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US Pharmacy Benefit Management Services Market

ID: MRFR/Pharma/14803-HCR
100 Pages
Vikita Thakur
Last Updated: April 06, 2026

US Pharmacy Benefit Management Services Market Research Report: Size, Share, Trend Analysis By Service Type (Claims Management, Formulary Management, Drug Utilization Review, Medication Therapy Management), By End Users (Pharmacies, Health Plans, Employers, Public Sector), By Service Provider (Standalone Pharmacy Benefit Managers, Health Insurance Companies, Integrated Health Systems) and By Operating Model (Fully-Managed Services, Pass-Through Services, Hybrid Services) - Growth Outlook & Industry Forecast 2025 To 2035

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US Pharmacy Benefit Management Services Market Infographic
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Summary Table of Contents Segmentation Download PDF
  1. 1 SECTION I: EXECUTIVE SUMMARY AND KEY HIGHLIGHTS
    1. 1.1 EXECUTIVE SUMMARY
      1. 1.1.1 Market Overview
      2. 1.1.2 Key Findings
      3. 1.1.3 Market Segmentation
      4. 1.1.4 Competitive Landscape
      5. 1.1.5 Challenges and Opportunities
      6. 1.1.6 Future Outlook
  2. 2 SECTION II: SCOPING, METHODOLOGY AND MARKET STRUCTURE
    1. 2.1 MARKET INTRODUCTION
      1. 2.1.1 Definition
      2. 2.1.2 Scope of the study
        1. 2.1.2.1 Research Objective
        2. 2.1.2.2 Assumption
        3. 2.1.2.3 Limitations
    2. 2.2 RESEARCH METHODOLOGY
      1. 2.2.1 Overview
      2. 2.2.2 Data Mining
      3. 2.2.3 Secondary Research
      4. 2.2.4 Primary Research
        1. 2.2.4.1 Primary Interviews and Information Gathering Process
        2. 2.2.4.2 Breakdown of Primary Respondents
      5. 2.2.5 Forecasting Model
      6. 2.2.6 Market Size Estimation
        1. 2.2.6.1 Bottom-Up Approach
        2. 2.2.6.2 Top-Down Approach
      7. 2.2.7 Data Triangulation
      8. 2.2.8 Validation
  3. 3 SECTION III: QUALITATIVE ANALYSIS
    1. 3.1 MARKET DYNAMICS
      1. 3.1.1 Overview
      2. 3.1.2 Drivers
      3. 3.1.3 Restraints
      4. 3.1.4 Opportunities
    2. 3.2 MARKET FACTOR ANALYSIS
      1. 3.2.1 Value chain Analysis
      2. 3.2.2 Porter's Five Forces Analysis
        1. 3.2.2.1 Bargaining Power of Suppliers
        2. 3.2.2.2 Bargaining Power of Buyers
        3. 3.2.2.3 Threat of New Entrants
        4. 3.2.2.4 Threat of Substitutes
        5. 3.2.2.5 Intensity of Rivalry
      3. 3.2.3 COVID-19 Impact Analysis
        1. 3.2.3.1 Market Impact Analysis
        2. 3.2.3.2 Regional Impact
        3. 3.2.3.3 Opportunity and Threat Analysis
  4. 4 SECTION IV: QUANTITATIVE ANALYSIS
    1. 4.1 Chemicals and Materials, BY Type (USD Billion)
      1. 4.1.1 Claims Management
      2. 4.1.2 Formulary Management
      3. 4.1.3 Drug Utilization Review
      4. 4.1.4 Medication Therapy Management
    2. 4.2 Chemicals and Materials, BY End User (USD Billion)
      1. 4.2.1 Pharmacies
      2. 4.2.2 Health Plans
      3. 4.2.3 Employers
      4. 4.2.4 Public Sector
    3. 4.3 Chemicals and Materials, BY Service Provider (USD Billion)
      1. 4.3.1 Standalone Pharmacy Benefit Managers
      2. 4.3.2 Health Insurance Companies
      3. 4.3.3 Integrated Health Systems
    4. 4.4 Chemicals and Materials, BY Operating Model (USD Billion)
      1. 4.4.1 Fully-Managed Services
      2. 4.4.2 Pass-Through Services
      3. 4.4.3 Hybrid Services
  5. 5 SECTION V: COMPETITIVE ANALYSIS
    1. 5.1 Competitive Landscape
      1. 5.1.1 Overview
      2. 5.1.2 Competitive Analysis
      3. 5.1.3 Market share Analysis
      4. 5.1.4 Major Growth Strategy in the Chemicals and Materials
      5. 5.1.5 Competitive Benchmarking
      6. 5.1.6 Leading Players in Terms of Number of Developments in the Chemicals and Materials
      7. 5.1.7 Key developments and growth strategies
        1. 5.1.7.1 New Product Launch/Service Deployment
        2. 5.1.7.2 Merger & Acquisitions
        3. 5.1.7.3 Joint Ventures
      8. 5.1.8 Major Players Financial Matrix
        1. 5.1.8.1 Sales and Operating Income
        2. 5.1.8.2 Major Players R&D Expenditure. 2023
    2. 5.2 Company Profiles
      1. 5.2.1 CVS Health (US)
        1. 5.2.1.1 Financial Overview
        2. 5.2.1.2 Products Offered
        3. 5.2.1.3 Key Developments
        4. 5.2.1.4 SWOT Analysis
        5. 5.2.1.5 Key Strategies
      2. 5.2.2 Express Scripts (US)
        1. 5.2.2.1 Financial Overview
        2. 5.2.2.2 Products Offered
        3. 5.2.2.3 Key Developments
        4. 5.2.2.4 SWOT Analysis
        5. 5.2.2.5 Key Strategies
      3. 5.2.3 OptumRx (US)
        1. 5.2.3.1 Financial Overview
        2. 5.2.3.2 Products Offered
        3. 5.2.3.3 Key Developments
        4. 5.2.3.4 SWOT Analysis
        5. 5.2.3.5 Key Strategies
      4. 5.2.4 Humana (US)
        1. 5.2.4.1 Financial Overview
        2. 5.2.4.2 Products Offered
        3. 5.2.4.3 Key Developments
        4. 5.2.4.4 SWOT Analysis
        5. 5.2.4.5 Key Strategies
      5. 5.2.5 Cigna (US)
        1. 5.2.5.1 Financial Overview
        2. 5.2.5.2 Products Offered
        3. 5.2.5.3 Key Developments
        4. 5.2.5.4 SWOT Analysis
        5. 5.2.5.5 Key Strategies
      6. 5.2.6 Prime Therapeutics (US)
        1. 5.2.6.1 Financial Overview
        2. 5.2.6.2 Products Offered
        3. 5.2.6.3 Key Developments
        4. 5.2.6.4 SWOT Analysis
        5. 5.2.6.5 Key Strategies
      7. 5.2.7 MedImpact (US)
        1. 5.2.7.1 Financial Overview
        2. 5.2.7.2 Products Offered
        3. 5.2.7.3 Key Developments
        4. 5.2.7.4 SWOT Analysis
        5. 5.2.7.5 Key Strategies
      8. 5.2.8 EnvisionRx (US)
        1. 5.2.8.1 Financial Overview
        2. 5.2.8.2 Products Offered
        3. 5.2.8.3 Key Developments
        4. 5.2.8.4 SWOT Analysis
        5. 5.2.8.5 Key Strategies
    3. 5.3 Appendix
      1. 5.3.1 References
      2. 5.3.2 Related Reports
  6. 6 LIST OF FIGURES
    1. 6.1 MARKET SYNOPSIS
    2. 6.2 US MARKET ANALYSIS BY TYPE
    3. 6.3 US MARKET ANALYSIS BY END USER
    4. 6.4 US MARKET ANALYSIS BY SERVICE PROVIDER
    5. 6.5 US MARKET ANALYSIS BY OPERATING MODEL
    6. 6.6 KEY BUYING CRITERIA OF CHEMICALS AND MATERIALS
    7. 6.7 RESEARCH PROCESS OF MRFR
    8. 6.8 DRO ANALYSIS OF CHEMICALS AND MATERIALS
    9. 6.9 DRIVERS IMPACT ANALYSIS: CHEMICALS AND MATERIALS
    10. 6.10 RESTRAINTS IMPACT ANALYSIS: CHEMICALS AND MATERIALS
    11. 6.11 SUPPLY / VALUE CHAIN: CHEMICALS AND MATERIALS
    12. 6.12 CHEMICALS AND MATERIALS, BY TYPE, 2024 (% SHARE)
    13. 6.13 CHEMICALS AND MATERIALS, BY TYPE, 2024 TO 2035 (USD Billion)
    14. 6.14 CHEMICALS AND MATERIALS, BY END USER, 2024 (% SHARE)
    15. 6.15 CHEMICALS AND MATERIALS, BY END USER, 2024 TO 2035 (USD Billion)
    16. 6.16 CHEMICALS AND MATERIALS, BY SERVICE PROVIDER, 2024 (% SHARE)
    17. 6.17 CHEMICALS AND MATERIALS, BY SERVICE PROVIDER, 2024 TO 2035 (USD Billion)
    18. 6.18 CHEMICALS AND MATERIALS, BY OPERATING MODEL, 2024 (% SHARE)
    19. 6.19 CHEMICALS AND MATERIALS, BY OPERATING MODEL, 2024 TO 2035 (USD Billion)
    20. 6.20 BENCHMARKING OF MAJOR COMPETITORS
  7. 7 LIST OF TABLES
    1. 7.1 LIST OF ASSUMPTIONS
  8. 7.1.1
    1. 7.2 US MARKET SIZE ESTIMATES; FORECAST
      1. 7.2.1 BY TYPE, 2025-2035 (USD Billion)
      2. 7.2.2 BY END USER, 2025-2035 (USD Billion)
      3. 7.2.3 BY SERVICE PROVIDER, 2025-2035 (USD Billion)
      4. 7.2.4 BY OPERATING MODEL, 2025-2035 (USD Billion)
    2. 7.3 PRODUCT LAUNCH/PRODUCT DEVELOPMENT/APPROVAL
  9. 7.3.1
    1. 7.4 ACQUISITION/PARTNERSHIP
  10. 7.4.1

US Chemicals and Materials Market Segmentation

Chemicals and Materials By Type (USD Billion, 2025-2035)

  • Claims Management
  • Formulary Management
  • Drug Utilization Review
  • Medication Therapy Management

Chemicals and Materials By End User (USD Billion, 2025-2035)

  • Pharmacies
  • Health Plans
  • Employers
  • Public Sector

Chemicals and Materials By Service Provider (USD Billion, 2025-2035)

  • Standalone Pharmacy Benefit Managers
  • Health Insurance Companies
  • Integrated Health Systems

Chemicals and Materials By Operating Model (USD Billion, 2025-2035)

  • Fully-Managed Services
  • Pass-Through Services
  • Hybrid Services

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