$557.5bn
$XX.Xbn
597k
87
$XX.Xbn
Since its inception in the 1960s, the Pharmacy Benefit Management (PBM) industry has evolved into one of the most central players in the pharmaceutical supply chain in the US. Responsible for administering prescription drug benefits, PBM providers have grown parallel with the leading drug manufacturers and health insurers in recent years as patients' use of pharmaceuticals has grown. Alongside this growth has come massive consolidation activity; horizontal integration over decades brought the number of PBMs down to 30 in 2016, with a spike in vertical integration activity in 2018 completely restructuring the industry. Today, the three leading PBMs are vertically integrated behemoths responsible for over 80.0% of all prescription claims in the US, on average. However, this vertical integration has captured the attention of regulators and policymakers concerned about anticompetitive practices and misaligned incentives. In all, revenue has been expanding at a CAGR of 1.3% to an estimated $557.5 billion over the past five years, including expected growth of 1.4% in 2024.
Industry revenue has grown at a CAGR of 1.3 % over the past five years, to reach an estimated $557.5bn in 2024.
Market size is projected to grow over the next five years.
Company | Market Share (%)
2024 | Revenue ($m)
2024 | Profit ($m)
2024 | Profit Margin (%)
2024 |
---|---|---|---|---|
Cvs Health Corporation | 148,833.7 | 5,962.4 | 4.0 | |
Cigna Corp | 118,555.1 | 6,077.0 | 5.1 | |
Unitedhealth Group Incorporated | 94,135.9 | 4,685.7 | 5.0 |
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Industry revenue is measured across several distinct product and services lines, including Retail pharmacy services, Specialty pharmacy services and Other services. Retail pharmacy services is the largest segment of the Pharmacy Benefit Management in the US.
Retail pharmacy services have been a stable source of revenue
Pharmacy benefit management (PBM) providers act as intermediaries between insurers, pharmacies and patients in managing prescription drug benefits. They negotiate pricing, process claims, develop formularies and offer clinical programs. PBMs aim to control medication costs, ensure access and improve patient adherence and health outcomes.
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NAICS 52411 - Pharmacy Benefit Management in the US
Get an indication of the industry's health through historical, current and forward-looking trends in the performance indicators that make or break businesses.
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The scale and scope of the leading PBMs draw anticompetitive concerns. Regulators and health stakeholders cite that vertical integration in the largest PBMs prevents healthy ...
Learn about the performance of the top companies in the industry.
The top three PBMs control around 80.0% of all prescription claims in the US. CVS Caremark, Cigna and UnitedHealth are vertically integrated PBMs whose annual revenue exceeds...
Understand the demographic, economic and regulatory factors that shape how businesses in an industry perform.
Regulators are scrutinizing PBMs' role and incentives in the pharmaceutical supply chain. Pending legislation and FTC inquiries are anticipated to restrict common practices i...
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PBMs leverage advanced technology platforms for various aspects of benefit management. Steep investments in IT infrastructure, software development and data security measures...
Including values and annual change:
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Key data sources in the US include:
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The market size of the Pharmacy Benefit Management in the US industry in United States is $557.5bn in 2024.
There are 87 businesses in the Pharmacy Benefit Management in the US industry in United States, which has grown at a CAGR of 5.7 % between 2019 and 2024.
The market size of the Pharmacy Benefit Management in the US industry in United States has been growing at a CAGR of 1.3 % between 2019 and 2024.
Over the next five years, the Pharmacy Benefit Management in the US industry in United States is expected to grow.
The biggest companies operating in the Pharmacy Benefit Management market in United States are Cvs Health Corporation, Cigna Corp and Unitedhealth Group Incorporated
Processing network revenue prescriptions and Processing home delivery and specialty prescriptions are part of the Pharmacy Benefit Management in the US industry.
The company holding the most market share in United States is Cvs Health Corporation.
The level of competition is moderate and increasing in the Pharmacy Benefit Management in the US industry in United States.