Pharmacy Benefit Management Market – Global Industry Analysis 2024

Pharmaceutical drug prices continue soaring up and have become a significant percentage of the total healthcare expenditure. The cost of drugs has risen more than any of the health care expenditure. As per the insurance consultants at Milliman, drug costs are merely 16% of the overall health costs, however rose by 102% over a decade and nearly 14% in 2015. Rising drug prices, increasing consumer spending on prescription drugs drives the demand for pharmacy benefit managers (PBMs). The pharmacy benefit management system is operated by third party administrators (TPAs) who act as a liaison between pharmacists, insurance providers (payors) and drug manufacturers. There are established companies offering these services who aid in reducing the drug prices by negotiating with the retail pharmacies and drug manufactures. Patients who have enrolled to various health plans and those uninsured can get the benefits of pharmacy benefit management system. Health plans collaborate with the pharmacy benefit managers to offer medications at a lower price than available at the retail pharmacy.

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Moreover, PBMs also aid in planning and managing the formulary as per the customer need, negotiating discounts and rebates with drug manufacturers, contracting with pharmacies, and processing the prescription claims. To manage the cost of prescription drugs and improve the customer value, PBMs use various tools such as pharmacy networks, mail-service pharmacies, drug formulary, e-prescribing, manufacturer’s discount, disease management, drug utilization review, and pharmacy discount cards (for the uninsured). To manage these tools and the PBMs account, there are various prescription claim software/systems marketed globally.

The global pharmacy benefit managers market can be analyzed based on the beneficiaries of these services i.e. the healthcare providers, employers, and drug manufacturers. A major population in the U.S. gets their health benefits from their employers. Therefore, employers are also seeking for reducing their costs and opt for pharmacy benefit management services. The providers of pharmacy benefit management services also manage the prescription drug claims i.e. acting as a link between the payers and health insurers.

Industry is Highly Concentrated in Developed Markets

The global pharmacy benefit management market is analyzed in four major regions - North America, Europe, Asia Pacific, Latin America and Rest of the World. Presence of PBM si concentrated in the developed markets of North America and Europe. Increase in the subscribers of Medicare prescription drug program will fuel the demand for PBMs in the U.S. Besides, the pharmacy benefit managers also aid in deciding whether a generic or branded product would benefit the patient. About 40 blockbuster brands worth USD 155 billion will feel the heat of patent expiry by 2020. Generics have a good profit margin which can benefit the pharmacy benefit managers/management companies. Similar market scenario is observed in the European region.

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Challenges faced in the PBM Market

With the introduction of expensive treatments/drugs for chronic diseases such as cancer, and hepatitis, the demand for PBMs will rise significantly. However, even with the presence of many big players in this industry, the PBMs have been ineffective in curbing the drug price hike. Further, with the advent of Affordable Care Act and the constant endeavor of the government to reduce and cap the drug prices, profitability of this industry will be significantly impacted.

Some of the major players present in the global pharmacy benefit management market include Express Scripts, CVS Caremark, Prime Therapeutics, United Health / OptumRx, Catamaran Corporation, Humana Pharmacy Solutions and MedImpact. Express Scripts acquired Medco Health Solutions for USD 29.1 billion in April 2012, making it a leader with a significant share in the global pharmacy benefit management market. With increasing competition, more of industry consolidation is anticipated in future.

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