Summary

Pharmacy Benefit Management Market
The pharmacy benefit management market was valued at $0.5 billion in 2023 and is projected to reach $1.0 billion by 2033, growing at a CAGR of 6.1% from 2024 to 2033.
Pharmacy benefit management (PBM) is a third-party administrator that plays a crucial role in the healthcare system as it acts as an intermediary between drug manufacturers, pharmacies, and health insurance companies. The role of PBM is to regulate prescription drug benefits for patients to control the surging medication costs, while ensuring access to essential treatments.

Rise in healthcare expenses is a key driver of the pharmacy benefit management market as PBMs effectively control the expenditure on drugs by the implementation of strategies such as formulary management and negotiating rebates. Furthermore, the ability of PBMs to ensure transparency in healthcare costs augments the development of the market significantly. To accelerate decision-making, the usage of data analytics tools is trending in the market. These tools use advanced analytics techniques for cost optimization, pattern identification in prescription drug usage, and favorable pricing negotiation with pharmaceutical manufacturers.

However, concerns pertaining to privacy of the personal health information of patients deter several individuals from availing services of PBMs, hampering the development of the market. Furthermore, as the pharmacy benefit management market is highly concentrated, the dominating companies hold maximum power to gain excessive total compensation from their customers. This power restrains the growth of the market. For instance, three firms controlled 79% of the U.S. market in 2022, offering them the authority to earn excessive profits. Contrarily, the integration of PBM services with telemedicine and digital health solutions is poised to present lucrative opportunities for the market expansion.

Segment Review
The pharmacy benefit management market is segmented into service, business model, end user, and region. On the basis of service, the market is divided into specialty pharmacy, drug formulatory management, benefit plan design & consultation, and other services. Depending on business model, it is classified into government health programs, employer-sponsored programs, and health insurance management. As per end user, it is categorized into pharmacy benefit management organization, mail order pharmacies, retail pharmacies, and other. Region wise, it is analyzed across North America, Europe, Asia-Pacific, and LAMEA.
Key Findings
On the basis of service, the specialty pharmacy segment is expected to dominate the market throughout the forecast period.
Depending on business model, the health insurance management segment is projected to acquire a high stake in the market by 2033.
As per end user, the pharmacy benefit management organization segment is predicted to be the highest shareholder during the forecast period.
Region wise, North America is anticipated to be the highest revenue generator by 2033.
Competition Analysis
The leading players operating in the global pharmacy benefit management market include CVS Health, The Cigna Group, OptumRx Inc., Anthem Inc, Centene Corporation, Abarca Health LLC, Medimpact, Elixir Rx Solutions LLC, Express Scripts Holding Company, and SS&C Technologies, Inc. These major players have adopted various key development strategies such as business expansion, new product launches, and partnerships to strengthen their foothold in the competitive market.

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Key Market Segments
By Service
● Specialty Pharmacy
● Drug Formulatory Management
● Benefit Plan Design and Consultation
● Other Services
By Business Model
● Government Health Programs
● Employer-Sponsored Programs
● Health Insurance Management
By End User
● Pharmacy Benefit Management Organization
● Mail Order Pharmacies
● Retail Pharmacies
● Other
By Region
● North America
○ U.S.
○ Canada
○ Mexico
● Europe
○ Germany
○ France
○ UK
○ Italy
○ Spain
○ Rest of Europe
● Asia-Pacific
○ Japan
○ China
○ Australia
○ India
○ South Korea
○ Rest of Asia-Pacific
● LAMEA
○ Brazil
○ Saudi Arabia
○ South Africa
○ Rest of LAMEA
● Key Market Players
○ CVS Health
○ The Cigna Group
○ OptumRx Inc
○ Anthem Inc
○ Centene Corporation
○ Abarca Health LLC
○ Medimpact
○ Elixir Rx Solutions LLC
○ Express Scripts Holding Company
○ SS&C Technologies, Inc

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Table of Contents

CHAPTER 1: INTRODUCTION
1.1. Report Description
1.2. Key Market Segments
1.3. Key Benefits
1.4. Research Methodology
1.4.1. Primary Research
1.4.2. Secondary Research
1.4.3. Analyst Tools and Models
CHAPTER 2: EXECUTIVE SUMMARY
2.1. CXO Perspective
CHAPTER 3: MARKET LANDSCAPE
3.1. Market Definition and Scope
3.2. Key Findings
3.2.1. Top Investment Pockets
3.2.2. Top Winning Strategies
3.3. Porter's Five Forces Analysis
3.3.1. Bargaining Power of Suppliers
3.3.2. Threat of New Entrants
3.3.3. Threat of Substitutes
3.3.4. Competitive Rivalry
3.3.5. Bargaining Power among Buyers
3.4. Market Dynamics
3.4.1. Drivers
3.4.2. Restraints
3.4.3. Opportunities
CHAPTER 4: PHARMACY BENEFIT MANAGEMENT MARKET, BY SERVICE
4.1. Market Overview
4.1.1 Market Size and Forecast, By Service
4.2. Specialty Pharmacy
4.2.1. Key Market Trends, Growth Factors and Opportunities
4.2.2. Market Size and Forecast, By Region
4.2.3. Market Share Analysis, By Country
4.3. Drug Formulatory Management
4.3.1. Key Market Trends, Growth Factors and Opportunities
4.3.2. Market Size and Forecast, By Region
4.3.3. Market Share Analysis, By Country
4.4. Benefit Plan Design And Consultation
4.4.1. Key Market Trends, Growth Factors and Opportunities
4.4.2. Market Size and Forecast, By Region
4.4.3. Market Share Analysis, By Country
4.5. Other Services
4.5.1. Key Market Trends, Growth Factors and Opportunities
4.5.2. Market Size and Forecast, By Region
4.5.3. Market Share Analysis, By Country
CHAPTER 5: PHARMACY BENEFIT MANAGEMENT MARKET, BY BUSINESS MODEL
5.1. Market Overview
5.1.1 Market Size and Forecast, By Business Model
5.2. Government Health Programs
5.2.1. Key Market Trends, Growth Factors and Opportunities
5.2.2. Market Size and Forecast, By Region
5.2.3. Market Share Analysis, By Country
5.3. Employer-Sponsored Programs
5.3.1. Key Market Trends, Growth Factors and Opportunities
5.3.2. Market Size and Forecast, By Region
5.3.3. Market Share Analysis, By Country
5.4. Health Insurance Management
5.4.1. Key Market Trends, Growth Factors and Opportunities
5.4.2. Market Size and Forecast, By Region
5.4.3. Market Share Analysis, By Country
CHAPTER 6: PHARMACY BENEFIT MANAGEMENT MARKET, BY END USER
6.1. Market Overview
6.1.1 Market Size and Forecast, By End User
6.2. Pharmacy Benefit Management Organization
6.2.1. Key Market Trends, Growth Factors and Opportunities
6.2.2. Market Size and Forecast, By Region
6.2.3. Market Share Analysis, By Country
6.3. Mail Order Pharmacies
6.3.1. Key Market Trends, Growth Factors and Opportunities
6.3.2. Market Size and Forecast, By Region
6.3.3. Market Share Analysis, By Country
6.4. Retail Pharmacies
6.4.1. Key Market Trends, Growth Factors and Opportunities
6.4.2. Market Size and Forecast, By Region
6.4.3. Market Share Analysis, By Country
6.5. Other
6.5.1. Key Market Trends, Growth Factors and Opportunities
6.5.2. Market Size and Forecast, By Region
6.5.3. Market Share Analysis, By Country
CHAPTER 7: PHARMACY BENEFIT MANAGEMENT MARKET, BY REGION
7.1. Market Overview
7.1.1 Market Size and Forecast, By Region
7.2. North America
7.2.1. Key Market Trends and Opportunities
7.2.2. Market Size and Forecast, By Service
7.2.3. Market Size and Forecast, By Business Model
7.2.4. Market Size and Forecast, By End User
7.2.5. Market Size and Forecast, By Country
7.2.6. U.S. Pharmacy Benefit Management Market
7.2.6.1. Market Size and Forecast, By Service
7.2.6.2. Market Size and Forecast, By Business Model
7.2.6.3. Market Size and Forecast, By End User
7.2.7. Canada Pharmacy Benefit Management Market
7.2.7.1. Market Size and Forecast, By Service
7.2.7.2. Market Size and Forecast, By Business Model
7.2.7.3. Market Size and Forecast, By End User
7.2.8. Mexico Pharmacy Benefit Management Market
7.2.8.1. Market Size and Forecast, By Service
7.2.8.2. Market Size and Forecast, By Business Model
7.2.8.3. Market Size and Forecast, By End User
7.3. Europe
7.3.1. Key Market Trends and Opportunities
7.3.2. Market Size and Forecast, By Service
7.3.3. Market Size and Forecast, By Business Model
7.3.4. Market Size and Forecast, By End User
7.3.5. Market Size and Forecast, By Country
7.3.6. Germany Pharmacy Benefit Management Market
7.3.6.1. Market Size and Forecast, By Service
7.3.6.2. Market Size and Forecast, By Business Model
7.3.6.3. Market Size and Forecast, By End User
7.3.7. France Pharmacy Benefit Management Market
7.3.7.1. Market Size and Forecast, By Service
7.3.7.2. Market Size and Forecast, By Business Model
7.3.7.3. Market Size and Forecast, By End User
7.3.8. UK Pharmacy Benefit Management Market
7.3.8.1. Market Size and Forecast, By Service
7.3.8.2. Market Size and Forecast, By Business Model
7.3.8.3. Market Size and Forecast, By End User
7.3.9. Italy Pharmacy Benefit Management Market
7.3.9.1. Market Size and Forecast, By Service
7.3.9.2. Market Size and Forecast, By Business Model
7.3.9.3. Market Size and Forecast, By End User
7.3.10. Spain Pharmacy Benefit Management Market
7.3.10.1. Market Size and Forecast, By Service
7.3.10.2. Market Size and Forecast, By Business Model
7.3.10.3. Market Size and Forecast, By End User
7.3.11. Rest Of Europe Pharmacy Benefit Management Market
7.3.11.1. Market Size and Forecast, By Service
7.3.11.2. Market Size and Forecast, By Business Model
7.3.11.3. Market Size and Forecast, By End User
7.4. Asia-Pacific
7.4.1. Key Market Trends and Opportunities
7.4.2. Market Size and Forecast, By Service
7.4.3. Market Size and Forecast, By Business Model
7.4.4. Market Size and Forecast, By End User
7.4.5. Market Size and Forecast, By Country
7.4.6. Japan Pharmacy Benefit Management Market
7.4.6.1. Market Size and Forecast, By Service
7.4.6.2. Market Size and Forecast, By Business Model
7.4.6.3. Market Size and Forecast, By End User
7.4.7. China Pharmacy Benefit Management Market
7.4.7.1. Market Size and Forecast, By Service
7.4.7.2. Market Size and Forecast, By Business Model
7.4.7.3. Market Size and Forecast, By End User
7.4.8. Australia Pharmacy Benefit Management Market
7.4.8.1. Market Size and Forecast, By Service
7.4.8.2. Market Size and Forecast, By Business Model
7.4.8.3. Market Size and Forecast, By End User
7.4.9. India Pharmacy Benefit Management Market
7.4.9.1. Market Size and Forecast, By Service
7.4.9.2. Market Size and Forecast, By Business Model
7.4.9.3. Market Size and Forecast, By End User
7.4.10. South Korea Pharmacy Benefit Management Market
7.4.10.1. Market Size and Forecast, By Service
7.4.10.2. Market Size and Forecast, By Business Model
7.4.10.3. Market Size and Forecast, By End User
7.4.11. Rest of Asia-Pacific Pharmacy Benefit Management Market
7.4.11.1. Market Size and Forecast, By Service
7.4.11.2. Market Size and Forecast, By Business Model
7.4.11.3. Market Size and Forecast, By End User
7.5. LAMEA
7.5.1. Key Market Trends and Opportunities
7.5.2. Market Size and Forecast, By Service
7.5.3. Market Size and Forecast, By Business Model
7.5.4. Market Size and Forecast, By End User
7.5.5. Market Size and Forecast, By Country
7.5.6. Brazil Pharmacy Benefit Management Market
7.5.6.1. Market Size and Forecast, By Service
7.5.6.2. Market Size and Forecast, By Business Model
7.5.6.3. Market Size and Forecast, By End User
7.5.7. Saudi Arabia Pharmacy Benefit Management Market
7.5.7.1. Market Size and Forecast, By Service
7.5.7.2. Market Size and Forecast, By Business Model
7.5.7.3. Market Size and Forecast, By End User
7.5.8. South Africa Pharmacy Benefit Management Market
7.5.8.1. Market Size and Forecast, By Service
7.5.8.2. Market Size and Forecast, By Business Model
7.5.8.3. Market Size and Forecast, By End User
7.5.9. Rest of LAMEA Pharmacy Benefit Management Market
7.5.9.1. Market Size and Forecast, By Service
7.5.9.2. Market Size and Forecast, By Business Model
7.5.9.3. Market Size and Forecast, By End User
CHAPTER 8: COMPETITIVE LANDSCAPE
8.1. Introduction
8.2. Top Winning Strategies
8.3. Product Mapping Of Top 10 Player
8.4. Competitive Dashboard
8.5. Competitive Heatmap
8.6. Top Player Positioning, 2023
CHAPTER 9: COMPANY PROFILES
9.1. CVS Health
9.1.1. Company Overview
9.1.2. Key Executives
9.1.3. Company Snapshot
9.1.4. Operating Business Segments
9.1.5. Product Portfolio
9.1.6. Business Performance
9.1.7. Key Strategic Moves and Developments
9.2. The Cigna Group
9.2.1. Company Overview
9.2.2. Key Executives
9.2.3. Company Snapshot
9.2.4. Operating Business Segments
9.2.5. Product Portfolio
9.2.6. Business Performance
9.2.7. Key Strategic Moves and Developments
9.3. OptumRx Inc
9.3.1. Company Overview
9.3.2. Key Executives
9.3.3. Company Snapshot
9.3.4. Operating Business Segments
9.3.5. Product Portfolio
9.3.6. Business Performance
9.3.7. Key Strategic Moves and Developments
9.4. Anthem Inc
9.4.1. Company Overview
9.4.2. Key Executives
9.4.3. Company Snapshot
9.4.4. Operating Business Segments
9.4.5. Product Portfolio
9.4.6. Business Performance
9.4.7. Key Strategic Moves and Developments
9.5. Centene Corporation
9.5.1. Company Overview
9.5.2. Key Executives
9.5.3. Company Snapshot
9.5.4. Operating Business Segments
9.5.5. Product Portfolio
9.5.6. Business Performance
9.5.7. Key Strategic Moves and Developments
9.6. Abarca Health LLC
9.6.1. Company Overview
9.6.2. Key Executives
9.6.3. Company Snapshot
9.6.4. Operating Business Segments
9.6.5. Product Portfolio
9.6.6. Business Performance
9.6.7. Key Strategic Moves and Developments
9.7. Medimpact
9.7.1. Company Overview
9.7.2. Key Executives
9.7.3. Company Snapshot
9.7.4. Operating Business Segments
9.7.5. Product Portfolio
9.7.6. Business Performance
9.7.7. Key Strategic Moves and Developments
9.8. Elixir Rx Solutions LLC
9.8.1. Company Overview
9.8.2. Key Executives
9.8.3. Company Snapshot
9.8.4. Operating Business Segments
9.8.5. Product Portfolio
9.8.6. Business Performance
9.8.7. Key Strategic Moves and Developments
9.9. Express Scripts Holding Company
9.9.1. Company Overview
9.9.2. Key Executives
9.9.3. Company Snapshot
9.9.4. Operating Business Segments
9.9.5. Product Portfolio
9.9.6. Business Performance
9.9.7. Key Strategic Moves and Developments
9.10. SSAndC Technologies, Inc
9.10.1. Company Overview
9.10.2. Key Executives
9.10.3. Company Snapshot
9.10.4. Operating Business Segments
9.10.5. Product Portfolio
9.10.6. Business Performance
9.10.7. Key Strategic Moves and Developments