The US Pharmacy Benefit Management Market to Reach $680 Billion by 2029 - Focus Insight Report by Arizton

According to the latest research report, the US pharmacy benefit management market is growing at a CAGR of 5.56% during 2023-2029. 

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The US is the largest global pharmacy benefit management market revenue contributor. The demand for the pharmacy benefit management market is rising due to multiple factors, including the rising baby boomers, the rising aging population, the increase in healthcare expenditure, the growing prevalence of heart diseases and nerve disorders, and the growing awareness among the general population. In 2023, the commercial health plans segment by health plans dominated the pharmacy benefit management market with 57.81% occupancy and is expected to grow at a CAGR of 5.29% during the forecast period as the commercial health plans are associated with the number of healthcare organizations. The Medicare plan segment is the fastest-growing segment and is expected to generate a revenue of $225.32 billion by the end of the forecasting period. 

The south region dominated the segment with 29.66% in 2023 and is expected to occupy 30.65% by the end of the forecasting year. This region is the fastest growing, with an absolute growth of 43.02% and incremental growth of $62.76 billion during the forecast period. It is observed that southern states have the highest number of adults who skip care due to the cost and some of the highest rates of uninsured people. Kentucky, West Virginia, Virginia, and Louisiana are the top states with a high percentage of insurers among the southern states in the US. It is observed that 90% of the total population is insured by government or non-government firms. 

The U.S. pharmacy benefit management (PBM) market report includes exclusive data on 27 vendors. CVS Health, Cigna Healthcare, United Health Group, Prime Therapeutics, MedImpact, and Humana dominate the U.S. Pharmacy Benefit Management market. The major players focus on strategic acquisitions and collaborations with emerging players to enter the pharmacy benefit management market and gain a competitive advantage. 

Product Segmentation & Forecast 

Health Plan 

• Commercial Health Plans 
• Medicare Plan 
• Medicaid Plan 
• Others 

Business Model 

• Insurance Companies & Retail Pharmacies 
• Pure Play PBMs 

Service 

• Special Pharmacy Services 
• Retail Pharmacy Networks 
• Mail-order pharmacy services 
• Claims Processing 
• Formulary Management 
• Drug Utilization Review 
• Price, Discount & Rebate Negotiations 
• Disease Management & Adherence Initiatives 

Region 

• Unites States 
• South  
• Mid-West 
• West 
• Northeast 

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Vendors List 

Key Vendors 

• CVS Health 
• Cigna Healthcare 
• UnitedHealth Group 
• Prime Therapeutics 
• MedImpact 
• Humana 

Other Prominent Vendors 

• Abarca 
• Elevance Health 
• AscellaHealth 
• CaptureRx 
• Centene 
• Change Healthcare 
• CitizensRx 
• Elixir 
• MedalistRx 
• MaxorPlus 
• Navitus Health Solutions 
• PerformRx 
• WellDyne 
• ProCare Rx 
• NirvanaHealth 
• Anthem 
• BeneCard PBM 
• Shields Health Solutions 
• MagellanRx Management 
• Walgreens Boots Alliance 
• RITE AID 

Key Questions Answered in the Report  

How big is the U.S. pharmacy benefit management market? 

What is the growth rate of the U.S. pharmacy benefit management market? 

Who are the dominating players in the U.S. pharmacy benefit management market? 

Table of Content 

CHAPTER – 1: Pharmacy Benefit Management Market Overview 

• Executive Summary 
• Key Findings 

CHAPTER – 2: Pharmacy Benefit Management Market 

• US: Projected Revenue of Pharmacy Benefit Management Market (2020-2029; $Billions) 

CHAPTER – 3: Pharmacy Benefit Management Market Segmentation Data 

• US: Projected Revenue by Health Plan (2020-2029; $Billions) 
• Commercial Health Plans 
• Medicare Plan 
• Medicaid Plan 
• Others 
• U.S.: Projected Revenue by Business Model (2020-2029; $Billions) 
• Insurance Companies & Retail Pharmacies 
• Pure Play PBMs 
• US: Projected Revenue by Services (2020-2029; $Billions) 
• Special Pharmacy Services 
• Retail Pharmacy Networks 
• Mail-Order Pharmacy Services 
• Claims Processing 
• Formulary Management 
• Drug Utilization Review 
• Price, Discount & Rebate Negotiations 
• Disease Management and Adherence Initiatives 
• U.S.: Projected Revenue by Region (2020-2029; $Billions) 
• South Region 
• Mid-West Region 
• West Region 
• Northeast Region 

CHAPTER – 4: Pharmacy Benefit Management Market Prospects & Opportunities 

• Pharmacy Benefit Management Market Opportunities & Trends 
• Pharmacy Benefit Management Market Drivers 
• Pharmacy Benefit Management Market Constraints 

CHAPTER – 5: Pharmacy Benefit Management Industry Overview 

• Pharmacy Benefit Management Market - Competitive Landscape 
• Pharmacy Benefit Management Market – Key Vendor Profiles 
• Pharmacy Benefit Management Market - Other Prominent Vendors 
• Pharmacy Benefit Management Market - Key Strategic Recommendations 

CHAPTER – 6: Appendix 

• Research Methodology 
• Abbreviations 
• About Arizton 

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