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Pharmacy Benefit Manager (PBM) Market in the US 2015-2019

Pharmacy Benefit Manager (PBM) Market in the US 2015-2019

About PBMs

PBMs are responsible for processing prescriptions for corporations or insurance companies. Earlier, their major role was administration and negotiation with drug pharmacies and manufacturers to get rebates on drug prices. Now they have evolved into entities taking over the drug benefit portion of health plans in the US. Recent healthcare reforms in the US have contributed significantly to increase their area of expertise. Increase in costs of drugs and other healthcare services has made PBM's services more desirable. PBMs act as an intermediary between the payer and other entities in a healthcare system. They generate revenue through service fees they charge from large customer contracts for activities such as operating mail-order pharmacies, processing prescriptions, and negotiating with drug manufacturers and pharmacies.

Technavio's analysts forecast the PBM market in the US to grow at a CAGR of 7.16% during 2014-2019.

Covered in this report

The report covers the current scenario and the growth prospects of the PBM market in the US for the period of 2015-2019. To calculate the market size, the report considers revenue generated by PBMs by offering pharmacy benefit services to end-users in the healthcare market in the US.

Technavio's report, Pharmacy Benefit Manager (PBM) Market in the US 2015-2019, has been prepared based on an in-depth market analysis with inputs from industry experts. The report covers the PBM market landscape in the US and its growth prospects in the coming years. The report also includes a discussion of the key vendors operating in this market.

Key vendors

  • Catamaran
  • CVS Health (CVS Caremark)
  • Express Scripts
  • OptumRx
  • Prime Therapeutics
Other prominent vendors
  • Aetna
  • Argus Health Systems
  • Centene
  • Cigna
  • Humana
  • Medlmpact
  • Rite Aid
Market driver
  • Increase in healthcare expenditure
  • For a full, detailed list, view our report
Market challenge
  • Criticisms of PBMs
  • For a full, detailed list, view our report
Market trend
  • Shift toward multi-tier prescription drug plans by employers
  • For a full, detailed list, view our report
Key questions answered in this report
  • What will the market size be in 2019 and what will the growth rate be?
  • What are the key market trends?
  • What is driving this market?
  • What are the challenges to market growth?
  • Who are the key vendors in this market space?
  • What are the market opportunities and threats faced by the key vendors?
  • What are the strengths and weaknesses of the key vendors?


Press Release

Technavio Announces the Publication of its Research Report – Pharmacy Benefit Manager Market in US 2015-2019
Technavio recognizes the following companies as the key players in the Pharmacy Benefit Manager Market in US: Catamaran, CVS Health, Express Scripts, OptumRX and Prime Therapeutics
Other Prominent Vendors in the market are: Aetna, Argus Health, Centene, Cigna, Humana, MedImpact, and Rite Aid.
Commenting on the report, an analyst from Technavio’s team said: “The market is dominated by five companies that hold more than 80% of market shares. M&A are to increase the market penetration of the acquirer or to enhance the product portfolio of the parent company, and to add to the revenue. Increasing pharmaceutical sales have led to the growth of the PBM market. Many vendors are likely to acquire small and domestic suppliers during the forecast period to increase their market shares, enhance their distribution channels, and improve their market reach.”
According to the report, the availability of healthcare provisions and advances in technology in the healthcare industry are leading to a reduction in the mortality rate in the US. According to the US population census, more than 40 million Americans were aged above 65 years in 2014. This population requires treatment for chronic and generic diseases, and the cost of treatment tends to increase with age. For instance, the cost of treatment for people suffering from diseases like Alzheimer's (mostly seen in people aged above 65 years) is high. Despite the high insurance costs, people in this age group tend to buy more pharmacy benefit plans. This will help the market grow during the forecast period.
Further, the report states that healthcare service providers in the US are subject to many federal laws governing their businesses such as the False Claim Act, the Anti-Kickback Act, and the Federal Trade Commission Act. However, there is no federal law or agency regulating the PBM market. The existing regulations in the various states in the US vary as per PBM activities. As of 2013, 21 US states regulated the PBM market and have passed regulations to benefit plan sponsors without any fiduciary duties.

Companies Mentioned

Catamaran, CVS Health, Express Scripts, OptumRX, Prime Therapeutics, Aetna, Argus Health, Centene, Cigna, Humana, MedImpact, Rite Aid.

  • Executive summary
    • Highlights
  • Scope of the report
    • Market overview
    • Top-vendor offerings
      • Table Product offerings
  • Market research methodology
    • Research methodology
    • Economic indicators
  • Introduction
    • Key market highlights
  • US: Economic profile
    • Table US GDP 2009-2014 ($ trillions)
    • Table US GDP per capita 2009-2014 ($ thousands)
    • Table US population 2009-2014 (millions)
    • Table US population by age group 2014
  • Global pharmaceuticals market
    • Global pharmaceuticals market
      • Table Global pharmaceuticals market 2014-2019 ($ trillions)
      • Table Global pharmaceuticals market by geography 2014
    • US pharmaceuticals market
      • Table Pharmaceuticals market in US 2006-2013 ($ billions)
      • Table Pharmaceuticals market in US 2014-2019 ($ billions)
      • Table US drug approvals: Specialty versus traditional drugs 2006-2014
      • Table US prescription drug spending 2014-2019 ($ billions)
      • Table Per capita pharmaceutical spending: US versus other countries 2014 and 2019 ($)
  • PBM: An overview
    • Table PBMs: Areas of expertise
    • Table Key activities of PBMs
  • PBM market in US
    • Market overview
    • Market size and forecast
      • Table PBM market in US 2014-2019 ($ billions)
      • Table Growth of insurance in US 2014-2019 (millions of lives)
      • Table Growth in PBM-managed lives in US 2012-2019 (millions of lives)
    • PBM market in US by Medicare members
      • Table PBM-managed lives under Medicare 2014-2019 (millions of lives)
      • Table Medicare members in US by PBM 2014
    • PBM market in US by managed Medicaid members
      • Table PBM-managed lives under managed Medicaid program 2014-2019 (millions of lives)
      • Table Managed Medicaid members in US by PBM 2014
    • Five forces analysis
      • Table Five forces analysis
  • Market drivers
    • Table Aging population in US 2010-2050
    • Table Decrease in mortality rate in US 2011-2012 (deaths per 100,000 in standard population)
  • Impact of drivers
    • Table Impact of drivers
  • Market challenges
    • Table Rise of private exchange contribution plans in US: 2010 versus 2014 (millions of lives)
    • Table US states with PBM regulations 2013
  • Impact of drivers and challenges
    • Table Impact of drivers and challenges
  • Market trends
    • Table Specialty drugs market in US 2014-2019 ($ billions)
    • Table M&A in PBM market in US
  • Vendor landscape
    • Competitive scenario
    • Market share analysis 2014
      • Table PBM market in US: Vendor segmentation by revenue 2014
      • Table PBM market in US: Vendor segmentation by equivalent prescription 2014
      • Table PBM market in US: Vendor segmentation by PBM lives 2014
    • Other prominent vendors
  • Key vendor analysis
    • Catamaran
      • Table Business segmentation of Catamaran
      • Table Catamaran: Business segmentation by revenue 2013 and 2014 ($ billions)
      • Table Catamaran: Geographical segmentation by revenue 2014
    • CVS Health
      • Table CVS Health: Business segmentation by revenue 2014
    • Express Scripts
      • Table Express Scripts: Business segmentation by revenue 2014
      • Table Express Scripts: Business segmentation by revenue 2013 and 2014 ($ billions)
    • OptumRx
      • Table OptumRx: Service segmentation
    • Prime Therapeutics
      • Table Prime Therapeutics: Business segmentation
  • Other prominent vendors
    • Aetna
    • Argus Health Systems
    • Centene
    • Cigna
    • Humana
    • MedImpact
    • Rite Aid
  • Appendix
    • List of abbreviations
  • Explore Technavio

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