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Global Pharmacy Benefit Management (PBM) Market to reach USD 819.21 billion by the end of 2030.

Global Pharmacy Benefit Management (PBM) Market Size Study & Forecast, by Service (Specialty Pharmacy Services, Benefit Plan Design & Administration, Pharmacy Claims Processing, Formulary Management, Others), by Service Provider (Insurance Companies, Retail Pharmacies, Standalone PBMs), and Regional Analysis, 2023-2030

Product Code: HLSHIT-13912284
Publish Date: 20-12-2023
Page: 200

Global Pharmacy Benefit Management (PBM) Market is at approximately USD 513.98 billion in 2022 and is anticipated to grow with a healthy growth rate of more than 6.0% over the forecast period 2023-2030. Pharmacy Benefit Management (PBM) is the process of managing prescription drug benefits for health insurers, employers, and other payers. PBMs design and maintain drug formularies, bargain drug pricing with manufacturers, and handle and settle claims for prescription medications. PBMs operate as go-betweens for many parties involved in the healthcare system, such as patients, pharmacists, medication makers, and insurance companies. Their main objective is to support the reduction of prescription drug expenditures and utilization while ensuring that patients have access to essential treatments. The Pharmacy Benefit Management (PBM) Market is expanding because of factors such as the increasing adoption of machine learning and artificial intelligence to smoothen workflow, increasing prevalence of chronic diseases, rising focus on data analytics, medication adherence and health outcomes, and growing prescription drug utilization. Also, the growing emphasis on pharmacy benefits management is expected to enhance the precision, safety, and efficiency of pharmacy operations, ultimately leading to better patient health outcomes. This trend is projected to stimulate market expansion throughout the forecast period.

In addition, the surge in global healthcare expenditures is poised to drive the adoption of advanced software and solutions for drug inventory and supply management, as well as the provision of cost-effective medications to patients. This is expected to fuel market expansion in the anticipated years. As per 2021 data released by the Centers for Medicare and Medicaid Services, national health spending escalated by 2.7% to reach USD 4.3 trillion in 2021 (equivalent to USD 12,914 per capita), representing 18.3% of the GDP. Furthermore, private health insurance spending rose by 5.8% to USD 1,211.4 billion, and prescription drug expenditure surged by 7.8% to reach USD 378 billion in 2021. Accordingly, these aforementioned factors are accelerating the growth of the Pharmacy Benefit Management (PBM) Market during the estimated period. Furthermore, the rising emphasis on developing advanced software and solutions, along with the robust demand for prescription products present various lucrative opportunities over the forecast years. However, the stringent government regulations and the rising drug prices are challenging the market growth throughout the forecast period of 2023-2030.

The key regions considered for the Global Pharmacy Benefit Management (PBM) Market study include Asia Pacific, North America, Europe, Latin America, and Middle East & Africa. North America dominated the market in 2022 owing to the rising number of medication errors, increasing adoption of pharmacy benefit management, and an upward trajectory in healthcare spending. For instance, in a study published by Oxford University Press in July 2022, it was stated that the overall prescription drug spending in the United States was projected to increase from 4% in the previous year to 6% in 2022. This heightened expenditure underscores the strong demand for prescription drugs in the region, which is expected to drive the demand for pharmacy management systems and, thus, contribute to market growth. Also, the substantial population under medical coverage, supportive government regulations for pharmacy benefit managers, and a growing number of pharmacy benefit management companies in the country further contribute to the region’s dominance. Whereas, the rest of the world is expected to grow at a significant CAGR over the forecast years. The growing prevalence of health awareness initiatives and the expansion of health plan options by insurance providers are expected to stimulate the uptake of pharmacy services, as well as the increasing complexity of the healthcare system is significantly propelling the market demand across the region.

Major market players included in this report are:
Optum, Inc.
Centene Corporation (Envolve Health)
CVS Health
SS&C Technologies, Inc.
Anthem, Inc.
Elixir Rx Solutions, LLC
Express Scripts Holding Company
Benecard Services, LLC
Change Healthcare

Recent Developments in the Market:
Ø In October 2022, Omnicell, Inc., a company specializing in medication management and adherence tools for healthcare systems and pharmacies, introduced Specialty Pharmacy Services. This comprehensive solution is tailored to assist healthcare systems in establishing or enhancing their hospital-owned specialty pharmacies, providing full management and optimization support.
Ø In November 2021, Anthem, Inc. agreed to acquire Integra Managed Care with the objective of expanding the company’s network and Medicaid operations.
Ø In March 2021, CVS Caremark and the Government-wide Service Benefit Plan signed a broader agreement that gave CVS Health the opportunity to reclaim the specialty pharmacy market.

Global Pharmacy Benefit Management (PBM) Market Report Scope:
ü Historical Data – 2020 – 2021
ü Base Year for Estimation – 2022
ü Forecast period – 2023-2030
ü Report Coverage – Revenue forecast, Company Ranking, Competitive Landscape, Growth factors, and Trends
ü Segments Covered – Service, Service Provider, Region
ü Regional Scope – North America; Europe; Asia Pacific; Latin America; Middle East & Africa
ü Customization Scope – Free report customization (equivalent up to 8 analyst’s working hours) with purchase. Addition or alteration to country, regional & segment scope*

The objective of the study is to define market sizes of different segments & countries in recent years and to forecast the values to the coming years. The report is designed to incorporate both qualitative and quantitative aspects of the industry within countries involved in the study.

The report also caters detailed information about the crucial aspects such as driving factors & challenges which will define the future growth of the market. Additionally, it also incorporates potential opportunities in micro markets for stakeholders to invest along with the detailed analysis of competitive landscape and product offerings of key players. The detailed segments and sub-segment of the market are explained below:

By Service:
Specialty Pharmacy Services
Benefit Plan Design & Administration
Pharmacy Claims Processing
Formulary Management

By Service Provider:
Insurance Companies
Retail Pharmacies
Standalone PBMs

By Region:

North America


Asia Pacific
South Korea

Latin America

Middle East & Africa
Saudi Arabia
South Africa
Rest of Middle East & Africa

Chapter 1. Executive Summary
1.1. Market Snapshot
1.2. Global & Segmental Market Estimates & Forecasts, 2020-2030 (USD Billion)
1.2.1. Pharmacy Benefit Management (PBM) Market, by Region, 2020-2030 (USD Billion)
1.2.2. Pharmacy Benefit Management (PBM) Market, by Service, 2020-2030 (USD Billion)
1.2.3. Pharmacy Benefit Management (PBM) Market, by Service Provider, 2020-2030 (USD Billion)
1.3. Key Trends
1.4. Estimation Methodology
1.5. Research Assumption
Chapter 2. Global Pharmacy Benefit Management (PBM) Market Definition and Scope
2.1. Objective of the Study
2.2. Market Definition & Scope
2.2.1. Industry Evolution
2.2.2. Scope of the Study
2.3. Years Considered for the Study
2.4. Currency Conversion Rates
Chapter 3. Global Pharmacy Benefit Management (PBM) Market Dynamics
3.1. Pharmacy Benefit Management (PBM) Market Impact Analysis (2020-2030)
3.1.1. Market Drivers Increasing adoption of machine learning and artificial intelligence to smoothen workflow Surge in global healthcare expenditures
3.1.2. Market Challenges Stringent government regulations Rising drug prices
3.1.3. Market Opportunities Growing emphasis on developing advanced software and solutions, as Robust demand for prescription products
Chapter 4. Global Pharmacy Benefit Management (PBM) Market Industry Analysis
4.1. Porter’s 5 Force Model
4.1.1. Bargaining Power of Suppliers
4.1.2. Bargaining Power of Buyers
4.1.3. Threat of New Entrants
4.1.4. Threat of Substitutes
4.1.5. Competitive Rivalry
4.2. Porter’s 5 Force Impact Analysis
4.3. PEST Analysis
4.3.1. Political
4.3.2. Economical
4.3.3. Social
4.3.4. Technological
4.3.5. Environmental
4.3.6. Legal
4.4. Top investment opportunity
4.5. Top winning strategies
4.6. COVID-19 Impact Analysis
4.7. Disruptive Trends
4.8. Industry Expert Perspective
4.9. Analyst Recommendation & Conclusion
Chapter 5. Global Pharmacy Benefit Management (PBM) Market, by Service
5.1. Market Snapshot
5.2. Global Pharmacy Benefit Management (PBM) Market by Service, Performance – Potential Analysis
5.3. Global Pharmacy Benefit Management (PBM) Market Estimates & Forecasts by Service 2020-2030 (USD Billion)
5.4. Pharmacy Benefit Management (PBM) Market, Sub Segment Analysis
5.4.1. Specialty Pharmacy Services
5.4.2. Benefit Plan Design & Administration
5.4.3. Pharmacy Claims Processing
5.4.4. Formulary Management
5.4.5. Others
Chapter 6. Global Pharmacy Benefit Management (PBM) Market, by Service Provider
6.1. Market Snapshot
6.2. Global Pharmacy Benefit Management (PBM) Market by Service Provider, Performance – Potential Analysis
6.3. Global Pharmacy Benefit Management (PBM) Market Estimates & Forecasts by Service Provider 2020-2030 (USD Billion)
6.4. Pharmacy Benefit Management (PBM) Market, Sub Segment Analysis
6.4.1. Insurance Companies
6.4.2. Retail Pharmacies
6.4.3. Standalone PBMs
Chapter 7. Global Pharmacy Benefit Management (PBM) Market, Regional Analysis
7.1. Top Leading Countries
7.2. Top Emerging Countries
7.3. Pharmacy Benefit Management (PBM) Market, Regional Market Snapshot
7.4. North America Pharmacy Benefit Management (PBM) Market
7.4.1. U.S. Pharmacy Benefit Management (PBM) Market Service breakdown estimates & forecasts, 2020-2030 Service Provider breakdown estimates & forecasts, 2020-2030
7.4.2. Canada Pharmacy Benefit Management (PBM) Market
7.5. Europe Pharmacy Benefit Management (PBM) Market Snapshot
7.5.1. U.K. Pharmacy Benefit Management (PBM) Market
7.5.2. Germany Pharmacy Benefit Management (PBM) Market
7.5.3. France Pharmacy Benefit Management (PBM) Market
7.5.4. Spain Pharmacy Benefit Management (PBM) Market
7.5.5. Italy Pharmacy Benefit Management (PBM) Market
7.5.6. Rest of Europe Pharmacy Benefit Management (PBM) Market
7.6. Asia-Pacific Pharmacy Benefit Management (PBM) Market Snapshot
7.6.1. China Pharmacy Benefit Management (PBM) Market
7.6.2. India Pharmacy Benefit Management (PBM) Market
7.6.3. Japan Pharmacy Benefit Management (PBM) Market
7.6.4. Australia Pharmacy Benefit Management (PBM) Market
7.6.5. South Korea Pharmacy Benefit Management (PBM) Market
7.6.6. Rest of Asia Pacific Pharmacy Benefit Management (PBM) Market
7.7. Latin America Pharmacy Benefit Management (PBM) Market Snapshot
7.7.1. Brazil Pharmacy Benefit Management (PBM) Market
7.7.2. Mexico Pharmacy Benefit Management (PBM) Market
7.8. Middle East & Africa Pharmacy Benefit Management (PBM) Market
7.8.1. Saudi Arabia Pharmacy Benefit Management (PBM) Market
7.8.2. South Africa Pharmacy Benefit Management (PBM) Market
7.8.3. Rest of Middle East & Africa Pharmacy Benefit Management (PBM) Market

Chapter 8. Competitive Intelligence
8.1. Key Company SWOT Analysis
8.1.1. Company 1
8.1.2. Company 2
8.1.3. Company 3
8.2. Top Market Strategies
8.3. Company Profiles
8.3.1. Optum, Inc. Key Information Overview Financial (Subject to Data Availability) Product Summary Recent Developments
8.3.2. Centene Corporation (Envolve Health)
8.3.3. CVS Health
8.3.4. SS&C Technologies, Inc.
8.3.5. Anthem, Inc.
8.3.6. Elixir Rx Solutions, LLC
8.3.7. Express Scripts Holding Company
8.3.8. Benecard Services, LLC
8.3.9. CaptureRx
8.3.10. Change Healthcare
Chapter 9. Research Process
9.1. Research Process
9.1.1. Data Mining
9.1.2. Analysis
9.1.3. Market Estimation
9.1.4. Validation
9.1.5. Publishing
9.2. Research Attributes
9.3. Research Assumption

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Data Collection:
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To ensure the accuracy and reliability of our findings, we extensively leverage data science techniques, which help us minimize discrepancies and uncertainties in our analysis. We employ Data Science to clean and preprocess the data, ensuring its quality and reliability. This involves handling missing data, removing outliers, standardizing variables, and transforming data into suitable formats for analysis. The application of data science techniques enhances our accuracy, efficiency, and depth of analysis, enabling us to stay competitive in dynamic market environments.
Market Size Estimation:
Our proprietary data tools play a crucial role in deriving our market estimates and forecasts. Each study involves the creation of a unique and customized model. The model incorporates the gathered information on market dynamics, technology landscape, application development, and pricing trends. AI techniques, such as machine learning and deep learning, aid us to analyze patterns within the data to identify correlations, trends, and relationships. By recognizing patterns in consumer behavior, purchasing habits, or market dynamics, our AI algorithms aid us in more precise estimations of market size. These factors are simultaneously analyzed within the model, allowing for a comprehensive assessment. To quantify their impact over the forecast period, correlation, regression, and time series analysis are employed.
To estimate and validate the market size, we employ both top-down and bottom-up approaches. The preference is given to a bottom-up approach, where key regional markets are analyzed as separate entities. This data is then integrated to obtain global estimates. This approach is crucial as it provides a deep understanding of the industry and helps minimize errors.
In our forecasting process, we consider various parameters such as economic tools, technological analysis, industry experience, and domain expertise. By taking all these factors into account, we strive to produce accurate and reliable market forecasts. When forecasting, we take into consideration several parameters, which include:
Market driving trends and favorable economic conditions
Restraints and challenges that are expected to be encountered during the forecast period.
Anticipated opportunities for growth and development
Technological advancements and projected developments in the market
Consumer spending trends and dynamics
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