Increased adoption of electronic prescriptions and mail-order pharmacies, increased FDA approvals for biologics and biosimilars, and entry into the payer market through mergers and acquisitions

DUBLIN, July 18, 2022 /PRNewswire/ — The report “U.S. Pharmacy Benefit Management Market – Industry Outlook and Forecast 2022-2027” has been added to from offer.

The US Pharmacy Benefit Management Market is expected to grow at a CAGR of 5.53% during the period 2022-2027

The study examines a detailed scenario of the current US Pharmacy Benefit Management market and its market dynamics. It covers a detailed overview of several industry growth catalysts, restraints, and trends. The report presents both the demand and supply sides of the market. It profiles and reviews the leading companies and other eminent ones operating in the market.


The PBM industry refers to companies that act as intermediaries between insurance companies, pharmacies, and pharmaceutical companies. PBM is responsible for reducing insurers and their drug costs. They achieve this by negotiating with pharmacies and pharmaceutical companies. Pharmacy benefit management systems entered the pharmaceutical industry in the 1960s to meet the health benefit needs of employers. They quickly became an important player in the entire pharmaceutical supply chain.

Pharmacy fees make up nearly 32% of total health care spending, and these expenses are expected to more than double over the forecast period. Currently, Pharmacy Benefits Management plays a major role and acts as an intermediary between payers, drug manufacturers and pharmacies.

Since PBMs play a significant role in influencing out-of-pocket spending and patient access to medicines due to their management tools, formulary power, and price concessions. They are in a strong position to pass the savings on to customers. According to PBM lobby groups, between 2020 and 2029, PBM tools will reduce spending by consumers and plan sponsors by more than $1 trillion.

PBMs are increasingly criticized, claiming they drive up drug prices, making huge gains through pharmacy price differentials, manufacturer rebates and supply chain fees. This is spurred by the opacity of the true cost of drugs for PBMs due to rules of engagement between manufacturers and PBMs.

The future of PBMs will be dictated by the implementation of state and national policies in terms of revenue streams and business practices in the pharmaceutical space.

US Pharmacy Benefit Management Market Segmentations

On a services basis, specialty pharmacy services is the leading contributor to the US pharmacy benefit management market, and it is likely to witness strong incremental growth from $48.24 billion during the forecast period.

On the basis of health plans, commercial health plans are the major contributor to the US pharmacy benefit management market, and it is expected to witness a high absolute growth of 34.69% during the forecast period. .


Presence of prominent players in the market, increase in favorable healthcare reforms, increase in e-prescribing, and increasing adoption of healthcare plans by US residents are the main drivers of significant market share in the country.

Key Company Profiles

  • SVC Health
  • Cigna
  • UnitedHealth Group

Top Companies to Watch

  • Human Pharmacy Solutions
  • Medimpact
  • First Therapeutic

Other Important Suppliers

  • Abarca Health
  • AscellaHealth
  • BeneCard PBF
  • CaptureRx
  • centene
  • Changing healthcare
  • Citizens Rx
  • EnvisionRxOptions
  • will excel
  • Magellan Rx Management
  • MedalistRx
  • MaxorMore
  • Navitus Health Solutions
  • PerformRx
  • ProCareRx
  • RxAdvance
  • Ritual Aid
  • WellDyneRx
  • Walgreens Boot Alliance

Main topics covered:

1 Research methodology

2 research objectives

3 Research process

4 Scope and coverage
4.1 Market definition
4.2 Reference year
4.3 Scope of the study
4.4 Market Segmentation

5 Report assumptions and caveats
5.1 Main caveats
5.2 Currency conversion
5.3 Market Derivation

6 The market at a glance

7 Presentation
7.1 Landscape of the US Economy and Healthcare Industry
7.2 Management of pharmaceutical benefits
7.2.1 Role of PBMs in money spent on prescription drugs
7.2.2 Reforms to regulate PBMs

8 Pharmaceutical ecosystem
8.1 Overview
8.2 Evolution of PBM ownership
8.2.1 PBM services over time
8.2.2 PBM and other players in the pharmaceutical ecosystem

9 Impact of Covid-19 on the PBM Market
9.1 Overview
9.1.1 PBM response strategies to Covid-19

10 gaps in information and care in America’s healthcare industry
10.1 Overview

11 Market Opportunities and Trends
11.1 Increased Adoption of E-Prescribing and Mail-Order Pharmacy
11.2 Growing FDA Approvals for Biologics and Biosimilars
11.3 Payer Market Entry through Mergers and Acquisitions
11.4 Digital Health Solutions Entry into PBM Industry

12 Market Growth Catalysts
12.1 Enabling health care reforms
12.2 Growing Adoption of Healthcare Plans by US Residents
12.3 Prevalence of Fraud, Waste and Abuse in Healthcare
12.4 Increased Demand for Personalized Medicines

13 Market Constraints
13.1 PBMs are more likely to be sued and scrutinized by the government
13.2 Lack of transparency of services by PBMs
13.3 Lower growth of generics
13.4 Legal uncertainty and impending limitations on PBM tools

14 Market Landscape
14.1 Market Overview
14.2 Market Size and Forecast
14.2.1 Overview by Health Plans
14.2.2 Overviews by services
14.2.3 Overview by Business Model
14.3 Five forces analysis

15 health plans
15.1 Market Overview and Growth Driver
15.2 Market Overview
15.3 Commercial Health Plans
15.3.1 Market Overview
15.3.2 Market Size and Forecast
15.4 Health insurance
15.5 Medical Aid
15.6 Others

16 Benefits
16.1 Market Overview and Growth Driver
16.2 Market Overview
16.3 Specialty Pharmacy Services
16.4 Retail Pharmacy Networks
16.5 Mail Order Pharmacy Services
16.6 Handling complaints
16.7 Form Management
16.8 Drug utilization review
16.9 Negotiations of prices, discounts and rebates
16.10 Disease management and compliance initiatives

17 Business model
17.1 Market Overview and Growth Driver
17.2 Market Overview
17.3 Insurance companies and retail pharmacies
17.4 PBM Pure Play

18 Competitive landscape
18.1 Competition Overview
18.2 Market Share Analysis
18.2.1 Resume Health
18.2.2 Cigna
18.2.3 Unitedhealth Group
18.2.4 Human Pharmacy Solutions
18.2.5 Medimpact
18.2.6 Main therapy

19 key company profiles
19.1 CVS Health
19.2 Cigna
19.3 Unitedhealth Group

20 key companies to watch
20.1 Humana Pharmaceutical Solutions
20.2 Medimpact
20.3 Main therapy

For more information about this report visit

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Research and Markets
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SOURCE Research and Markets

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