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The US Pharmacy Benefit Management (PBM) Market: Industry Analysis & Outlook (2016-2020)

The US Pharmacy Benefit Management (PBM) Market: Industry Analysis & Outlook (2016-2020)

A pharmacy benefit manager (PBM) is a third-party administrator (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, and federal employee’s health benefits program in the US. Pharmacy benefit managers act as an intermediary between the payer and everyone else in the healthcare system. The healthcare system is very complex with many components working together to meet health needs. The pharmaceutical industry is growing rapidly owing to an increase in population and number of diseases. PBMs bring value through lower drug costs for insurers by negotiating with pharmacies and drug manufacturers.

The competition in the PBM market is quite concentrated with major market share divided between top three companies. The competition is expected to become severe in the future due to the emerging popularity of generics and biologics. The industry is also witnessing a lot of merger and acquisitions eyeing the growth in the market.

The key factors driving the growth of the US PBM market are increase in ageing population, increase in healthcare expenditure, improving economic conditions, increase in Life expectancy rate and rising use of drugs. Some of the noteworthy trends and developments of this industry are increasing trend towards consumerism, increasing trend of specialty drugs, increase in the medical enrollments, rising prevalence of narrow network, growth in retail prescriptions, mail order penetration and claims, increasing mix of insured individuals and drug prices trend. However, the expansion of the US PBM market is hindered by high cost of drugs, reimbursement rate pressure and legal regulations.

The report “The US Pharmacy Benefit Management (PBM) Market: Industry Analysis & Outlook (2016-2020)” provides an in-depth analysis of the market. The major trends, growth drivers as well as issues being faced by the industry are being presented in this report. The industry comprises large players such as CVS, Express Scripts, Optum Rx Humana. All these companies have been profiled in the present report highlighting their key financials and business strategies for growth.


1. PBM Overview
1.1 An Introduction
1.2 Types of PBM Services
Table 1: PBM Services Types
1.3 PBM Managers Formulary Structure
Table 2: PBM Managers Formulary Structure
1.4 PBM Timeline
Table 3: History of PBM
1.5 Retail Dispensing Process & Flow of Funds
Table 4: Retail Dispensing Process and Flow of Funds
1.6 Mail Dispensing Process & Flow of Funds
Table 5: Mail Dispensing Process and Flow of Funds
2. Global Pharmaceutical Market Analysis
2.1 Global Pharmaceutical Market by Value
Table 6: Global Pharmaceutical Market by Value (2010-2015)
2.2 Global Pharmaceutical Market Forecast by Value
Table 7: Global Pharmaceutical Market Forecast by Value (2016-2020)
2.3 Global Pharmaceutical Market Share by Region
Table 8: Global Pharmaceutical Market Share by Region (2015)
3. The US Pharmaceutical Market Analysis
3.1 The US Pharmaceutical Market
3.1.1 The US Pharmaceutical Market by Value
Table 9: The US Pharmaceutical Market by Value (2010-2015)
3.1.2 The US Pharmaceutical Market Forecast by Value
Table 10: The US Pharmaceutical Market Forecast by Value (2016-2020)
3.1.3 The US Annual Pharmaceutical Market Sales by Dispensing Channel
Table A: The US Annual Pharmaceutical Market Sales by Dispensing Channel (2011-2015)
3.1.4 The US Pharmaceutical Market by Segments
Table 11: The US Pharmaceutical Market by Segments (2015)
3.1.5 The US Pharmaceutical Market Channel Type by Value
Table 12: The US Pharmaceutical Market Channel Type by Value (2015)
3.1.6 The US Pharmaceutical Market Types by Value
Table 13: The US Pharmaceutical Market Types by Value (2015/2018)
3.1.7 The US Pharmaceutical Market Share by Types
Table 14: The US Pharmaceutical Market Share by Type (2015)
Table 15: The US Pharmaceutical Market Share Forecast by Type (2018)
3.2 The US Prescription (Rx) Market
3.2.1 The US Prescription Market by Volume
Table 16: The US Prescription Market by Volume (2009-2015)
3.2.2 The US Prescription Market Forecast by Volume
Table 17: The US Prescription Market Forecast by Volume (2016-2020)
3.2.3 The US Prescription Market Volume by Category
Table 18: The US Prescription Market Volume by Category (2011-2015)
3.2.4 The US Prescription Market Volume Forecast by Category
Table 19: The US Prescription Market Volume Forecast by Category (2016-2020)
3.2.5 The US Prescription Market Share by Channel Type
Table 20: The US Prescription Market Share by Channel Type (2015)
3.2.6 The US Pharmaceutical Market Quarterly Prescriptions
Table 21: The US Pharmaceutical Market Quarterly Prescriptions (June 2014 – March 2016)
3.2.7 The US Pharmaceutical Generic Market Quarterly Prescriptions
Table 22: The US Pharmaceutical Generic Market Quarterly Prescriptions (June 2014 – March 2016)
3.2.8 The US Pharmaceutical Branded Market Quarterly Prescriptions
Table 23: The US Pharmaceutical Branded Market Quarterly Prescriptions (June 2014 – March 2016)
3.2.9 The US Generic Market Penetration Rate
Table 24: The US Generic Market Penetration Rate (June 2014 – March 2016)
4. Market Dynamics
4.1 Growth Drivers
4.1.1 Growth in Ageing Population
Table 25: The US Ageing Population (2007-2015)
4.1.2 Increasing Healthcare Expenditure
Table 26: The US Healthcare Expenditure Per Capita (2007-2015)
4.1.3 Improving Economic Conditions
Table 27: The US GDP Growth (2008-2015)
4.1.4 Increasing Life Expectancy Rate
Table 28: The US Life Expectancy Rate (2009-2015)
4.1.5 Rising Use of Drugs
4.2 Market Trends
4.2.1 Increasing Trend towards Consumerism
Table 29: Health Plan Enrollment Distribution by Plan Type (2011-2016)
4.2.2 Growing Trend of Specialty Drugs
4.2.3 Rising Prevalence of Narrow Networks
4.2.4 Increase in the Medicare Enrollments
Table 30: Enrollments in Medicare Program by Beneficiary Type (2011-2015)
4.2.5 Drug Prices Trend
Table 31: Drug Price Index (2009-2015)
4.2.6 Growth in Retail Prescriptions
Table B: Growth in Retail Prescriptions (2011-2015)
4.2.7 Declining Claims and Mail Order Penetration
Table 32: Mail Order Penetration and Claims (2010-2018)
4.2.8 Increasing Mix of Insured Individuals
Table 33: Insured Individuals Mix (2013-2020)
4.3 Challenges
4.3.1 High Drug Prices
4.3.2 Reimbursement Rate Pressure
4.3.3 Legal Regulations
5. Competitive Landscape
5.1 The US PBM Market Share by Prescription Claim
Table 34: The US PBM Market Share by Prescription Claim (2015)
5.2 The US PBM Market Share Forecast by Prescription Claim
Table 35: The US PBM Market Share Forecast by Prescription Claim (2020)
5.3 The US PBM Market by Annual Script Volume
Table 36: The US PBM Market by Annual Script Volume (2015)
5.4 The US Specialty Pharmacy Market Share by Company
Table 37: The US Specialty Pharmacy Market Share by Company (2015)
5.5 The US PBM Drug Cost Trend by Company
Table 38: The US PBM Drug Cost Trend by Company (2015)
5.6 The US PBM Specialty Drug Cost Trend by Company
Table 39: The US PBM Specialty Drug Cost Trend by Company (2015)
6. Company Profiles
6.1 Express Scripts
6.1.1 Business Overview
Table 40: Express Script’s Revenues Share by Segment (2015)
6.1.2 Financial Overview
Table 41: Express Script's Revenue and Net Income (2011-2015)
6.1.3 Business Strategies
6.2 CVS Health
6.2.1 Business Overview
Table 42: CVS Health’s Revenues Share by Segment (2015)
6.2.2 Financial Overview
Table 43: CVS Health’s Net Revenue and Net Income (2011-2015)
6.2.3 Business Strategies
6.3 OptumRx
6.3.1 Business Overview
6.3.2 Financial Overview
Table 44: OptumRx’s Revenues and Net Income (2011-2015)
6.3.3 Business Strategies
6.4 Humana
6.4.1 Business Overview
Table 45: Humana’s Revenues Share by Segment (2015)
6.4.2 Financial Overview
Table 46: Humana’s Revenue and Net Income (2011-2015)
6.4.3 Business Strategies

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