatient pharmacies can be segmented into hospital retail settings and outpatient clinics.

The retail pharmacy segment holds the largest share in the global pharmacy benefit management market as these services help patients to avail drugs at an affordable price.

The regional segment includes the current and forecast demand for North America, Europe, Asia Pacific, Latin America, and the Middle East and Africa.

Global Pharmacy Benefit Management Market: Regional analysis

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North America holds the largest share in the global pharmacy benefit management market owing to the significant surge in the number of Medicare prescription drug program subscribers. The pharmacy benefits merger also helps in checking on whether a generic or branded drug will be fit for the patient. Moreover, there is significant growth in the region due to the proliferation of the pharmaceutical and biopharmaceutical sector. The region has a huge base of pharmacy benefit management vendors.

Europe is a growing region in the global pharmacy benefit management market due to the added benefits of the PBM. The region has a good profit margin from generic drugs.

Asia Pacific is anticipated to witness huge growth during the forecast period due to the constant technological advancements in developing countries like India and China.

Global Pharmacy Benefit Management Market: Competitive Players

Some of the significant players in the global pharmacy benefit management market are:

• Prime Therapeutics
• Accredo
• ProCare Rx
• Anthem, Inc.
• Catamaran Corporation
• Change Healthcare
• Aetna
• CaptureRx
• Humana Pharmacy Solutions
• Benecard Services, LLC.
• Express Scripts Holding Company
• Rite Aid Corp.
• UnitedHealth Group
• SS&C Technologies, Inc.
• And CVS Health.

Global Pharmacy Benefit Management Market: Segmentation

By Service

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

By Service Provider

• Insurance Companies
• Retail Pharmacies
• Standalone PBMs

Global Pharmacy Benefit Management Market: Regional Segment Analysis

• North America
  • The U.S.
  • Canada
• Europe
  • France
  • The UK
  • Spain
  • Germany
  • Italy
  • Rest of Europe
• Asia Pacific
  • China
  • Japan
  • India
  • South Korea
  • Southeast Asia
  • Rest of Asia Pacific
• Latin America
  • Brazil
  • Mexico
  • Rest of Latin America
• Middle East & Africa
  • GCC
  • South Africa
  • Rest of Middle East & Africa

What Reports Provides

• Full in-depth analysis of the parent market
• Important changes in market dynamics
• Segmentation details of the market
• Former, on-going, and projected market analysis in terms of volume and value
• Assessment of niche industry developments
• Market share analysis
• Key strategies of major players
• Emerging segments and regional markets
• Testimonials to companies in order to fortify their foothold in the market