Pharmacy Benefit Management Services Market Research Report—Forecast till 2027

Pharmacy Benefit Management Services Market Report: Information by Service (Retail pharmacy services, Specialty pharmacy services, Benefit plan design and consultation, Others), End User (Healthcare Providers, Employers)- Forecast till 2027

ID: MRFR/HC/6374-HCR | February 2021 | Region: Global | 85 pages

Impact of COVID-19 on the Global Pharmacy Benefit Management Services Market


The World Health Organization (WHO) declared COVID-19 a pandemic in March 2020 owing to the surging outbreaks in several countries across the globe. A public health emergency was declared, and measures were circulated to prevent the spread of the virus. Currently, the quick spread of COVID-19 is having a pervasive impact on several industries and markets.


Many pharmacy benefit management (PBM) companies are working on developing policies to address the rapidly changing market landscape. These companies act as third-party drug program administrators for their clients, typically interfacing with health plan insurers, retail pharmacy chains, and drug manufacturers. PBM systems ensure that every drug dispensed by a prescription is cross-checked with rules set by the health authority and insurance companies. Thus, PBM companies are the foremost influencers in the supply chain of outpatient pharmaceutical products, such as medications and drugs. Financing, distributing, pricing, and shipping are factors that affect how prescription medications are dispensed. The current scenario can have a significant effect on the global pharmacy benefit management services market.


Due to the global pandemic scenario, it is evident that there is a shortage of medications. As several countries depend on imports for medications, this can cause a major disruption in the supply chain of drugs. Therefore, it is uncertain whether the PBM companies will be able to ensure an adequate supply of medicines. A possible short-term supply disruption within pharmacies and healthcare provider organizations for select medications, as a direct result of demand surge, can occur. PBM companies that own pharmacies can increase their orders to keep up with the demand owing to the significant growth of mail-order and specialty utilization. Since inventory levels can be affected, ramping up the on-premises inventory levels of the most used drugs to ensure easy access is crucial.


With the increasing prescription rates, the administrative burden of the service providers can increase drastically. This can result in interference in the functioning of the pharmacy management systems. PBM companies can decide on extending prior authorizations for previously approved prescriptions. These policies can aid in the reduction of the administrative burden on providers, allowing more resources to be devoted to combating the COVID-19 outbreak. Several drugs are being used in the acute care setting to treat severe cases of COVID-19. A lot of companies offering PBM services are introducing utilization management product bundles for these medications. These measures are being enacted to help ensure that an adequate supply of necessary medications is maintained for use in acute care settings while also balancing the needs of existing patients in outpatient settings.


Many PBM companies are using shelter-in-place policies as an opportunity to migrate members with medications for chronic conditions to mail-order pharmacies. Proactive strategies such as direct-to-member mail and telephone communications are being used to engage members and educate them about mail-order pharmacy services.


Moreover, some PBMs are allowing temporary overrides for non-preferred items, but still allowing members to pay preferred co-pays. This can be enacted if a specific pharmacy is out of stock for the preferred drug, and the patient has an immediate need for the prescription. This could cause plan costs to increase due to increased utilization of non-preferred drugs compared to preferred drugs.


Supply chain management and drug availability play an important role in the algorithm that PBMs and pharmacies employ to manage pricing. Owing to the increasing supply-demand gap, the pricing schemes and the factors used in the pricing algorithms have been negatively affected. Managing compound utilization to ensure treatments are paid in line with plan designs can be difficult for companies that provide PBM services.


Parameters that influence the pricing for PBM services include:



  • Monitoring the categorization of drugs, such as specialty, single-source, or limited distribution drugs

  • Reviewing the type of pharmacy channel that is being used for dispensing

  • Validating the coding applied by pharmacies such as price override codes

  • Employing co-pay or formulary overrides for treatments

  • Confirming that rebate-eligible drugs are receiving the full value as per the PBM contract

  • Obtaining the price protections that PBM companies have contracted with plan sponsors to maximize contract value

Table of Contents:

Chapter 1. Report Prologue

Chapter 2. Market Introduction

2.1. Definition

2.2. Scope of the Study

2.2.1. Research Objective

2.2.2. Assumptions

2.2.3. Limitations

Chapter 3. Research Methodology

3.1. Introduction

3.2. Primary Research

3.3. Secondary Research

3.4. Market Size Estimation

Chapter 4. Market Dynamics

4.1. Drivers

4.2. Restraints

4.3. Opportunities

4.4. Challenges

4.5. Macroeconomic Indicators

Chapter 5. Market Factor Analysis

5.1. Porter’s Five Forces Analysis

5.1.1. Bargaining Power of Suppliers

5.1.2. Bargaining Power of Buyers

5.1.3. Threat of New Entrants

5.1.4. Threat of Substitutes

5.1.5. Intensity of Rivalry

5.2. Value Chain Analysis

5.3. Investment Feasibility Analysis

Chapter 6. Global Pharmacy Benefit Management Services Market, by Service

6.1. Introduction

6.2. Retail Pharmacy Services

Market Estimates & Forecast, by Region, 2020–2027

Market Estimates & Forecast, by Country, 2020–2027

6.3. Specialty Pharmacy Services

Market Estimates & Forecast, by Region, 2020–2027

Market Estimates & Forecast, by Country, 2020–2027

6.4. Benefit Plan Design and Consultation

Market Estimates & Forecast, by Region, 2020–2027

Market Estimates & Forecast, by Country, 2020–2027

6.5. Drug Formulary Management

Market Estimates & Forecast, by Region, 2020–2027

Market Estimates & Forecast, by Country, 2020–2027

6.6. Others

Chapter 7. Global Pharmacy Benefit Management Services Market, by End User

7.1. Introduction

7.2. Healthcare Providers

Market Estimates & Forecast, by Region, 2020–2027

Market Estimates & Forecast, by Country, 2020–2027

7.3. Employers

Market Estimates & Forecast, by Region, 2020–2027

Market Estimates & Forecast, by Country, 2020–2027

7.4. Drug Manufacturers

Market Estimates & Forecast, by Region, 2020–2027

Market Estimates & Forecast, by Country, 2020–2027

7.5. Others

Chapter 8. Global Pharmacy Benefit Management Services Market, by Region

8.1. Introduction

8.2. Americas

8.2.1. North America

8.2.1.1. US

8.2.1.2. Canada

8.2.2. Latin America

8.3. Europe

8.3.1. Western Europe

8.3.1.1. Germany

8.3.1.2. France

8.3.1.3. Italy

8.3.1.4. Spain

8.3.1.5. UK

8.3.1.6. Rest of Western Europe

8.3.2. Eastern Europe

8.4. Asia-Pacific

8.4.1. Japan

8.4.2. China

8.4.3. India

8.4.4. Australia

8.4.5. South Korea

8.4.6. Rest of Asia-Pacific

8.5. Middle East & Africa

8.5.1. Middle East

8.5.2. Africa

Chapter 9. Company Landscape

9.1. Introduction

9.2. Market Share Analysis

9.3. Key Developments & Strategies

Chapter 10. Company Profiles

10.1. abarca health LLC.

10.1.1. Company Overview

10.1.2. Product Overview

10.1.3. Financial Overview

10.1.4. Key Developments

10.1.5. SWOT Analysis

10.1.6. Key Strategies

10.2. CVS Health

10.2.1. Company Overview

10.2.2. Product Overview

10.2.3. Financial Overview

10.2.4. Key Developments

10.2.5. SWOT Analysis

10.2.6. Key Strategies

10.3. Express Scripts

10.3.1. Company Overview

10.3.2. Product Overview

10.3.3. Financial Overview

10.3.4. Key Developments

10.3.5. SWOT Analysis

10.3.6. Key Strategies

10.4. Humana Pharmacy Solutions

10.4.1. Company Overview

10.4.2. Product Overview

10.4.3. Financial Overview

10.4.4. Key Developments

10.4.5. SWOT Analysis

10.4.6. Key Strategies

10.5. Magellan Rx Management

10.5.1. Company Overview

10.5.2. Product Overview

10.5.3. Financial Overview

10.5.4. Key Developments

10.5.5. SWOT Analysis

10.5.6. Key Strategies

10.6. McKesson Corporation

10.6.1. Company Overview

10.6.2. Product Overview

10.6.3. Financial Overview

10.6.4. Key Developments

10.6.5. SWOT Analysis

10.6.6. Key Strategies

10.7. Medimpact Healthcare

10.7.1. Company Overview

10.7.2. Product Overview

10.7.3. Financial Overview

10.7.4. Key Developments

10.7.5. SWOT Analysis

10.7.6. Key Strategies

10.8. MeridianRx

10.8.1. Company Overview

10.8.2. Product Overview

10.8.3. Financial Overview

10.8.4. Key Developments

10.8.5. SWOT Analysis

10.8.6. Key Strategies

10.9. OptumRx (UnitedHealth)

10.9.1. Company Overview

10.9.2. Product Overview

10.9.3. Financial Overview

10.9.4. Key Developments

10.9.5. SWOT Analysis

10.9.6. Key Strategies

10.10. Prime Therapeutics

10.10.1. Company Overview

10.10.2. Product Overview

10.10.3. Financial Overview

10.10.4. Key Developments

10.10.5. SWOT Analysis

10.10.6. Key Strategies

10.11. Sea Rainbow

10.11.1. Company Overview

10.11.2. Product Overview

10.11.3. Financial Overview

10.11.4. Key Developments

10.11.5. SWOT Analysis

10.11.6. Key Strategies

10.12. Vidalink

10.12.1. Company Overview

10.12.2. Product Overview

10.12.3. Financial Overview

10.12.4. Key Developments

10.12.5. SWOT Analysis

10.12.6. Key Strategies

10.13. Others

10.14. .

Chapter 11. MRFR Conclusion

11.1. Key Findings

11.1.1. From CEO’s Viewpoint

11.1.2. Unmet Needs of the Market

11.2. Key Companies to Watch

11.3. Predictions for the Pharmacy Benefit Management Services Industry

Chapter 12. Appendix


LIST OF TABLES

Table 1. Global Pharmacy Benefit Management Services Market Synopsis, 2020–2027

Table 2. Global Pharmacy Benefit Management Services Market Estimates and Forecast, 2020–2027 (USD Million)

Table 3. Global Pharmacy Benefit Management Services Market, by Region, 2020–2027 (USD Million)

Table 4. Global Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 5. Global Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 6. North America: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 7. North America: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 8. US: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 9. US: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 10. Canada: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 11. Canada: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 12. Latin America: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 13. Latin America: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 14. Europe: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 15. Europe: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 16. Western Europe: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 17. Western Europe: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 18. Eastern Europe: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 19. Eastern Europe: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 20. Asia-Pacific: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 21. Asia-Pacific: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

Table 22. Middle East & Africa: Pharmacy Benefit Management Services Market, by Service, 2020–2027 (USD Million)

Table 23. Middle East & Africa: Pharmacy Benefit Management Services Market, by End User, 2020–2027 (USD Million)

LIST OF FIGURES

Figure 1. Research Process

Figure 2. Segmentation for Global Pharmacy Benefit Management Services Market

Figure 3. Segmentation Market Dynamics for Global Pharmacy Benefit Management Services Market

Figure 4. Global Pharmacy Benefit Management Services Market Share, by Service, 2020

Figure 5. Global Pharmacy Benefit Management Services Market Share, by End User, 2020

Figure 6. Global Pharmacy Benefit Management Services Market Share, by Region, 2020

Figure 7. North America: Pharmacy Benefit Management Services Market Share, by Country, 2020

Figure 8. Europe: Pharmacy Benefit Management Services Market Share, by Country, 2020

Figure 9. Asia-Pacific: Pharmacy Benefit Management Services Market Share, by Country, 2020

Figure 10. Middle East & Africa: Pharmacy Benefit Management Services Market Share, by Country, 2020

Figure 11. Global Pharmacy Benefit Management Services Market: Company Share Analysis, 2020 (%)

Figure 12. Abarca health LLC.: Key Financials

Figure 13. Abarca health LLC.: Segmental Revenue

Figure 14. Abarca health LLC.: Geographical Revenue

Figure 15. CVS Health: Key Financials

Figure 16. CVS Health: Segmental Revenue

Figure 17. CVS Health: Geographical Revenue

Figure 18. Express Scripts: Key Financials

Figure 19. Express Scripts: Segmental Revenue

Figure 20. Express Scripts: Geographical Revenue

Figure 21. Humana Pharmacy Solutions: Key Financials

Figure 22. Humana Pharmacy Solutions: Segmental Revenue

Figure 23. Humana Pharmacy Solutions: Geographical Revenue

Figure 24. Magellan Rx Management: Key Financials

Figure 25. Magellan Rx Management: Segmental Revenue

Figure 26. Magellan Rx Management: Geographical Revenue

Figure 27. McKesson Corporation: Key Financials

Figure 28. McKesson Corporation: Segmental Revenue

Figure 29. McKesson Corporation: Geographical Revenue

Figure 30. Medimpact Healthcare: Key Financials

Figure 31. Medimpact Healthcare: Segmental Revenue

Figure 32. Medimpact Healthcare: Geographical Revenue

Figure 33. MeridianRx: Key Financials

Figure 34. MeridianRx: Segmental Revenue

Figure 35. MeridianRx: Geographical Revenue

Figure 36. OptumRx (UnitedHealth): Key Financials

Figure 37. OptumRx (UnitedHealth): Segmental Revenue

Figure 38. OptumRx (UnitedHealth): Geographical Revenue

Figure 39. Prime Therapeutics: Key Financials

Figure 40. Prime Therapeutics: Segmental Revenue

Figure 41. Prime Therapeutics: Geographical Revenue

Figure 42. Sea Rainbow: Key Financials

Figure 43. Sea Rainbow: Segmental Revenue

Figure 44. Sea Rainbow: Geographical Revenue

Figure 45. Vidalink: Key Financials

Figure 46. Vidalink: Segmental Revenue

Figure 47. Vidalink: Geographical Revenue



This table of content is tentative and subject to change as the research progresses.

Please Note:  Financial details of company cannot be provided if the information of the company is not available in public domain and or reliable source.