Market Research Logo

U.S. Pharmacy Benefit Management (PBM) Market Analysis Report By Business Model (Standalone, Health Insurance Providers, Retail Pharmacy), By End Use (Commercial, Federal), And Segment Forecasts, 2019 - 2026

U.S. Pharmacy Benefit Management (PBM) Market Analysis Report By Business Model (Standalone, Health Insurance Providers, Retail Pharmacy), By End Use (Commercial, Federal), And Segment Forecasts, 2019 - 2026

The U.S. pharmacy benefits management market size is projected to reach USD 744.6 billion by 2026, according to a new report by Grand View Research, Inc., exhibiting a CAGR of 9.2% during the forecast period. Increasing vertical integration of key market players, rising prevalence of chronic disease, and shrinking FDA generic-approval backlog are some of the primary growth stimulants for the market.

Vertical integration of pharmacy benefits management (PBM) organizations with health insurance companies are poised to result in increased control of PBMs over distribution systems. This will lead to rise in rebates, ultimately increasing the cost of drug list prices. Moreover, it will result in a monopoly of certain market player, concentrating sales and revenue generation.

The business of insuring and administering employee benefit programs in the country, especially, health care programs, is heavily regulated by federal and state laws and administrative agencies, such as the Department of Health and Human Services (HHS), State Departments of Insurance, Centers for Medicare & Medicaid Services (CMS), Internal Revenue Services, and Departments of Labor.

All PBM businesses in the U.S. must include home delivery and specialty pharmacies licensed as pharmacies in the states of establishment. Several states in the country regulate the scope of prescription (Rx) drug coverage and delivery channels to receive drugs for managed care organizations (MCOs), insurers, and Medicaid care plans. Certain home delivery and specialty pharmacies must be registered with the U.S. Drug Enforcement Administration (DEA) and individual state controlled substance authorities.

Further key findings from the study suggest:

Based on business model, the market has been segmented into standalone PBM, health insurance providers, and retail pharmacy. Of these, PBMs associated with health insurers are likely to witness the fastest growth over the forecast period

Rise in mergers and partnerships between market players is expected to result in an increased demand for PBM systems

OptumRx and Express Scripts (merged with Cigna in December 2018) are among the key players merged or acquired by large health insurance providers

Based on end use, the market has been divided into commercial and federal. Commercial PBM systems dominated the market and are estimated to maintain their dominance through 2026 owing to a large number of covered patients

CVS Health; Aetna; Express Scripts; Cigna; OptumRx, Inc.; Walgreens Booth Alliance; MedImpact Healthcare Systems, Inc.; Anthem; and Rite Aid are some of the key players in the market.Please note The report will be updated with the latest data and delivered to you within 2-3 business days.

Please note The report will be updated with the latest data and delivered to you within 2-3 business days.


Chapter 1 Methodology and Scope
1.1 Market Segmentation & Scope
1.1.1 Business Model
1.1.1.1 Standalone PBM
1.1.1.2 Health Insurance Providers
1.1.1.3 Retail Pharmacy
1.1.2 END USE
1.1.2.1 Commercial
1.1.2.2 Federal
1.1.3 Estimates And Forecast TimelinE
1.2 Research Methodology
1.3 Information Procurement
1.3.1 Purchased Database:
1.3.2 Gvr’s Internal Database
1.3.3 Secondary Sources:
1.3.4 Primary Research
1.4 Information or Data Analysis
1.5 Market Formulation & Validation
1.6 Model Details
1.6.1 Commodity Flow Analysis (Model 1)
1.6.2 Volume Price Analysis (Model 2)
1.7 List of Secondary Sources
1.8 List of Primary Sources
1.9 List of Abbreviations
1.10 Objectives
1.10.1 Objective - 1:
1.10.2 Objective - 2:
Chapter 2 Executive Summary
2.1 Market Outlook
2.2 Segment Outlook
Chapter 3 Market Variables, Trends & Scope
3.1 Market Segmentation
3.2 User Perspective Analysis
3.2.1 Consumer Behavior Analysis
3.2.2 Market Influencer Analysis
3.3 Market Dynamics
3.3.1 Market Driver Analysis
3.3.1.1 Vertical Integration Of Key Market Players
3.3.1.2 Introduction Of Improved Health Benefit Plans
3.3.1.3 Growing Prevalence Of Chronic Diseases In The U.S.
3.3.2 Market Restraint Analysis
3.3.2.1 Stringent regulations to cut back rebates
3.4 Penetration & Growth Prospect Mapping
3.4.1 Penetration & Growth Prospect Mapping Analysis
3.5 Business Environment Analysis Tools
3.5.1 Porter’s Five Forces Analysis
3.5.1.1 Bargaining power of buyers: High
3.5.1.2 Bargaining power of suppliers: Moderate
3.5.1.3 Competitive rivalry: High
3.5.1.4 Threat of new entrants: Low
3.5.1.5 Threat of substitutes: High
3.5.2 Pestel Analysis
3.5.2.1 Political & Legal Landscape
3.5.2.2 Economic Landscape
3.5.2.3 Social Landscape
3.5.2.4 Technological Landscape
3.5.2.5 Environmental Landscape
3.6 Supply Chain Analysis
3.7 Regulatory Framework
Chapter 4 U.S. Pharmacy Benefits Management Market: Business Model Analysis
4.1 U.S. Pharmacy Benefits Management Business Model Market Share Analysis, 2018 & 2026
4.2 U.S. Pharmacy Benefits Management Business Model Market: Segment Dashboard:
4.3 Market Size & Forecasts and Trend Analyses, 2015 to 2026 for the Business Model Segment
4.3.1 Standalone PBM
4.3.1.1 Standalone PBM Market, 2015 - 2026 (USD Billion)
4.3.2 Health Insurance Providers
4.3.2.1 Health Insurance Providers Market, 2015 - 2026 (USD Billion)
4.3.3 Retail Pharmacy
4.3.3.1 Retail Pharmacy Market, 2015 - 2026 (USD Billion)
Chapter 5 U.S. Pharmacy Benefits Management Market: End Use Analysis
5.1 U.S. Pharmacy Benefits Management End Use Market Share Analysis, 2018 & 2026
5.2 U.S. Pharmacy Benefits Management End Use Market: Segment Dashboard
5.3 Market Size & Forecasts and Trend Analyses, 2015 to 2026 for the End Use
5.3.1 CommerciaL
5.3.1.1 Commercial PBM market, 2015 - 2026 (USD Billion)
5.3.2 Federal
5.3.2.1 Federal PBM market, 2015 - 2026 (USD Billion)
Chapter 6 Competitive Analysis
6.1 Recent Developments & Impact Analysis, by Key Market Participants
6.2 Strategic Framework/ Competition Categorization (Key innovators, Market leaders, emerging players
6.3 Vendor Landscape
6.3.1 List Of Key Distributors And Channel Partners
6.3.2 Strategy Mapping
6.3.3 Major Deals & Strategic Alliances AnalysiS
6.4 U.S. Pharmacy Benefits Management (PBM) Market: Market Position Analysis (Based on Regional Presence and Recent Updates)
6.5 Company Profiles
6.5.1 CVS HEALTH
6.5.1.1 Company overview
6.5.1.2 Financial performance
6.5.1.3 Service benchmarking
6.5.1.4 Strategic initiatives
6.5.1.5 SWOT analysis
6.5.2 AETNA
6.5.2.1 Company overview
6.5.2.2 Financial performance
6.5.2.3 Service benchmarking
6.5.2.4 Strategic initiatives
6.5.2.5 SWOT analysis
6.5.3 EXPRESS SCRIPTS HOLDING COMPANY
6.5.3.1 Company overview
6.5.3.2 Financial performance
6.5.3.3 Service benchmarking
6.5.3.4 Strategic initiatives
6.5.3.5 SWOT analysis
6.5.4 CIGNA
6.5.4.1 Company overview
6.5.4.2 Financial performance
6.5.4.3 Service benchmarking
6.5.4.4 Strategic initiatives
6.5.4.5 SWOT analysis
6.5.5 OPTUMRX, INC.
6.5.5.1 Company overview
6.5.5.2 Financial performance
6.5.5.3 Service benchmarking
6.5.5.4 Strategic initiatives
6.5.5.5 SWOT analysis
6.5.6 WALGREENS BOOTS ALLIANCE, INC.
6.5.6.1 Company overview
6.5.6.2 Service benchmarking
6.5.6.3 Strategic initiatives
6.5.6.5 SWOT analysis
6.5.7 ANTHEM
6.5.7.1 Company overview
6.5.7.2 Financial performance
6.5.7.3 Service benchmarking
6.5.7.4 Strategic initiatives
6.5.7.5 SWOT analysis
6.5.8 MEDIMPACT HEALTHCARE SYSTEMS, INC.
6.5.8.1 Company overview
6.5.8.2 Financial performance
6.5.8.3 Service benchmarking
6.5.8.4 Strategic initiatives
6.5.8.5 SWOT analysis
6.5.9 RITE AID
6.5.9.1 Company overview
6.5.9.2 Financial performance
6.5.9.3 Service benchmarking
6.5.9.4 Strategic initiatives
6.5.9.5 SWOT analysis
Chapter 7 Recommendations
List of Tables
TABLE 1 List of secondary sources
TABLE 2 List of Abbreviation
TABLE 3 U.S. pharmacy benefits management (PBM) market, by business model, 2015 - 2026 (USD Billion)
TABLE 4 U.S. pharmacy benefits management (PBM) market, by end use, 2015 - 2026 (USD Billion)
List of Figures
Fig. 1 Market research process
Fig. 2 Information procurement
Fig. 3 Primary research pattern
Fig. 4 Market research approaches
Fig. 5 Value chain based sizing & forecasting
Fig. 6 QFD modelling for market share assessment
Fig. 7 Market formulation & validation
Fig. 8 Market outlook
Fig. 9 Pharmacy benefits management market segmentation
Fig. 10 Market trends & outlook
Fig. 11 Market driver relevance analysis (Current & future impact)
Fig. 12 Market restraint relevance analysis (Current & future impact)
Fig. 13 Penetration & growth prospect mapping
Fig. 14 Porter’s five forces analysis
Fig. 15 PESTLE analysis
Fig. 16 U.S. pharmacy benefits management market: Supply chain analysis
Fig. 17 U.S. pharmacy benefits management business model market share analysis, 2018 & 2026
Fig. 18 U.S. pharmacy benefits management business model market: Segment dashboard
Fig. 19 Standalone PBM market, 2015 - 2026 (USD Billion)
Fig. 20 Health insurance providers market, 2015 - 2026 (USD Billion)
Fig. 21 Retail pharmacy market, 2015- 2026 (USD Billion)
Fig. 22 U.S. pharmacy benefits management market end use movement analysis, 2018 & 2026
Fig. 23 U.S. pharmacy benefits management end use market: Segment dashboard
Fig. 24 Commercial PBM market, 2015 - 2026 (USD Billion)
Fig. 25 Federal PBM market, 2015- 2026 (USD Billion)
Fig. 26 Recent developments & impact analysis, by key market participants
Fig. 27 Strategy framework
Fig. 28 Strategy mapping
Fig. 29 Company market position analysis

Download our eBook: How to Succeed Using Market Research

Learn how to effectively navigate the market research process to help guide your organization on the journey to success.

Download eBook

Share this report