US Pharmacy Benefit Management (PBM) Industry Report: 2014 Edition
In the US, Pharmacy Benefit Management (PBM) deals with the management of prescription drug programs. It acts as an intermediary between health plans, drug companies, retail pharmacies and patients. Initially, PBMs used to process pharmaceutical claims for health plans. But nowadays in addition to this, PBMs have created more significant ‘pharmacy benefit’ by providing a system for reimbursement of drug claims, processing and cost control. The US prescription volume and pharmaceutical sales has witnessed an exceptional growth over the past few years and the same pattern is likely to continue in the near future. Therefore, through rebates from pharmaceutical manufacturers, price discounts from retails, and effective mail service pharmacies, the PBMs emphasis on enabling the plan sponsors and individuals to obtain prescribed drugs at lower prices.
The PBM providers control drug spending and utilization by virtue of their advanced tools and techniques, encouraging use of generics and other lower-cost medications. In the US, there are some independent PBM’s while some are owned by managed care organizations and retail pharmacies. Today, the PBM industry has become more determined through a series of mergers and acquisitions.
Some of the factors driving the growth of the PBM industry are: accelerating US aging population, increasing life expectancy rate and incidences of chronic and infectious diseases which further increase the healthcare expenditure and pharmaceutical sales in the US. The ongoing trends and development in the PBM industry include rising medicare enrollments and increased acceptance of specialty drugs.
This report assesses the US PBM industry in terms of both market volume and market value. The increasing competition in the PBM industry has been analyzed on number of factors: revenue, dispensing specialty pharmaceuticals, claims and PDP lives. The top three companies having a vicious competition with each other and dominating the PBM industry are- Express Script, CVS Health and Catamaran. These players are being profiled in the report along with their key financials and strategies for growth.