Pharmacy Benefit Management Market Size, Growth, Report 2032

The global pharmacy benefit management market size reached USD 559.40 billion in 2023 and is projected to surpass around USD 1,218.98 billion by 2032 with a CAGR of 9.04% from 2023 to 2032.

Key Points

North America led the global market with the highest market share in 2022.
Asia Pacific region is estimated to expand the fastest CAGR between 2023 and 2032.
By Service, the Specialty Pharmacy Services segment has held the largest market share of 34% in 2022.
By Service Provider, the insurance companies segment captured the biggest revenue share in 2022.
By Service Provider, the retail pharmacy segment is expected to expand at the fastest CAGR over the projected period.

The rapidly growing prevalence of various chronic diseases such as cancer, cardiovascular diseases, respiratory diseases, and diabetes among the global population, rising healthcare expenditure, growing adoption of healthcare insurances among the people, and rising penetration of the pharmacy benefit management service providers across the globe are the prominent factors that are expected to boost the growth of the global pharmacy benefit management market during the forecast period.

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The rising costs of the drugs leads to unaffordability among the majority of the patients. The major role of the pharmacy benefit management service providers is to reduce the prices of such drugs and make it affordable for the patients. The growing demand for the pharmacy benefit management services among the drug manufacturers, retail pharmacies, and health insurance providers is boosting the demand for the pharmacy benefit management services across the globe. The rising awareness among the people regarding the benefits of health insurances is boosting the adoption of insurance policies which is spurring the growth of the market significantly.

Moreover, the rising penetration of the online pharmacies and the growing number of acquisitions and mergers between the pharmacy benefit managers and the health insurance companies is significantly contributing to the growth of the global pharmacy benefit management market.

Report Highlights

Based on the service, the specialty pharmacies segment led the global market. This is attributed to the growing prevalence of chronic diseases and rising healthcare expenditure. The high prices of the specialty drugs are offered at low costs by the pharmacy benefit management service providers and hence led the growth of this segment in the market.
By service providers, the insurance companies dominated the market in 2021. The rapidly growing number of acquisitions and mergers between the pharmacy benefit managers and the insurance companies is the major factor behind the bolstering growth of this segment in the global market.

Regional Snapshot

North America dominated the global pharmacy benefit management market in 2021. The increased prevalence of chronic diseases among the US population, higher healthcare expenditure, and high penetration of the health insurance companies in US has led to the growth of the North America pharmacy benefit management market. More than half of the US population has one or more chronic diseases. Total healthcare expenditure increased to US$4.1 trillion or an increase of 9.7% in 2020 as compared to the previous year, as per the data provided by the Centers for Medicare and Medicaid Services. The US is home to the leading drug manufacturers, pharmacy benefit management service providers, and insurers. These market participants have significantly contributed to the growth of the North America pharmacy benefit management market.

Asia Pacific is witnessing an increasing prevalence of various chronic diseases and rising healthcar4e expenditure. The growing adoption of the health insurances and regulatory reforms regarding the reimbursements are some of the prominent factors driving the Asia Pacific pharmacy benefit management market. The rapidly surging penetration on the various pharmacy benefit management providers in the region is expected to have a significant impact on the growth of the market during the forecast period.

Table of Contents

Pharmacy Benefit Management Market Scope

Report Coverage	Details
Growth Rate from 2023 to 2032	CAGR of 9.04%
Market Size in 2023	USD 559.40 Billion
Market Size by 2032	USD 1,218.98 Billion
Largest Market	North America
Fastest Growing Region	Asia Pacific
Base Year	2022
Forecast Period	2023 to 2032
Segments Covered	Service, Service Provider, Business Model, Region

Pharmacy Benefit Management Market Dynamics

Driver

Rising pharmaceutical expenditures

The growing prevalence of chronic diseases is increasing the demand for the various treatment options. The leading pharma manufacturers are focusing on the development branded and high cost drugs for the treatment of the diseases. The rising healthcare expenditures due to the rising prices of various OTC drugs and prescription drugs has led to the increased demand for the pharmacy benefit management service providers who act as a middlemen and reduces the costs of the drugs for the insurance companies and makes it available to the patient at affordable rates. This factor is expected to boost the demand for the pharmacy benefit managers in the forthcoming years.

Restraint

No transparency in the earnings

The rising drug spending and surging number of prescription filings are the major growth drivers of the pharmacy benefit management market. There is a transparency issue associated with the business model of the pharmacy benefit managers that are a major concern. The revenue sources of the pharmacy benefit service providers are rarely disclosed to the insurers, drug manufacturers, and the retail pharmacies. It results in a huge portion of costs of the drugs going into the pockets of the service providers. This factor is expected to reduce the adoption of these services which may hamper the market growth.

Opportunity

Rise in the adoption of Artificial intelligence

The surging adoption of the machine learning technologies in the pharmacy benefit management services is shifting the preferences of the service providers from the traditional workflow to the new and advanced workflow. This results in companies to offer streamline supply chain, quick delivery, and serve to a large number of retail pharmacies and insurers.

Challenge

Lack of insurance policies adoption

In the developing and underdeveloped economies, there is a low penetration and adoption of the healthcare insurance policies among the population owing to their low literacy rates and low awareness regarding the benefits of insurance policies. This is a major challenge that may restrict the market growth.

Pharmacy Benefit Management Market Players:

CVS Health
SS&C Technologies, Inc.
Anthem Inc.
Medimpact
Express Scripts Holding Company
Benecard Services, LLC
CaptureRx Inc.
Change Healthcare
OptumRx, Inc.
Cigna

Segments Covered in the Report

By Service

Specialty Pharmacy Services
Benefit Plan Design & Administration
Formulary Management
Pharmacy Claims Processing
Others

By Service Provider

Retail Pharmacies
Insurance Companies
Standalone Pharmacy Benefit Management Providers

By Business Model

Government Health Programs
Employer-sponsored Programs
Health Insurance Management

By Geography

North America
- U.S.
- Canada
Europe
- U.K.
- Germany
- France
Asia-Pacific
- China
- India
- Japan
- South Korea
- Malaysia
- Philippines
Latin America
- Brazil
- Rest of Latin America
Middle East & Africa (MEA)
- GCC
- North Africa
- South Africa
- Rest of the Middle East & Africa