Summary

The Pharmacy Benefit Manager (PBM) Market is poised to expand at a CAGR of 6.8% from 2024 to 2031, climbing from its current valuation of USD 630.54 billion to exceed a trillion dollars by the end of the forecast period. This growth is driven by increasing prescription drug prices, the adoption of advanced technologies, and a rising focus on reducing global healthcare costs.

The pharmacy benefit manager market is experiencing substantial growth due to rising healthcare expenditures and the increasing prevalence of chronic diseases. The United States dominates the market with a 66.5% share, supported by its advanced healthcare infrastructure and widespread health insurance adoption. Meanwhile, the retail pharmacy services segment represents 27.6% of the global market, bolstered by the growing popularity of online and offline retail pharmacy channels.

Key Drivers of Growth

1.Soaring Drug Prices:

oThe rising prevalence of chronic diseases has driven demand for branded medicines, increasing pharmaceutical spending globally.

oIn the United States, prescription drug prices rose by 4% in 2021, while individual medicine prices increased by 5% (Source: SingleCare Administrators).

2.Surge in Prescription Volume:

oApproximately 4 billion prescriptions are issued annually in the U.S., with further growth expected (SingleCare Administrators, 2022).

3.Technological Advancements:

oCompanies like CAPITAL RX utilize AI and ML to enhance claim processing, improve supply chain efficiency, and minimize operational errors, enabling PBMs to deliver cost-effective and efficient services.

4.Impact of COVID-19:

oThe pandemic significantly increased demand for PBM services due to higher healthcare spending on specialty drugs and vaccines.

oExample: U.S. healthcare expenditure reached USD 4 trillion in 2020, reflecting a 9.6% increase from the prior year.

Emerging Opportunities

The integration of AI and ML into PBM workflows is unlocking new growth avenues. These technologies enable:

•Optimized supply chain operations.

•Faster mail-order delivery services.

•Reduced healthcare costs alongside improved operational efficiency.

Such innovations are anticipated to accelerate market growth, creating opportunities for industry leaders.

Regional Insights

1.United States:

oWith over 50% of its population managing chronic conditions, the U.S. remains the leader in the pharmacy benefit manager market.

oExtensive health insurance adoption and favorable reimbursement policies bolster market growth.

oExample: U.S. healthcare spending grew by 9.8% in 2020 (Centers for Medicare and Medicaid Services).

2.Developing Nations:

oPoor literacy rates and limited awareness of health insurance policies hinder market penetration in these regions.

oEfforts to enhance healthcare education and infrastructure could drive future growth.

Challenges Impacting Growth

1.Transparency Issues:

oA lack of clarity in PBM revenue models raises costs for drug manufacturers and insurers.

oExample: Over 50% of spending on branded pharmaceuticals benefits the supply chain, including PBMs, rather than manufacturers (Berkeley Research Group, 2022).

2.Limited Adoption in Emerging Markets:

oLimited awareness of health insurance and inadequate access to healthcare restrict PBM adoption in underdeveloped areas.

Category Analysis

•Retail Pharmacy Services:

oGrowth is driven by the increasing popularity of online pharmacies, supported by greater internet penetration and smartphone use.

oThese platforms offer convenience, discounts, and quick delivery, making them a favored choice among consumers.

•Specialty Pharmacy Services:

oThe prevalence of chronic conditions requiring specialized medications is propelling growth in this segment.

Competitive Analysis

Leading PBM market players are prioritizing innovation, acquisitions, and collaborations to enhance their global presence. Prominent companies include:

•Express Scripts Holding Company

•CVS Health Corporation

•DST Systems, Inc.

•Rite Aid Corp.

•UnitedHealth Group

•Change Healthcare

•Benecard Services, LLC

•BioScrip, Inc.

These companies are leveraging advanced technologies and broadening their service portfolios to meet the rising demand for cost-effective healthcare solutions.

Pharmacy Benefit Manager Market Segmentation

By Service:

•Retail Pharmacy Services

•Specialty Pharmacy Services

•Benefit Plan Design and Consultation

•Drug Formulary Management

•Other Services

By Demand Determinant:

•Government Health Programs

•Employer-Sponsored Programs

•Health Insurance Companies

•Other Programs

By Region:

•North America

•Latin America

•Europe

•South Asia

•East Asia

•Oceania

•Middle East & Africa

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Table of Contents

1. Executive Summary
1.1. Global Pharmacy Benefit Manager Market Snapshot
1.2. Future Projections
1.3. Key Market Trends
1.4. Regional Snapshot, by Value, 2024
1.5. Analyst Recommendations
2. Market Overview
2.1. Market Definitions and Segmentations
2.2. Market Dynamics
2.2.1. Drivers
2.2.2. Restraints
2.2.3. Market Opportunities
2.3. Value Chain Analysis
2.4. Porter’s Five Forces Analysis
2.5. COVID-19 Impact Analysis
2.5.1. Supply
2.5.2. Demand
2.6. Impact of Ukraine-Russia Conflict
2.7. Economic Overview
2.7.1. World Economic Projections
2.8. PESTLE Analysis
3. Global Pharmacy Benefit Manager Market Outlook, 2019-2031
3.1. Global Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
3.1.1. Key Highlights
3.1.1.1. Retail Pharmacy Services
3.1.1.2. Specialty Pharmacy Services
3.1.1.3. Benefit Plan Design and Consultation
3.1.1.4. Drug Formulary Management
3.1.1.5. Other
3.2. Global Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
3.2.1. Key Highlights
3.2.1.1. Government Health Programs
3.2.1.2. Employer-Sponsored Programs
3.2.1.3. Health Insurance Companies
3.2.1.4. Other Programs
3.3. Global Pharmacy Benefit Manager Market Outlook, by Region, Value (US$ Bn), 2019-2031
3.3.1. Key Highlights
3.3.1.1. North America
3.3.1.2. Europe
3.3.1.3. Asia Pacific
3.3.1.4. Latin America
3.3.1.5. Middle East & Africa
4. North America Pharmacy Benefit Manager Market Outlook, 2019-2031
4.1. North America Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
4.1.1. Key Highlights
4.1.1.1. Retail Pharmacy Services
4.1.1.2. Specialty Pharmacy Services
4.1.1.3. Benefit Plan Design and Consultation
4.1.1.4. Drug Formulary Management
4.1.1.5. Other
4.2. North America Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
4.2.1. Key Highlights
4.2.1.1. Government Health Programs
4.2.1.2. Employer-Sponsored Programs
4.2.1.3. Health Insurance Companies
4.2.1.4. Other Programs
4.2.2. BPS Analysis/Market Attractiveness Analysis
4.3. North America Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
4.3.1. Key Highlights
4.3.1.1. U.S. Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
4.3.1.2. U.S. Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
4.3.1.3. Canada Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
4.3.1.4. Canada Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
4.3.2. BPS Analysis/Market Attractiveness Analysis
5. Europe Pharmacy Benefit Manager Market Outlook, 2019-2031
5.1. Europe Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
5.1.1. Key Highlights
5.1.1.1. Retail Pharmacy Services
5.1.1.2. Specialty Pharmacy Services
5.1.1.3. Benefit Plan Design and Consultation
5.1.1.4. Drug Formulary Management
5.1.1.5. Other
5.2. Europe Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
5.2.1. Key Highlights
5.2.1.1. Government Health Programs
5.2.1.2. Employer-Sponsored Programs
5.2.1.3. Health Insurance Companies
5.2.1.4. Other Programs
5.2.2. BPS Analysis/Market Attractiveness Analysis
5.3. Europe Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
5.3.1. Key Highlights
5.3.1.1. Germany Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
5.3.1.2. Germany Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
5.3.1.3. U.K. Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
5.3.1.4. U.K. Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
5.3.1.5. France Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
5.3.1.6. France Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
5.3.1.7. Italy Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
5.3.1.8. Italy Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
5.3.1.9. Turkey Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
5.3.1.10. Turkey Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
5.3.1.11. Russia Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
5.3.1.12. Russia Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
5.3.1.13. Rest of Europe Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
5.3.1.14. Rest of Europe Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
5.3.2. BPS Analysis/Market Attractiveness Analysis
6. Asia Pacific Pharmacy Benefit Manager Market Outlook, 2019-2031
6.1. Asia Pacific Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
6.1.1. Key Highlights
6.1.1.1. Retail Pharmacy Services
6.1.1.2. Specialty Pharmacy Services
6.1.1.3. Benefit Plan Design and Consultation
6.1.1.4. Drug Formulary Management
6.1.1.5. Other
6.2. Asia Pacific Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
6.2.1. Key Highlights
6.2.1.1. Government Health Programs
6.2.1.2. Employer-Sponsored Programs
6.2.1.3. Health Insurance Companies
6.2.1.4. Other Programs
6.2.2. BPS Analysis/Market Attractiveness Analysis
6.3. Asia Pacific Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
6.3.1. Key Highlights
6.3.1.1. China Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
6.3.1.2. China Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
6.3.1.3. Japan Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
6.3.1.4. Japan Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
6.3.1.5. South Korea Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
6.3.1.6. South Korea Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
6.3.1.7. India Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
6.3.1.8. India Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
6.3.1.9. Southeast Asia Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
6.3.1.10. Southeast Asia Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
6.3.1.11. Rest of Asia Pacific Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
6.3.1.12. Rest of Asia Pacific Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
6.3.2. BPS Analysis/Market Attractiveness Analysis
7. Latin America Pharmacy Benefit Manager Market Outlook, 2019-2031
7.1. Latin America Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
7.1.1. Key Highlights
7.1.1.1. Retail Pharmacy Services
7.1.1.2. Specialty Pharmacy Services
7.1.1.3. Benefit Plan Design and Consultation
7.1.1.4. Drug Formulary Management
7.1.1.5. Other
7.2. Latin America Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
7.2.1. Key Highlights
7.2.1.1. Government Health Programs
7.2.1.2. Employer-Sponsored Programs
7.2.1.3. Health Insurance Companies
7.2.1.4. Other Programs
7.2.2. BPS Analysis/Market Attractiveness Analysis
7.3. Latin America Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
7.3.1. Key Highlights
7.3.1.1. Brazil Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
7.3.1.2. Brazil Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
7.3.1.3. Mexico Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
7.3.1.4. Mexico Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
7.3.1.5. Argentina Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
7.3.1.6. Argentina Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
7.3.1.7. Rest of Latin America Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
7.3.1.8. Rest of Latin America Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
7.3.2. BPS Analysis/Market Attractiveness Analysis
8. Middle East & Africa Pharmacy Benefit Manager Market Outlook, 2019-2031
8.1. Middle East & Africa Pharmacy Benefit Manager Market Outlook, by Service, Value (US$ Bn), 2019-2031
8.1.1. Key Highlights
8.1.1.1. Retail Pharmacy Services
8.1.1.2. Specialty Pharmacy Services
8.1.1.3. Benefit Plan Design and Consultation
8.1.1.4. Drug Formulary Management
8.1.1.5. Other
8.2. Middle East & Africa Pharmacy Benefit Manager Market Outlook, by Demand Determinant, Value (US$ Bn), 2019-2031
8.2.1. Key Highlights
8.2.1.1. Government Health Programs
8.2.1.2. Employer-Sponsored Programs
8.2.1.3. Health Insurance Companies
8.2.1.4. Other Programs
8.2.2. BPS Analysis/Market Attractiveness Analysis
8.3. Middle East & Africa Pharmacy Benefit Manager Market Outlook, by Country, Value (US$ Bn), 2019-2031
8.3.1. Key Highlights
8.3.1.1. GCC Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
8.3.1.2. GCC Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
8.3.1.3. South Africa Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
8.3.1.4. South Africa Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
8.3.1.5. Egypt Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
8.3.1.6. Egypt Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
8.3.1.7. Nigeria Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
8.3.1.8. Nigeria Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
8.3.1.9. Rest of Middle East & Africa Pharmacy Benefit Manager Market by Service, Value (US$ Bn), 2019-2031
8.3.1.10. Rest of Middle East & Africa Pharmacy Benefit Manager Market by Demand Determinant, Value (US$ Bn), 2019-2031
8.3.2. BPS Analysis/Market Attractiveness Analysis
9. Competitive Landscape
9.1. Company Market Share Analysis, 2024
9.2. Competitive Dashboard
9.3. Company Profiles
9.3.1. Express Scripts Holding Company
9.3.1.1. Company Overview
9.3.1.2. Therapy Portfolio
9.3.1.3. Financial Overview
9.3.1.4. Business Strategies and Development
9.3.2. CVS Health Corporation
9.3.2.1. Company Overview
9.3.2.2. Therapy Portfolio
9.3.2.3. Financial Overview
9.3.2.4. Business Strategies and Development
9.3.3. DST Systems, Inc.
9.3.3.1. Company Overview
9.3.3.2. Therapy Portfolio
9.3.3.3. Financial Overview
9.3.3.4. Business Strategies and Development
9.3.4. Rite Aid Corp.
9.3.4.1. Company Overview
9.3.4.2. Therapy Portfolio
9.3.4.3. Financial Overview
9.3.4.4. Business Strategies and Development
9.3.5. ProCare Rx.
9.3.5.1. Company Overview
9.3.5.2. Therapy Portfolio
9.3.5.3. Financial Overview
9.3.5.4. Business Strategies and Development
9.3.6. UnitedHealth Group
9.3.6.1. Company Overview
9.3.6.2. Therapy Portfolio
9.3.6.3. Financial Overview
9.3.6.4. Business Strategies and Development
9.3.7. Benecard Services, LLC
9.3.7.1. Company Overview
9.3.7.2. Therapy Portfolio
9.3.7.3. Financial Overview
9.3.7.4. Business Strategies and Development
9.3.8. BioScrip, Inc.
9.3.8.1. Company Overview
9.3.8.2. Therapy Portfolio
9.3.8.3. Financial Overview
9.3.8.4. Business Strategies and Development
9.3.9. CaptureRx
9.3.9.1. Company Overview
9.3.9.2. Therapy Portfolio
9.3.9.3. Financial Overview
9.3.9.4. Business Strategies and Development
9.3.10. Change Healthcare
9.3.10.1. Company Overview
9.3.10.2. Therapy Portfolio
9.3.10.3. Financial Overview
9.3.10.4. Business Strategies and Development
10. Appendix
10.1. Research Methodology
10.2. Report Assumptions
10.3. Acronyms and Abbreviations