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Emergence of Pharma-Tech Companies and Unicorns to Help Improve Revenue of Pharmacy Benefit Manager (PBM) Market in Near Future | Express Scripts Holding Company, Rite Aid, CVS Health Corporation, DST Systems, Benecard Services, BioScrip, ProCare

Emergence of Pharma-Tech Companies and Unicorns to Help Improve

A pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. According to the American Pharmacists Association, PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims. PBMs operate inside of integrated healthcare systems (e.g., Kaiser Permanente or Veterans Health Administration), as part of retail pharmacies.

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Health insurance providers often hire an outside company to handle price negotiations, insurance claims, and distribution of prescription drugs. Providers which use such pharmacy benefit managers include commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. PBMs are designed to aggregate the collective buying power of enrollees through their client health plans, enabling plan sponsors and individuals to obtain lower prices for their prescription drugs. PBMs negotiate price discounts from retail pharmacies, rebates from pharmaceutical manufacturers, and mail-service pharmacies which home-deliver prescriptions without consulting face-to-face with a pharmacist.

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Health Insurance PBM and Retail Pharmacy Segments to Experience Decent Growth

Based on type, the global pharmacy benefit manager (PBM) market can be segmented into standalone PBM, health insurance PBM, and retail pharmacy. Of these, the segment of health insurance PBM and retail pharmacy PBMs are expected to witness a highly promising rate of growth in the coming years of the forecast period. The growth of the segments is primarily attributed to the strong presence of notable and established health insurance providers and a strong network of retail pharmacies.

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In terms of applications, the global pharmacy benefit manager (PBM) market can be segmented into hospital pharmacies, retail pharmacies, and online pharmacies. Among these, the segment of online pharmacies is expected to witness a highly notable rate of growth in the coming years of the forecast period. With increasing emergence of e-pharmacies and pharma-tech companies, the online pharmacy segment of the global pharmacy benefit manager (PBM) market is expected to witness a substantial rate of growth.

Competitive Landscape Fragmentation Beneficial For Market Growth?

Pharmacy benefit management companies can make revenue in several ways. First, they collect administrative and service fees from the original insurance plan. They can also collect rebates from the manufacturer. Traditional PBMs do not disclose the negotiated net price of the prescription drugs, allowing them to resell drugs at a public list price (also known as a sticker price) which is higher than the net price they negotiate with the manufacturer. This practice is known as spread pricing. Savings are generally considered trade secrets. Pharmacies and insurance companies are often prohibited by the PBM from discussing costs and reimbursements. Some of the key players operating in the global pharmacy benefit management market include names such as Express Scripts Holding Company, Rite Aid, CVS Health Corporation, DST Systems, Benecard Services, BioScrip, ProCare, CaptureRx, Change Healthcare, and UnitedHealth Group among others.

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