About PBMs
PBMs are responsible for processing prescriptions for corporations or insurance companies. Earlier, their major role was administration and negotiation with drug pharmacies and manufacturers to get rebates on drug prices. Now they have evolved into entities taking over the drug benefit portion of health plans in the US. Recent healthcare reforms in the US have contributed significantly to increase their area of expertise. Increase in costs of drugs and other healthcare services has made PBM's services more desirable. PBMs act as an intermediary between the payer and other entities in a healthcare system. They generate revenue through service fees they charge from large customer contracts for activities such as operating mail-order pharmacies, processing prescriptions, and negotiating with drug manufacturers and pharmacies.
Technavio's analysts forecast the PBM market in the US to grow at a CAGR of 7.16% during 2014-2019.
Covered in this report
The report covers the current scenario and the growth prospects of the PBM market in the US for the period of 2015-2019. To calculate the market size, the report considers revenue generated by PBMs by offering pharmacy benefit services to end-users in the healthcare market in the US.
Technavio's report, Pharmacy Benefit Manager (PBM) Market in the US 2015-2019, has been prepared based on an in-depth market analysis with inputs from industry experts. The report covers the PBM market landscape in the US and its growth prospects in the coming years. The report also includes a discussion of the key vendors operating in this market.
Key vendors
• Catamaran
• CVS Health (CVS Caremark)
• Express Scripts
• OptumRx
• Prime Therapeutics
Other prominent vendors
• Aetna
• Argus Health Systems
• Centene
• Cigna
• Humana
• Medlmpact
• Rite Aid
Market driver
• Increase in healthcare expenditure
• For a full, detailed list, view our report
Market challenge
• Criticisms of PBMs
• For a full, detailed list, view our report
Market trend
• Shift toward multi-tier prescription drug plans by employers
• For a full, detailed list, view our report
Key questions answered in this report
• What will the market size be in 2019 and what will the growth rate be?
• What are the key market trends?
• What is driving this market?
• What are the challenges to market growth?
• Who are the key vendors in this market space?
• What are the market opportunities and threats faced by the key vendors?
• What are the strengths and weaknesses of the key vendors?
PART 01: Executive summary
Highlights
PART 02: Scope of the report
Market overview
Top-vendor offerings
PART 03: Market research methodology
Research methodology
Economic indicators
PART 04: Introduction
Key market highlights
PART 05: US: Economic profile
PART 06: Global pharmaceuticals market
Global pharmaceuticals market
US pharmaceuticals market
PART 07: PBM: An overview
PART 08: PBM market in US
Market overview
Market size and forecast
PBM market in US by Medicare members
PBM market in US by managed Medicaid members
Five forces analysis
PART 09: Market drivers
PART 10: Impact of drivers
PART 11: Market challenges
PART 12: Impact of drivers and challenges
PART 13: Market trends
PART 14: Vendor landscape
Competitive scenario
Market share analysis 2014
Other prominent vendors
PART 15: Key vendor analysis
Catamaran
CVS Health
Express Scripts
OptumRx
Prime Therapeutics
PART 16: Other prominent vendors
Aetna
Argus Health Systems
Centene
Cigna
Humana
MedImpact
Rite Aid
PART 17: Appendix
List of abbreviations
PART 18: Explore Technavio
List of Exhibits
Exhibit 01: Product offerings
Exhibit 02: US GDP 2009-2014 ($ trillions)
Exhibit 03: US GDP per capita 2009-2014 ($ thousands)
Exhibit 04: US population 2009-2014 (millions)
Exhibit 05: US population by age group 2014
Exhibit 06: Global pharmaceuticals market 2014-2019 ($ trillions)
Exhibit 07: Global pharmaceuticals market by geography 2014
Exhibit 08: Pharmaceuticals market in US 2006-2013 ($ billions)
Exhibit 09: Pharmaceuticals market in US 2014-2019 ($ billions)
Exhibit 10: US drug approvals: Specialty versus traditional drugs 2006-2014
Exhibit 11: US prescription drug spending 2014-2019 ($ billions)
Exhibit 12: Per capita pharmaceutical spending: US versus other countries 2014 and 2019 ($)
Exhibit 13: PBMs: Areas of expertise
Exhibit 14: Key activities of PBMs
Exhibit 15: PBM market in US 2014-2019 ($ billions)
Exhibit 16: Growth of insurance in US 2014-2019 (millions of lives)
Exhibit 17: Growth in PBM-managed lives in US 2012-2019 (millions of lives)
Exhibit 18: PBM-managed lives under Medicare 2014-2019 (millions of lives)
Exhibit 19: Medicare members in US by PBM 2014
Exhibit 20: PBM-managed lives under managed Medicaid program 2014-2019 (millions of lives)
Exhibit 21: Managed Medicaid members in US by PBM 2014
Exhibit 22: Five forces analysis
Exhibit 23: Aging population in US 2010-2050
Exhibit 24: Decrease in mortality rate in US 2011-2012 (deaths per 100,000 in standard population)
Exhibit 25: Impact of drivers
Exhibit 26: Rise of private exchange contribution plans in US: 2010 versus 2014 (millions of lives)
Exhibit 27: US states with PBM regulations 2013
Exhibit 28: Impact of drivers and challenges
Exhibit 29: Specialty drugs market in US 2014-2019 ($ billions)
Exhibit 30: M&A in PBM market in US
Exhibit 31: PBM market in US: Vendor segmentation by revenue 2014
Exhibit 32: PBM market in US: Vendor segmentation by equivalent prescription 2014
Exhibit 33: PBM market in US: Vendor segmentation by PBM lives 2014
Exhibit 34: Business segmentation of Catamaran
Exhibit 35: Catamaran: Business segmentation by revenue 2013 and 2014 ($ billions)
Exhibit 36: Catamaran: Geographical segmentation by revenue 2014
Exhibit 37: CVS Health: Business segmentation by revenue 2014
Exhibit 38: Express Scripts: Business segmentation by revenue 2014
Exhibit 39: Express Scripts: Business segmentation by revenue 2013 and 2014 ($ billions)
Exhibit 40: OptumRx: Service segmentation
Exhibit 41: Prime Therapeutics: Business segmentation
