Pharmacy Benefit Management

Global Pharmacy Benefit Management Market to Reach US$690.4 Billion by 2030

The global market for Pharmacy Benefit Management estimated at US$547.3 Billion in the year 2024, is expected to reach US$690.4 Billion by 2030, growing at a CAGR of 3.9% over the analysis period 2024-2030. Specialty Pharmacy Services, one of the segments analyzed in the report, is expected to record a 4.5% CAGR and reach US$261.1 Billion by the end of the analysis period. Growth in the Pharmacy Claims Processing segment is estimated at 3.4% CAGR over the analysis period.

The U.S. Market is Estimated at US$147.5 Billion While China is Forecast to Grow at 7.5% CAGR

The Pharmacy Benefit Management market in the U.S. is estimated at US$147.5 Billion in the year 2024. China, the world`s second largest economy, is forecast to reach a projected market size of US$147.1 Billion by the year 2030 trailing a CAGR of 7.5% over the analysis period 2024-2030. Among the other noteworthy geographic markets are Japan and Canada, each forecast to grow at a CAGR of 1.3% and 3.0% respectively over the analysis period. Within Europe, Germany is forecast to grow at approximately 2.1% CAGR.

Pharmacy Benefit Management - Key Trends and Drivers

Pharmacy Benefit Management (PBM) refers to the administrative and clinical services provided by third-party organizations to manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. PBMs are responsible for negotiating with drug manufacturers and pharmacies to control drug costs, processing prescription drug claims, and implementing clinical programs to ensure effective and efficient medication use. By leveraging their purchasing power, PBMs can secure discounts and rebates from drug manufacturers, thereby reducing overall drug costs for their clients and the end consumers.

The role of PBMs has become increasingly significant as prescription drug prices continue to rise. PBMs employ several strategies to manage drug costs and ensure the affordability of medications. These include formulary management, where they create lists of preferred drugs that provide the best value, and the use of pharmacy networks to negotiate lower prices with pharmacies. PBMs also implement utilization management programs such as prior authorization, step therapy, and drug utilization reviews to promote the use of cost-effective and clinically appropriate medications. Additionally, PBMs provide clinical services such as medication therapy management and patient adherence programs to improve health outcomes and reduce unnecessary healthcare costs.

The growth in the Pharmacy Benefit Management market is driven by several factors. The rising cost of prescription drugs has led to an increased demand for cost-containment strategies, positioning PBMs as crucial players in the healthcare system. Advances in data analytics and health information technology have enhanced the ability of PBMs to analyze drug utilization patterns and implement more effective cost-control measures. The growing prevalence of chronic diseases and the increasing complexity of drug therapies have also contributed to the demand for PBM services. Furthermore, regulatory changes and government initiatives aimed at increasing transparency and reducing drug prices have influenced the PBM landscape. The expansion of healthcare coverage and the shift towards value-based care models have further underscored the importance of PBMs in managing prescription drug benefits efficiently. These factors collectively drive the robust growth of the PBM market, highlighting its critical role in the healthcare industry.

SCOPE OF STUDY:

The report analyzes the Pharmacy Benefit Management market in terms of units by the following Segments, and Geographic Regions/Countries:

Segments:
Service (Specialty Pharmacy Services, Pharmacy Claims Processing, Benefit Plan Design & Administration, Formulary Management, Other Services); Service Provider (Insurance Company, Retail Pharmacy, Standalone PBMs)

Geographic Regions/Countries:
World; United States; Canada; Japan; China; Europe (France; Germany; Italy; United Kingdom; Spain; Russia; and Rest of Europe); Asia-Pacific (Australia; India; South Korea; and Rest of Asia-Pacific); Latin America (Argentina; Brazil; Mexico; and Rest of Latin America); Middle East (Iran; Israel; Saudi Arabia; United Arab Emirates; and Rest of Middle East); and Africa.

Select Competitors (Total 51 Featured) -

• Abarca Health LLC
• AffirmedRx, PBC
• Assaf Al Saab Company (Waseel)
• Burgess Information Systems, Inc. (ProCare Rx)
• Carelon
• Cigna Healthcare
• CVS Health Corporation
• Elixir Rx Solutions, LLC
• Express Scripts Holding Company
• Magellan Health Inc.
• MediKredit Integrated Healthcare Solutions (Pty) Ltd
• MedImpact Healthcare Systems, Inc.
• Optum, Inc.
• Prime Therapeutics
• SS&C Technologies, Inc.

TARIFF IMPACT FACTOR

Our new release incorporates impact of tariffs on geographical markets as we predict a shift in competitiveness of companies based on HQ country, manufacturing base, exports and imports (finished goods and OEM). This intricate and multifaceted market reality will impact competitors by artificially increasing the COGS, reducing profitability, reconfiguring supply chains, amongst other micro and macro market dynamics.

We are diligently following expert opinions of leading Chief Economists (14,949), Think Tanks (62), Trade & Industry bodies (171) worldwide, as they assess impact and address new market realities for their ecosystems. Experts and economists from every major country are tracked for their opinions on tariffs and how they will impact their countries.

We expect this chaos to play out over the next 2-3 months and a new world order is established with more clarity. We are tracking these developments on a real time basis.

As we release this report, U.S. Trade Representatives are pushing their counterparts in 183 countries for an early closure to bilateral tariff negotiations. Most of the major trading partners also have initiated trade agreements with other key trading nations, outside of those in the works with the United States. We are tracking such secondary fallouts as supply chains shift.

To our valued clients, we say, we have your back. We will present a simplified market reassessment by incorporating these changes!

APRIL 2025: NEGOTIATION PHASE

Our April release addresses the impact of tariffs on the overall global market and presents market adjustments by geography. Our trajectories are based on historic data and evolving market impacting factors.

JULY 2025 FINAL TARIFF RESET

Complimentary Update: Our clients will also receive a complimentary update in July after a final reset is announced between nations. The final updated version incorporates clearly defined Tariff Impact Analyses.

Reciprocal and Bilateral Trade & Tariff Impact Analyses:

USA
CHINA
MEXICO
CANADA
EU
JAPAN
INDIA
176 OTHER COUNTRIES.

Leading Economists - Our knowledge base tracks 14,949 economists including a select group of most influential Chief Economists of nations, think tanks, trade and industry bodies, big enterprises, and domain experts who are sharing views on the fallout of this unprecedented paradigm shift in the global econometric landscape. Most of our 16,491+ reports have incorporated this two-stage release schedule based on milestones.

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