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US Pharmacy Benefit Management (PBM) Industry Report: 2015 Edition

  • December 2015
  • -
  • Koncept Analytics
  • -
  • 55 pages

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PBMs initially enacted the role of a third-party administrator, administering the drug claims of health plans/employers. However, they widened the horizon by expanding into a wide variety of business functions, eventually resulting in better management of drug benefits for members and reducing the overall drug spending costs for plan sponsors. Some of the key functions performed by PBMs that have an impact on reducing drug expenditures are formulary and benefit plan designing, retail network management and operating mail order pharmacies. In the US, Pharmacy Benefit Management (PBM) deals with the management of prescription drug programs. It acts as an intermediary between health plans, drug companies, retail pharmacies and patients.

The PBM suppliers control medication spending and usage by the righteousness of their propelled apparatuses and strategies, empowering utilization of generics and other lower-cost pharmaceuticals. In the US, there are some autonomous PBM's while some are claimed by overseeing care associations and retail drug stores. Today, the PBM business has turned out to be more decided through a progression of mergers and acquisitions.

Some of the factors driving the growth of the US PBM industry are: accelerating US aging population, increasing life expectancy rate and incidences of chronic and infectious diseases which further increase the healthcare expenditure and pharmaceutical sales in the US. The ongoing trends and developments in the PBM industry include rising medicare enrollments, rising number of exclusions on the formulary list and increased acceptance of specialty drugs.

This report assesses the US PBM industry in terms of both market volume and market value. The increasing competition in the PBM industry has been analyzed on a variety of factors: revenue, dispensing specialty pharmaceuticals and claims. The top three companies having a vicious competition with each other and dominating the PBM industry are- Express Script, CVS Health and Catamaran. These players are being profiled in the report along with their key financials and strategies for growth.

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