Pharmacy Benefit Manager (PBM) Market in the US 2015-2019
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.
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.
Catamaran, CVS Health, Express Scripts, OptumRX, Prime Therapeutics, Aetna, Argus Health, Centene, Cigna, Humana, MedImpact, Rite Aid.
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