Pharmacy Benefit Manager Market - Global Industry Analysis, Size, Share, Growth, Trends, and Forecast 2031

Description

The Pharmacy Benefit Manager (PBM) Market is on track to grow at a CAGR of 6.8% between 2024 and 2031, increasing from its current valuation of USD 630.54 billion to over a trillion dollars by the end of the forecast period. This growth is driven by rising prescription drug prices, the adoption of advanced technologies, and an increasing focus on reducing healthcare costs worldwide.

The pharmacy benefit manager market is witnessing robust growth, fueled by increasing healthcare expenditures and the rising prevalence of chronic diseases. The United States leads the market, holding a 66.5% share, thanks to its advanced healthcare infrastructure and widespread adoption of health insurance. Meanwhile, the retail pharmacy services segment accounts for 27.6% of the global market, supported by the growing popularity of online and offline retail pharmacy channels.

Key Drivers of Growth

1.Soaring Drug Prices:

The rising prevalence of chronic diseases has led to higher demand for branded medicines, driving up pharmaceutical spending globally.
In the United States, prescription drug prices increased by 4% in 2021, while individual medicine prices rose by 5% (Source: SingleCare Administrators).

2.Surge in Prescription Volume:

The number of prescriptions issued annually in the U.S. is approximately 4 billion, with further growth anticipated (SingleCare Administrators, 2022).

3.Technological Advancements:

Companies like CAPITAL RX are leveraging AI and ML to streamline claim processing, enhance supply chain efficiency, and minimize operational errors. These technologies enable PBMs to offer cost-effective solutions while improving service delivery.

4.Impact of COVID-19:

The pandemic significantly boosted demand for PBM services due to increased healthcare spending on specialty drugs and vaccines.
Example: U.S. healthcare expenditure reached USD 4 trillion in 2020, a 9.6% rise compared to the previous year.

Emerging Opportunities

The integration of artificial intelligence (AI) and machine learning (ML) into PBM workflows is creating new growth opportunities. These technologies allow companies to:

Optimize the supply chain.
Provide faster mail-order delivery services.
Reduce healthcare costs while enhancing operational efficiency.

Such advancements are expected to accelerate market growth and create significant opportunities for industry players.

Regional Insights

1.United States:

With over 50% of its population suffering from chronic conditions, the U.S. continues to lead the pharmacy benefit manager market.
The widespread adoption of health insurance, combined with favorable reimbursement policies, supports market growth.
Example: U.S. healthcare spending grew by 9.8% in 2020 (Centers for Medicare and Medicaid Services).

2.Developing Nations:

Poor literacy rates and limited awareness about health insurance policies in developing regions hinder market penetration.
Efforts to improve healthcare education and infrastructure in these areas could unlock future growth potential.

Challenges Impacting Growth

1.Transparency Issues:

Lack of clarity regarding PBM revenue models is a major concern, as it leads to higher costs for drug manufacturers and insurance providers.
Example: Over 50% of spending on branded pharmaceuticals benefits the supply chain, including PBMs, rather than manufacturers (Berkeley Research Group, 2022).

2.Limited Adoption in Emerging Markets:

A lack of awareness about health insurance and limited access to healthcare services restrict PBM adoption in underdeveloped regions.

Category Analysis

Retail Pharmacy Services:
- The segment is expanding due to the rising popularity of online pharmacies, driven by increased internet penetration and smartphone use.
- Online pharmacies offer convenience, discounts, and speedy delivery, making them a preferred choice for consumers.
Specialty Pharmacy Services:
- With the growing prevalence of chronic conditions requiring specialized medications, this segment is poised for steady growth during the forecast period.

Competitive Analysis

Leading players in the PBM market are focusing on innovation, acquisitions, and collaborations to expand their global footprint. Key players include:

Express Scripts Holding Company
CVS Health Corporation
DST Systems, Inc.
Rite Aid Corp.
UnitedHealth Group
Change Healthcare
Benecard Services, LLC
BioScrip, Inc.

These companies are investing in advanced technologies and expanding their services to cater to the growing demand for cost-effective healthcare solutions.

Pharmacy Benefit Manager Market Segmentation

By Service:

Retail Pharmacy Services
Specialty Pharmacy Services
Benefit Plan Design and Consultation
Drug Formulary Management
Other Services

By Demand Determinant:

Government Health Programs
Employer-Sponsored Programs
Health Insurance Companies
Other Programs

By Region:

North America
Latin America
Europe
South Asia
East Asia
Oceania
Middle East & Africa

1. Executive Summary

1.1. Global Pharmacy Benefit Manager Market Snapshot
1.2. Future Projections
1.3. Key Market Trends
1.4. Regional Snapshot, by Value, 2024
1.5. Analyst Recommendations

2. Market Overview

2.1. Market Definitions and Segmentations
2.2. Market Dynamics
- 2.2.1. Drivers
- 2.2.2. Restraints
- 2.2.3. Market Opportunities
2.3. Value Chain Analysis
2.4. Porter's Five Forces Analysis
2.5. COVID-19 Impact Analysis
- 2.5.1. Supply
- 2.5.2. Demand
2.6. Impact of Ukraine-Russia Conflict
2.7. Economic Overview
- 2.7.1. World Economic Projections
2.8. PESTLE Analysis

3. Global Pharmacy Benefit Manager Market Outlook, 2019-2031

3.1. Global Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
- 3.1.1. Key Highlights
  - 3.1.1.1. Retail Pharmacy Services
  - 3.1.1.2. Specialty Pharmacy Services
  - 3.1.1.3. Benefit Plan Design and Consultation
  - 3.1.1.4. Drug Formulary Management
  - 3.1.1.5. Other
3.2. Global Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
- 3.2.1. Key Highlights
  - 3.2.1.1. Government Health Programs
  - 3.2.1.2. Employer-Sponsored Programs
  - 3.2.1.3. Health Insurance Companies
  - 3.2.1.4. Other Programs
3.3. Global Pharmacy Benefit Manager Market Outlook, by Region, Value (US$ Bn), 2019-2031
- 3.3.1. Key Highlights
  - 3.3.1.1. North America
  - 3.3.1.2. Europe
  - 3.3.1.3. Asia Pacific
  - 3.3.1.4. Latin America
  - 3.3.1.5. Middle East & Africa

4. North America Pharmacy Benefit Manager Market Outlook, 2019-2031

4.1. North America Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
- 4.1.1. Key Highlights
  - 4.1.1.1. Retail Pharmacy Services
  - 4.1.1.2. Specialty Pharmacy Services
  - 4.1.1.3. Benefit Plan Design and Consultation
  - 4.1.1.4. Drug Formulary Management
  - 4.1.1.5. Other
4.2. North America Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
- 4.2.1. Key Highlights
  - 4.2.1.1. Government Health Programs
  - 4.2.1.2. Employer-Sponsored Programs
  - 4.2.1.3. Health Insurance Companies
  - 4.2.1.4. Other Programs
- 4.2.2. BPS Analysis/Market Attractiveness Analysis
4.3. North America Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
- 4.3.1. Key Highlights
  - 4.3.1.1. U.S. Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 4.3.1.2. U.S. Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 4.3.1.3. Canada Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 4.3.1.4. Canada Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
- 4.3.2. BPS Analysis/Market Attractiveness Analysis

5. Europe Pharmacy Benefit Manager Market Outlook, 2019-2031

5.1. Europe Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
- 5.1.1. Key Highlights
  - 5.1.1.1. Retail Pharmacy Services
  - 5.1.1.2. Specialty Pharmacy Services
  - 5.1.1.3. Benefit Plan Design and Consultation
  - 5.1.1.4. Drug Formulary Management
  - 5.1.1.5. Other
5.2. Europe Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
- 5.2.1. Key Highlights
  - 5.2.1.1. Government Health Programs
  - 5.2.1.2. Employer-Sponsored Programs
  - 5.2.1.3. Health Insurance Companies
  - 5.2.1.4. Other Programs
- 5.2.2. BPS Analysis/Market Attractiveness Analysis
5.3. Europe Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
- 5.3.1. Key Highlights
  - 5.3.1.1. Germany Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 5.3.1.2. Germany Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 5.3.1.3. U.K. Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 5.3.1.4. U.K. Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 5.3.1.5. France Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 5.3.1.6. France Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 5.3.1.7. Italy Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 5.3.1.8. Italy Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 5.3.1.9. Turkey Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 5.3.1.10. Turkey Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 5.3.1.11. Russia Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 5.3.1.12. Russia Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 5.3.1.13. Rest of Europe Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 5.3.1.14. Rest of Europe Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
- 5.3.2. BPS Analysis/Market Attractiveness Analysis

6. Asia Pacific Pharmacy Benefit Manager Market Outlook, 2019-2031

6.1. Asia Pacific Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
- 6.1.1. Key Highlights
  - 6.1.1.1. Retail Pharmacy Services
  - 6.1.1.2. Specialty Pharmacy Services
  - 6.1.1.3. Benefit Plan Design and Consultation
  - 6.1.1.4. Drug Formulary Management
  - 6.1.1.5. Other
6.2. Asia Pacific Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
- 6.2.1. Key Highlights
  - 6.2.1.1. Government Health Programs
  - 6.2.1.2. Employer-Sponsored Programs
  - 6.2.1.3. Health Insurance Companies
  - 6.2.1.4. Other Programs
- 6.2.2. BPS Analysis/Market Attractiveness Analysis
6.3. Asia Pacific Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
- 6.3.1. Key Highlights
  - 6.3.1.1. China Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 6.3.1.2. China Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 6.3.1.3. Japan Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 6.3.1.4. Japan Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 6.3.1.5. South Korea Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 6.3.1.6. South Korea Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 6.3.1.7. India Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 6.3.1.8. India Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 6.3.1.9. Southeast Asia Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 6.3.1.10. Southeast Asia Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 6.3.1.11. Rest of Asia Pacific Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 6.3.1.12. Rest of Asia Pacific Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
- 6.3.2. BPS Analysis/Market Attractiveness Analysis

7. Latin America Pharmacy Benefit Manager Market Outlook, 2019-2031

7.1. Latin America Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
- 7.1.1. Key Highlights
  - 7.1.1.1. Retail Pharmacy Services
  - 7.1.1.2. Specialty Pharmacy Services
  - 7.1.1.3. Benefit Plan Design and Consultation
  - 7.1.1.4. Drug Formulary Management
  - 7.1.1.5. Other
7.2. Latin America Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
- 7.2.1. Key Highlights
  - 7.2.1.1. Government Health Programs
  - 7.2.1.2. Employer-Sponsored Programs
  - 7.2.1.3. Health Insurance Companies
  - 7.2.1.4. Other Programs
- 7.2.2. BPS Analysis/Market Attractiveness Analysis
7.3. Latin America Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
- 7.3.1. Key Highlights
  - 7.3.1.1. Brazil Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 7.3.1.2. Brazil Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 7.3.1.3. Mexico Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 7.3.1.4. Mexico Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 7.3.1.5. Argentina Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 7.3.1.6. Argentina Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 7.3.1.7. Rest of Latin America Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 7.3.1.8. Rest of Latin America Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
- 7.3.2. BPS Analysis/Market Attractiveness Analysis

8. Middle East & Africa Pharmacy Benefit Manager Market Outlook, 2019-2031

8.1. Middle East & Africa Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
- 8.1.1. Key Highlights
  - 8.1.1.1. Retail Pharmacy Services
  - 8.1.1.2. Specialty Pharmacy Services
  - 8.1.1.3. Benefit Plan Design and Consultation
  - 8.1.1.4. Drug Formulary Management
  - 8.1.1.5. Other
8.2. Middle East & Africa Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
- 8.2.1. Key Highlights
  - 8.2.1.1. Government Health Programs
  - 8.2.1.2. Employer-Sponsored Programs
  - 8.2.1.3. Health Insurance Companies
  - 8.2.1.4. Other Programs
- 8.2.2. BPS Analysis/Market Attractiveness Analysis
8.3. Middle East & Africa Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
- 8.3.1. Key Highlights
  - 8.3.1.1. GCC Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 8.3.1.2. GCC Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 8.3.1.3. South Africa Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 8.3.1.4. South Africa Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 8.3.1.5. Egypt Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 8.3.1.6. Egypt Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 8.3.1.7. Nigeria Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 8.3.1.8. Nigeria Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
  - 8.3.1.9. Rest of Middle East & Africa Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
  - 8.3.1.10. Rest of Middle East & Africa Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
- 8.3.2. BPS Analysis/Market Attractiveness Analysis

9. Competitive Landscape

9.1. Company Market Share Analysis, 2024
9.2. Competitive Dashboard
9.3. Company Profiles
- 9.3.1. Express Scripts Holding Company
  - 9.3.1.1. Company Overview
  - 9.3.1.2. Therapy Portfolio
  - 9.3.1.3. Financial Overview
  - 9.3.1.4. Business Strategies and Development
- 9.3.2. CVS Health Corporation
  - 9.3.2.1. Company Overview
  - 9.3.2.2. Therapy Portfolio
  - 9.3.2.3. Financial Overview
  - 9.3.2.4. Business Strategies and Development
- 9.3.3. DST Systems, Inc.
  - 9.3.3.1. Company Overview
  - 9.3.3.2. Therapy Portfolio
  - 9.3.3.3. Financial Overview
  - 9.3.3.4. Business Strategies and Development
- 9.3.4. Rite Aid Corp.
  - 9.3.4.1. Company Overview
  - 9.3.4.2. Therapy Portfolio
  - 9.3.4.3. Financial Overview
  - 9.3.4.4. Business Strategies and Development
- 9.3.5. ProCare Rx.
  - 9.3.5.1. Company Overview
  - 9.3.5.2. Therapy Portfolio
  - 9.3.5.3. Financial Overview
  - 9.3.5.4. Business Strategies and Development
- 9.3.6. UnitedHealth Group
  - 9.3.6.1. Company Overview
  - 9.3.6.2. Therapy Portfolio
  - 9.3.6.3. Financial Overview
  - 9.3.6.4. Business Strategies and Development
- 9.3.7. Benecard Services, LLC
  - 9.3.7.1. Company Overview
  - 9.3.7.2. Therapy Portfolio
  - 9.3.7.3. Financial Overview
  - 9.3.7.4. Business Strategies and Development
- 9.3.8. BioScrip, Inc.
  - 9.3.8.1. Company Overview
  - 9.3.8.2. Therapy Portfolio
  - 9.3.8.3. Financial Overview
  - 9.3.8.4. Business Strategies and Development
- 9.3.9. CaptureRx
  - 9.3.9.1. Company Overview
  - 9.3.9.2. Therapy Portfolio
  - 9.3.9.3. Financial Overview
  - 9.3.9.4. Business Strategies and Development
- 9.3.10. Change Healthcare
  - 9.3.10.1. Company Overview
  - 9.3.10.2. Therapy Portfolio
  - 9.3.10.3. Financial Overview
  - 9.3.10.4. Business Strategies and Development

10. Appendix

10.1. Research Methodology
10.2. Report Assumptions
10.3. Acronyms and Abbreviations