The U.S. pharmacy benefits management market size is projected to reach USD 744.6 billion by 2026, according to a new report by Grand View Research, Inc., exhibiting a CAGR of 9.2% during the forecast period. Increasing vertical integration of key market players, rising prevalence of chronic disease, and shrinking FDA generic-approval backlog are some of the primary growth stimulants for the market.
Vertical
integration of pharmacy benefits management (PBM) organizations with health
insurance companies are poised to result in increased control of PBMs over
distribution systems. This will lead to rise in rebates, ultimately increasing
the cost of drug list prices. Moreover, it will result in a monopoly of certain
market player, concentrating sales and revenue generation.
The
business of insuring and administering employee benefit programs in the
country, especially, health care programs, is heavily regulated by federal and
state laws and administrative agencies, such as the Department of Health and
Human Services (HHS), State Departments of Insurance, Centers for Medicare
& Medicaid Services (CMS), Internal Revenue Services, and Departments of
Labor.
All
PBM businesses in the U.S. must include home delivery and specialty pharmacies
licensed as pharmacies in the states of establishment. Several states in the
country regulate the scope of prescription (Rx) drug coverage and delivery
channels to receive drugs for managed care organizations (MCOs), insurers, and
Medicaid care plans. Certain home delivery and specialty pharmacies must be
registered with the U.S. Drug Enforcement Administration (DEA) and individual
state controlled substance authorities.
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Further key
findings from the study suggest:
- Based on
business model, the market has been segmented into standalone PBM, health
insurance providers, and retail pharmacy. Of these, PBMs associated with
health insurers are likely to witness the fastest growth over the forecast
period
- Rise in
mergers and partnerships between market players is expected to result in
an increased demand for PBM systems
- OptumRx and
Express Scripts (merged with Cigna in December 2018) are among the key
players merged or acquired by large health insurance providers
- Based on end
use, the market has been divided into commercial and federal. Commercial
PBM systems dominated the market and are estimated to maintain their
dominance through 2026 owing to a large number of covered patients
- CVS Health;
Aetna; Express Scripts; Cigna; OptumRx, Inc.; Walgreens Booth Alliance;
MedImpact Healthcare Systems, Inc.; Anthem; and Rite Aid are some of the
key players in the market.
Grand View Research has
segmented the U.S. pharmacy benefits management (PBM) market based on business
model and end use:
U.S. Pharmacy
Benefit Management Business Model Outlook (Revenue, USD Billion, 2015 - 2026)
- Standalone PBMs
- Health Insurance Providers
- Retail Pharmacy
U.S. Pharmacy
Benefit Management End-use Outlook (Revenue, USD Billion, 2015 - 2026)
- Commercial
- Federal
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About Grand View Research
Grand
View Research, Inc. is a U.S. based market research and consulting company,
registered in the State of California and headquartered in San Francisco. The
company provides syndicated research reports, customized research reports, and
consulting services. To help clients make informed business decisions, we offer
market intelligence studies ensuring relevant and fact-based research across a
range of industries, from technology to chemicals, materials and healthcare.
For more info visit @ https://www.grandviewresearch.com
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