薬剤給付管理市場の2030年までの予測：サービス別、ビジネスモデル別、エンドユーザー別、地域別の世界分析

Stratistics MRCによると、世界の薬剤給付管理市場は2023年に5,021億米ドルを占め、予測期間中にCAGR 7.7％で成長し、2030年には8,439億米ドルに達すると予想されています。

Pharmacy Benefit Management（PBM）は、健康保険プランの処方薬給付を管理するサービスです。PBMは薬局と交渉し、処方箋を管理し、請求を処理することで、薬剤利用の最適化とコスト抑制を目指します。PBMの役割は、医薬品へのアクセスを合理化し、手頃な価格を実現し、効率的なヘルスケアデリバリーを促進することです。

メディケア・メディケイド・サービスセンター（CMS）のMedicare Advantage Enrollment Filesによると、米国では3,080万人がMedicare Advantageプランに加入しており、2023年にはMedicare適格人口の51.0%を占めています。

慢性疾患の蔓延が後押し

慢性疾患の世界の負担は増加の一途をたどっており、薬へのアクセスと服薬アドヒアランスの効率的な管理に対する需要が高まっています。PBMは、薬価交渉、処方の最適化、慢性疾患治療に関連するコスト管理戦略の実施を通じて、このような状況において極めて重要な役割を果たしています。パーソナライズされた投薬計画を通じて患者の転帰を改善することに重点を置くPBMは、進化するヘルスケアの状況に合致しており、慢性疾患の複雑性に対処し、長期的な健康ニーズを抱える人口増加のために必要な医薬品への費用対効果の高いアクセスを確保する上で不可欠な存在となっています。

薬価の透明性の欠如

このような価格設定メカニズムの不透明さは、消費者とPBMの双方にとって、医薬品の真のコストを理解する上での課題を生み出しています。PBMと製薬メーカー間の複雑なリベート構造や非公開の価格交渉により、利害関係者は処方された医薬品の実際の価値を理解する上でしばしば困難に直面します。このような透明性の欠如は、十分な情報に基づいた意思決定を妨げるだけでなく、ヘルスケアシステムに対する信頼を低下させる。患者は高額な自己負担額の負担を強いられ、PBMは薬剤費の効果的な交渉と管理に苦慮することになるかもしれないです。

支援的な政策と政策

政府は、ヘルスケアの効率化と薬剤費の抑制においてPBMが極めて重要な役割を果たすことを認識しつつあり、有利な規制の枠組みは市場の成長を促す可能性があります。PBMセクターの透明性、公正な競合、標準化を促進する政策は、イノベーションとコラボレーションを促進する環境を作り出します。規制をヘルスケアシステムの進化するニーズに合わせることで、政策立案者はPBMに処方薬給付を最適化する権限を与えることができ、最終的に患者と医療提供者に利益をもたらすことができます。このような規制による支援は、より弾力的で競争力のあるPBM市場を育成するだけでなく、ヘルスケアのアフォーダビリティとアクセシビリティの全体的な向上にも貢献します。

標準化の欠如

薬剤の処方、給付構造、償還モデルが多様化する中、統一性がないため、PBM業務に複雑さが生じる。この標準化の欠如は相互運用性を阻害し、ヘルスケア・エコシステムにおける様々な利害関係者間のシームレスな情報交換を妨げる可能性があります。また、PBMの実績の比較やベンチマークに課題が生じ、透明性が制限され、ベストプラクティスの確立が阻害されます。さらに、標準化されたプロセスがないため、非効率やエラーが発生し、医療の質や患者の転帰に影響を与える可能性があります。

COVID-19の影響：

COVID-19の流行は薬剤給付管理（PBM）市場に多面的な影響を及ぼしています。ヘルスケア需要の増加、医薬品サプライチェーンの混乱、患者行動の変化は、処方薬管理のダイナミクスを再構築しました。遠隔医療の拡大、デジタル化の加速、公衆衛生への新たな関心は、パンデミックがもたらす課題に適応するためのPBMの役割の進化を強調しています。この危機は技術革新を促す一方で、進行中のヘルスケア情勢を乗り切るための弾力的で柔軟なPBM戦略の必要性も浮き彫りにしています。

予測期間中、専門薬局サービス分野が最大となる見込み

専門薬局サービス分野は、慢性疾患や希少疾患のために複雑で高コストの薬剤を必要とする患者特有のニーズに対応することで、有利な成長が見込まれています。これらのサービスは、特殊医薬品へのアクセスを最適化し、タイムリーなドラッグデリバリー、患者教育、包括的なサポートを保証します。専門薬局サービスを提供するPBMは、服薬アドヒアランスの向上、コスト管理、患者転帰の改善に貢献し、急速に進化する医薬品給付の状況において個別化ケアへの重要なコミットメントを示しています。

予測期間中、小売薬局セグメントのCAGRが最も高くなると予想される

小売薬局セグメントは、予測期間中に最も速いCAGRの成長が見込まれます。PBMは、処方薬給付の最適化、価格交渉、請求処理の合理化のために小売薬局と協力しています。このパートナーシップにより、ヘルスケアシステムにおける費用対効果や効率性を高めつつ、患者にとって便利な医薬品へのアクセスが保証されます。小売薬局は、PBMのエコシステムにおける重要なプレーヤーとして、幅広い人々に安価で利用しやすい医薬品ケアを提供するという全体的な目標に貢献しています。

最大のシェアを持つ地域

北米は、強固なヘルスケア・インフラ、高額な医療費、慢性疾患の大きな負担を背景に、予測期間中、市場で最大のシェアを確保しています。同地域の確立された規制環境と健康保険の普及がPBMの存在感を高めています。さらに、コスト抑制が常に重視され、ヘルスケアにおける先端技術の統合がPBMの成長をさらに後押ししているため、北米は薬剤給付管理サービスの進化を形作る重要なプレーヤーとなっています。

CAGRが最も高い地域：

アジア太平洋地域は、ヘルスケア意識の高まり、慢性疾患の増加、保険適用範囲の拡大といった複数の要因によって、予測期間中、市場で最も高いCAGRを示します。医療費抑制と医薬品アクセスの改善に向けた各国政府の取り組みが、PBMの採用をさらに後押ししています。この地域の医薬品市場は多様性に富み、成長しているため、PBMは医薬品給付を最適化する機会を得ることができます。しかし、課題としては、多様な規制状況や多様なヘルスケアシステムを克服することが挙げられます。PBMの認知度が高まるにつれ、アジア太平洋地域は、医薬品コスト管理と患者ケアの強化を目指す企業にとってダイナミックな展望を提示しています。

無料カスタマイズサービス：

本レポートをご購読のお客様には、以下の無料カスタマイズオプションのいずれかをご利用いただけます：

• 企業プロファイル
  • 追加市場プレーヤーの包括的プロファイリング（3社まで）
  • 主要企業のSWOT分析（3社まで）
• 地域セグメンテーション
  • 顧客の関心に応じた主要国の市場推計・予測・CAGR（注：フィージビリティチェックによる）
• 競合ベンチマーキング
  • 製品ポートフォリオ、地理的プレゼンス、戦略的提携に基づく主要企業のベンチマーキング

目次

第1章 エグゼクティブサマリー

第2章 序文

• 概要
• ステークホルダー
• 調査範囲
• 調査手法
  • データマイニング
  • データ分析
  • データ検証
  • 調査アプローチ
• 調査ソース
  • 1次調査ソース
  • 2次調査ソース
  • 前提条件

第3章 市場動向分析

• 促進要因
• 抑制要因
• 機会
• 脅威
• エンドユーザー分析
• 新興市場
• 新型コロナウイルス感染症（COVID-19）の影響

第4章 ポーターのファイブフォース分析

• 供給企業の交渉力
• 買い手の交渉力
• 代替品の脅威
• 新規参入業者の脅威
• 競争企業間の敵対関係

第5章 世界の薬剤給付管理市場：サービス別

• 専門薬局サービス
• 福利厚生プランの設計と管理
• 薬局クレーム処理
• フォーミュラリー管理
• その他

第6章 世界の薬剤給付管理市場：ビジネスモデル別

• 政府の保健プログラム
• 雇用主主催のプログラム
• 健康保険管理

第7章 世界の薬剤給付管理市場：エンドユーザー別

• 薬剤給付管理機構
• 通信販売薬局
• 小売薬局
• その他のエンドユーザー

第8章 世界の薬剤給付管理市場：地域別

• 北米
  • 米国
  • カナダ
  • メキシコ
• 欧州
  • ドイツ
  • 英国
  • イタリア
  • フランス
  • スペイン
  • その他欧州
• アジア太平洋地域
  • 日本
  • 中国
  • インド
  • オーストラリア
  • ニュージーランド
  • 韓国
  • その他アジア太平洋地域
• 南米
  • アルゼンチン
  • ブラジル
  • チリ
  • その他南米
• 中東とアフリカ
  • サウジアラビア
  • アラブ首長国連邦
  • カタール
  • 南アフリカ
  • その他中東とアフリカ

第9章 主な発展

• 契約、パートナーシップ、コラボレーション、合弁事業
• 買収と合併
• 新製品の発売
• 事業拡大
• その他の主要戦略

第10章 企業プロファイル

• Abarca Health LLC.
• SS&C Technologies, Inc.
• Anthem, Inc.
• Benecard Services, LLC
• CaptureRx
• Centene Corporation
• ProCare Rx
• Change Healthcare
• OptumRx, Inc.
• Cigna
• Medimpact
• CVS Health
• Elixir Rx Solutions, LLC
• Express Scripts Holding Company

List of Tables

• Table 1 Global Pharmacy Benefit Management Market Outlook, By Region (2021-2030) ($MN)
• Table 2 Global Pharmacy Benefit Management Market Outlook, By Service (2021-2030) ($MN)
• Table 3 Global Pharmacy Benefit Management Market Outlook, By Specialty Pharmacy Services (2021-2030) ($MN)
• Table 4 Global Pharmacy Benefit Management Market Outlook, By Benefit Plan Design & Administration (2021-2030) ($MN)
• Table 5 Global Pharmacy Benefit Management Market Outlook, By Pharmacy Claims Processing (2021-2030) ($MN)
• Table 6 Global Pharmacy Benefit Management Market Outlook, By Formulary Management (2021-2030) ($MN)
• Table 7 Global Pharmacy Benefit Management Market Outlook, By Other Services (2021-2030) ($MN)
• Table 8 Global Pharmacy Benefit Management Market Outlook, By Business Model (2021-2030) ($MN)
• Table 9 Global Pharmacy Benefit Management Market Outlook, By Government Health Programs (2021-2030) ($MN)
• Table 10 Global Pharmacy Benefit Management Market Outlook, By Employer-Sponsored Programs (2021-2030) ($MN)
• Table 11 Global Pharmacy Benefit Management Market Outlook, By Health Insurance Management (2021-2030) ($MN)
• Table 12 Global Pharmacy Benefit Management Market Outlook, By End User (2021-2030) ($MN)
• Table 13 Global Pharmacy Benefit Management Market Outlook, By Pharmacy Benefit Management Organization (2021-2030) ($MN)
• Table 14 Global Pharmacy Benefit Management Market Outlook, By Mail Order Pharmacies (2021-2030) ($MN)
• Table 15 Global Pharmacy Benefit Management Market Outlook, By Retail Pharmacies (2021-2030) ($MN)
• Table 16 Global Pharmacy Benefit Management Market Outlook, By Other End Users (2021-2030) ($MN)
• Table 17 North America Pharmacy Benefit Management Market Outlook, By Country (2021-2030) ($MN)
• Table 18 North America Pharmacy Benefit Management Market Outlook, By Service (2021-2030) ($MN)
• Table 19 North America Pharmacy Benefit Management Market Outlook, By Specialty Pharmacy Services (2021-2030) ($MN)
• Table 20 North America Pharmacy Benefit Management Market Outlook, By Benefit Plan Design & Administration (2021-2030) ($MN)
• Table 21 North America Pharmacy Benefit Management Market Outlook, By Pharmacy Claims Processing (2021-2030) ($MN)
• Table 22 North America Pharmacy Benefit Management Market Outlook, By Formulary Management (2021-2030) ($MN)
• Table 23 North America Pharmacy Benefit Management Market Outlook, By Other Services (2021-2030) ($MN)
• Table 24 North America Pharmacy Benefit Management Market Outlook, By Business Model (2021-2030) ($MN)
• Table 25 North America Pharmacy Benefit Management Market Outlook, By Government Health Programs (2021-2030) ($MN)
• Table 26 North America Pharmacy Benefit Management Market Outlook, By Employer-Sponsored Programs (2021-2030) ($MN)
• Table 27 North America Pharmacy Benefit Management Market Outlook, By Health Insurance Management (2021-2030) ($MN)
• Table 28 North America Pharmacy Benefit Management Market Outlook, By End User (2021-2030) ($MN)
• Table 29 North America Pharmacy Benefit Management Market Outlook, By Pharmacy Benefit Management Organization (2021-2030) ($MN)
• Table 30 North America Pharmacy Benefit Management Market Outlook, By Mail Order Pharmacies (2021-2030) ($MN)
• Table 31 North America Pharmacy Benefit Management Market Outlook, By Retail Pharmacies (2021-2030) ($MN)
• Table 32 North America Pharmacy Benefit Management Market Outlook, By Other End Users (2021-2030) ($MN)
• Table 33 Europe Pharmacy Benefit Management Market Outlook, By Country (2021-2030) ($MN)
• Table 34 Europe Pharmacy Benefit Management Market Outlook, By Service (2021-2030) ($MN)
• Table 35 Europe Pharmacy Benefit Management Market Outlook, By Specialty Pharmacy Services (2021-2030) ($MN)
• Table 36 Europe Pharmacy Benefit Management Market Outlook, By Benefit Plan Design & Administration (2021-2030) ($MN)
• Table 37 Europe Pharmacy Benefit Management Market Outlook, By Pharmacy Claims Processing (2021-2030) ($MN)
• Table 38 Europe Pharmacy Benefit Management Market Outlook, By Formulary Management (2021-2030) ($MN)
• Table 39 Europe Pharmacy Benefit Management Market Outlook, By Other Services (2021-2030) ($MN)
• Table 40 Europe Pharmacy Benefit Management Market Outlook, By Business Model (2021-2030) ($MN)
• Table 41 Europe Pharmacy Benefit Management Market Outlook, By Government Health Programs (2021-2030) ($MN)
• Table 42 Europe Pharmacy Benefit Management Market Outlook, By Employer-Sponsored Programs (2021-2030) ($MN)
• Table 43 Europe Pharmacy Benefit Management Market Outlook, By Health Insurance Management (2021-2030) ($MN)
• Table 44 Europe Pharmacy Benefit Management Market Outlook, By End User (2021-2030) ($MN)
• Table 45 Europe Pharmacy Benefit Management Market Outlook, By Pharmacy Benefit Management Organization (2021-2030) ($MN)
• Table 46 Europe Pharmacy Benefit Management Market Outlook, By Mail Order Pharmacies (2021-2030) ($MN)
• Table 47 Europe Pharmacy Benefit Management Market Outlook, By Retail Pharmacies (2021-2030) ($MN)
• Table 48 Europe Pharmacy Benefit Management Market Outlook, By Other End Users (2021-2030) ($MN)
• Table 49 Asia Pacific Pharmacy Benefit Management Market Outlook, By Country (2021-2030) ($MN)
• Table 50 Asia Pacific Pharmacy Benefit Management Market Outlook, By Service (2021-2030) ($MN)
• Table 51 Asia Pacific Pharmacy Benefit Management Market Outlook, By Specialty Pharmacy Services (2021-2030) ($MN)
• Table 52 Asia Pacific Pharmacy Benefit Management Market Outlook, By Benefit Plan Design & Administration (2021-2030) ($MN)
• Table 53 Asia Pacific Pharmacy Benefit Management Market Outlook, By Pharmacy Claims Processing (2021-2030) ($MN)
• Table 54 Asia Pacific Pharmacy Benefit Management Market Outlook, By Formulary Management (2021-2030) ($MN)
• Table 55 Asia Pacific Pharmacy Benefit Management Market Outlook, By Other Services (2021-2030) ($MN)
• Table 56 Asia Pacific Pharmacy Benefit Management Market Outlook, By Business Model (2021-2030) ($MN)
• Table 57 Asia Pacific Pharmacy Benefit Management Market Outlook, By Government Health Programs (2021-2030) ($MN)
• Table 58 Asia Pacific Pharmacy Benefit Management Market Outlook, By Employer-Sponsored Programs (2021-2030) ($MN)
• Table 59 Asia Pacific Pharmacy Benefit Management Market Outlook, By Health Insurance Management (2021-2030) ($MN)
• Table 60 Asia Pacific Pharmacy Benefit Management Market Outlook, By End User (2021-2030) ($MN)
• Table 61 Asia Pacific Pharmacy Benefit Management Market Outlook, By Pharmacy Benefit Management Organization (2021-2030) ($MN)
• Table 62 Asia Pacific Pharmacy Benefit Management Market Outlook, By Mail Order Pharmacies (2021-2030) ($MN)
• Table 63 Asia Pacific Pharmacy Benefit Management Market Outlook, By Retail Pharmacies (2021-2030) ($MN)
• Table 64 Asia Pacific Pharmacy Benefit Management Market Outlook, By Other End Users (2021-2030) ($MN)
• Table 65 South America Pharmacy Benefit Management Market Outlook, By Country (2021-2030) ($MN)
• Table 66 South America Pharmacy Benefit Management Market Outlook, By Service (2021-2030) ($MN)
• Table 67 South America Pharmacy Benefit Management Market Outlook, By Specialty Pharmacy Services (2021-2030) ($MN)
• Table 68 South America Pharmacy Benefit Management Market Outlook, By Benefit Plan Design & Administration (2021-2030) ($MN)
• Table 69 South America Pharmacy Benefit Management Market Outlook, By Pharmacy Claims Processing (2021-2030) ($MN)
• Table 70 South America Pharmacy Benefit Management Market Outlook, By Formulary Management (2021-2030) ($MN)
• Table 71 South America Pharmacy Benefit Management Market Outlook, By Other Services (2021-2030) ($MN)
• Table 72 South America Pharmacy Benefit Management Market Outlook, By Business Model (2021-2030) ($MN)
• Table 73 South America Pharmacy Benefit Management Market Outlook, By Government Health Programs (2021-2030) ($MN)
• Table 74 South America Pharmacy Benefit Management Market Outlook, By Employer-Sponsored Programs (2021-2030) ($MN)
• Table 75 South America Pharmacy Benefit Management Market Outlook, By Health Insurance Management (2021-2030) ($MN)
• Table 76 South America Pharmacy Benefit Management Market Outlook, By End User (2021-2030) ($MN)
• Table 77 South America Pharmacy Benefit Management Market Outlook, By Pharmacy Benefit Management Organization (2021-2030) ($MN)
• Table 78 South America Pharmacy Benefit Management Market Outlook, By Mail Order Pharmacies (2021-2030) ($MN)
• Table 79 South America Pharmacy Benefit Management Market Outlook, By Retail Pharmacies (2021-2030) ($MN)
• Table 80 South America Pharmacy Benefit Management Market Outlook, By Other End Users (2021-2030) ($MN)
• Table 81 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Country (2021-2030) ($MN)
• Table 82 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Service (2021-2030) ($MN)
• Table 83 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Specialty Pharmacy Services (2021-2030) ($MN)
• Table 84 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Benefit Plan Design & Administration (2021-2030) ($MN)
• Table 85 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Pharmacy Claims Processing (2021-2030) ($MN)
• Table 86 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Formulary Management (2021-2030) ($MN)
• Table 87 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Other Services (2021-2030) ($MN)
• Table 88 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Business Model (2021-2030) ($MN)
• Table 89 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Government Health Programs (2021-2030) ($MN)
• Table 90 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Employer-Sponsored Programs (2021-2030) ($MN)
• Table 91 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Health Insurance Management (2021-2030) ($MN)
• Table 92 Middle East & Africa Pharmacy Benefit Management Market Outlook, By End User (2021-2030) ($MN)
• Table 93 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Pharmacy Benefit Management Organization (2021-2030) ($MN)
• Table 94 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Mail Order Pharmacies (2021-2030) ($MN)
• Table 95 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Retail Pharmacies (2021-2030) ($MN)
• Table 96 Middle East & Africa Pharmacy Benefit Management Market Outlook, By Other End Users (2021-2030) ($MN)

According to Stratistics MRC, the Global Pharmacy Benefit Management Market is accounted for $502.1 billion in 2023 and is expected to reach $843.9 billion by 2030 growing at a CAGR of 7.7% during the forecast period. Pharmacy Benefit Management (PBM) is a service that administers prescription drug benefits for health insurance plans. PBMs negotiate with pharmacies, manage formularies, and process claims, aiming to optimize drug utilization and control costs. Their role streamlines drug access, enhances affordability, and promotes efficient healthcare delivery.

According to the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage Enrollment Files, 30.8 million people in the U.S. were enrolled in a Medicare Advantage plan, which accounted for 51.0% of the eligible Medicare population in 2023.

Market Dynamics:

Driver:

Growing prevalence of chronic conditions boosts

The global burden of chronic diseases continues to rise, there is an increased demand for efficient management of medication access and adherence. PBMs play a pivotal role in this landscape by negotiating drug prices, optimizing formularies, and implementing strategies to control costs associated with chronic disease treatments. Their focus on improving patient outcomes through personalized medication plans aligns with the evolving healthcare landscape, making PBMs essential in addressing the complexities of chronic conditions and ensuring cost-effective access to necessary medications for a growing population with long-term health needs.

Restraint:

Lack of transparency in drug pricing

This opacity in pricing mechanisms creates challenges for both consumers and PBMs in understanding the true cost of medications. With intricate rebate structures and undisclosed pricing negotiations between PBMs and pharmaceutical manufacturers, stakeholders often face difficulties in comprehending the actual value of prescribed drugs. This lack of transparency not only hampers informed decision-making but also diminishes trust in the healthcare system. Patients may bear the brunt of high out-of-pocket costs, while PBMs may struggle to effectively negotiate and manage drug expenses.

Opportunity:

Supportive policies and regulations

Governments increasingly recognize the pivotal role of PBMs in enhancing healthcare efficiency and controlling drug costs, favorable regulatory frameworks can stimulate market growth. Policies that promote transparency, fair competition, and standardization within the PBM sector create a conducive environment for innovation and collaboration. By aligning regulations with the evolving needs of healthcare systems, policymakers can empower PBMs to optimize prescription drug benefits, ultimately benefiting patients and healthcare providers. This regulatory support not only fosters a more resilient and competitive PBM market but also contributes to the overall improvement of healthcare affordability and accessibility.

Threat:

Lack of Standardization

With diverse drug formularies, benefit structures, and reimbursement models, the absence of uniformity introduces complexities in PBM practices. This lack of standardization can impede interoperability, hindering seamless information exchange among various stakeholders in the healthcare ecosystem. It also creates challenges in comparing and benchmarking PBM performance, limiting transparency and inhibiting the establishment of best practices. Moreover, the absence of standardized processes may lead to inefficiencies and errors, impacting the quality of care and patient outcomes.

COVID-19 Impact:

The COVID-19 pandemic has exerted a multifaceted impact on the Pharmacy Benefit Management (PBM) market. Increased healthcare demands, disruptions in the drug supply chain, and altered patient behavior have reshaped the dynamics of prescription drug management. Telehealth expansion, accelerated digitalization, and a renewed focus on public health underscore the evolving role of PBMs in adapting to the challenges posed by the pandemic. While the crisis has prompted innovation, it has also highlighted the need for resilient and flexible PBM strategies to navigate the ongoing healthcare landscape.

The specialty pharmacy services segment is expected to be the largest during the forecast period

The specialty pharmacy services segment is expected to have a lucrative growth by addressing the unique needs of patients requiring complex, high-cost medications for chronic and rare conditions. These services optimize access to specialty drugs, ensuring timely delivery, patient education, and comprehensive support. PBMs offering specialty pharmacy services enhance medication adherence, manage costs, and contribute to improved patient outcomes, demonstrating a vital commitment to personalized care in the rapidly evolving landscape of pharmaceutical benefits.

The retail pharmacies segment is expected to have the highest CAGR during the forecast period

The retail pharmacies segment is anticipated to witness the fastest CAGR growth during the forecast period. PBMs collaborate with retail pharmacies to optimize prescription drug benefits, negotiate pricing, and streamline claims processing. This partnership ensures convenient access to medications for patients while enhancing cost-effectiveness and efficiency in the healthcare system. Retail pharmacies, as key players in the PBM ecosystem, contribute to the overall goal of providing affordable and accessible pharmaceutical care to a broad population.

Region with largest share:

North America secures the largest share in the market over the forecast period driven by a robust healthcare infrastructure, high healthcare spending, and a significant burden of chronic diseases. The region's well-established regulatory environment and widespread adoption of health insurance contribute to the strong presence of PBMs. Moreover, the constant emphasis on cost containment and the integration of advanced technologies in healthcare further propel the growth of PBMs, making North America a key player in shaping the evolution of pharmacy benefit management services.

Region with highest CAGR:

The Asia Pacific region exhibits the highest CAGR in the market over the forecast period due to multiple factors driven by increasing healthcare awareness, rising chronic diseases and expanding insurance coverage. Governments' efforts to control healthcare costs and improve access to medications further propel PBM adoption. The region's diverse and growing pharmaceutical market offers opportunities for PBMs to optimize drug benefits. However, challenges include navigating varied regulatory landscapes and diverse healthcare systems. As PBM awareness rises, the Asia Pacific presents a dynamic landscape for companies aiming to enhance pharmaceutical cost management and patient care.

Key players in the market:

Some of the key players in Pharmacy Benefit Management market include Abarca Health LLC., SS&C Technologies, Inc., Anthem, Inc., Benecard Services, LLC, CaptureRx, Centene Corporation, ProCare Rx, Change Healthcare, OptumRx, Inc., Cigna, Medimpact, CVS Health, Elixir Rx Solutions, LLC and Express Scripts Holding Company.

Key Developments:

In July 2023, CVS Caremark announced a partnership with the discount drug service provider GoodRx to reduce out-of-pocket prescription costs for millions of people.

In October 2022, Omnicell, Inc., a provider of medication management and adherence tools for health systems and pharmacies, launched Specialty Pharmacy Services, a comprehensive offering designed to help health systems launch and/or optimize a fully managed, hospital-owned specialty pharmacy.

In March 2022, ProdigyRx, a pharmacy benefits manager, launched its business operations that offer PBM services and clinical solutions for workers' compensation insurers, third-party administrators, and self-insured/administered employers.

Services Covered:

• Specialty Pharmacy Services
• Benefit Plan Design & Administration
• Pharmacy Claims Processing
• Formulary Management
• Other Services

Business Models Covered:

• Government Health Programs
• Employer-Sponsored Programs
• Health Insurance Management

End Users Covered:

• Pharmacy Benefit Management Organization
• Mail Order Pharmacies
• Retail Pharmacies
• Other End Users

Regions Covered:

• North America
  • US
  • Canada
  • Mexico
• Europe
  • Germany
  • UK
  • Italy
  • France
  • Spain
  • Rest of Europe
• Asia Pacific
  • Japan
  • China
  • India
  • Australia
  • New Zealand
  • South Korea
  • Rest of Asia Pacific
• South America
  • Argentina
  • Brazil
  • Chile
  • Rest of South America
• Middle East & Africa
  • Saudi Arabia
  • UAE
  • Qatar
  • South Africa
  • Rest of Middle East & Africa

What our report offers:

• Market share assessments for the regional and country-level segments
• Strategic recommendations for the new entrants
• Covers Market data for the years 2021, 2022, 2023, 2026, and 2030
• Market Trends (Drivers, Constraints, Opportunities, Threats, Challenges, Investment Opportunities, and recommendations)
• Strategic recommendations in key business segments based on the market estimations
• Competitive landscaping mapping the key common trends
• Company profiling with detailed strategies, financials, and recent developments
• Supply chain trends mapping the latest technological advancements

Free Customization Offerings:

All the customers of this report will be entitled to receive one of the following free customization options:

• Company Profiling
  • Comprehensive profiling of additional market players (up to 3)
  • SWOT Analysis of key players (up to 3)
• Regional Segmentation
  • Market estimations, Forecasts and CAGR of any prominent country as per the client's interest (Note: Depends on feasibility check)
• Competitive Benchmarking
  • Benchmarking of key players based on product portfolio, geographical presence, and strategic alliances

Table of Contents

1 Executive Summary

2 Preface

• 2.1 Abstract
• 2.2 Stake Holders
• 2.3 Research Scope
• 2.4 Research Methodology
  • 2.4.1 Data Mining
  • 2.4.2 Data Analysis
  • 2.4.3 Data Validation
  • 2.4.4 Research Approach
• 2.5 Research Sources
  • 2.5.1 Primary Research Sources
  • 2.5.2 Secondary Research Sources
  • 2.5.3 Assumptions

3 Market Trend Analysis

• 3.1 Introduction
• 3.2 Drivers
• 3.3 Restraints
• 3.4 Opportunities
• 3.5 Threats
• 3.6 End User Analysis
• 3.7 Emerging Markets
• 3.8 Impact of Covid-19

4 Porters Five Force Analysis

• 4.1 Bargaining power of suppliers
• 4.2 Bargaining power of buyers
• 4.3 Threat of substitutes
• 4.4 Threat of new entrants
• 4.5 Competitive rivalry

5 Global Pharmacy Benefit Management Market, By Service

• 5.1 Introduction
• 5.2 Specialty Pharmacy Services
• 5.3 Benefit Plan Design & Administration
• 5.4 Pharmacy Claims Processing
• 5.5 Formulary Management
• 5.6 Other Services

6 Global Pharmacy Benefit Management Market, By Business Model

• 6.1 Introduction
• 6.2 Government Health Programs
• 6.3 Employer-Sponsored Programs
• 6.4 Health Insurance Management

7 Global Pharmacy Benefit Management Market, By End User

• 7.1 Introduction
• 7.2 Pharmacy Benefit Management Organization
• 7.3 Mail Order Pharmacies
• 7.4 Retail Pharmacies
• 7.5 Other End Users

8 Global Pharmacy Benefit Management Market, By Geography

• 8.1 Introduction
• 8.2 North America
  • 8.2.1 US
  • 8.2.2 Canada
  • 8.2.3 Mexico
• 8.3 Europe
  • 8.3.1 Germany
  • 8.3.2 UK
  • 8.3.3 Italy
  • 8.3.4 France
  • 8.3.5 Spain
  • 8.3.6 Rest of Europe
• 8.4 Asia Pacific
  • 8.4.1 Japan
  • 8.4.2 China
  • 8.4.3 India
  • 8.4.4 Australia
  • 8.4.5 New Zealand
  • 8.4.6 South Korea
  • 8.4.7 Rest of Asia Pacific
• 8.5 South America
  • 8.5.1 Argentina
  • 8.5.2 Brazil
  • 8.5.3 Chile
  • 8.5.4 Rest of South America
• 8.6 Middle East & Africa
  • 8.6.1 Saudi Arabia
  • 8.6.2 UAE
  • 8.6.3 Qatar
  • 8.6.4 South Africa
  • 8.6.5 Rest of Middle East & Africa

9 Key Developments

• 9.1 Agreements, Partnerships, Collaborations and Joint Ventures
• 9.2 Acquisitions & Mergers
• 9.3 New Product Launch
• 9.4 Expansions
• 9.5 Other Key Strategies

10 Company Profiling

• 10.1 Abarca Health LLC.
• 10.2 SS&C Technologies, Inc.
• 10.3 Anthem, Inc.
• 10.4 Benecard Services, LLC
• 10.5 CaptureRx
• 10.6 Centene Corporation
• 10.7 ProCare Rx
• 10.8 Change Healthcare
• 10.9 OptumRx, Inc.
• 10.10 Cigna
• 10.11 Medimpact
• 10.12 CVS Health
• 10.13 Elixir Rx Solutions, LLC
• 10.14 Express Scripts Holding Company