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US Pharmacy Benefit Management (PBM) Industry Report: 2014 Edition
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Date: 21, January 2015 | Pages: 50
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In the US, Pharmacy Benefit Management (PBM) deals with the management of prescription drug programs. It acts as an intermediary between health plans, drug companies, retail pharmacies and patients. Initially, PBMs used to process pharmaceutical claims for health plans. But nowadays in addition to this, PBMs have created more significant ‘pharmacy benefit’ by providing a system for reimbursement of drug claims, processing and cost control. The US prescription volume and pharmaceutical sales has witnessed an exceptional growth over the past few years and the same pattern is likely to continue in the near future. Therefore, through rebates from pharmaceutical manufacturers, price discounts from retails, and effective mail service pharmacies, the PBMs emphasis on enabling the plan sponsors and individuals to obtain prescribed drugs at lower prices.


The PBM providers control drug spending and utilization by virtue of their advanced tools and techniques, encouraging use of generics and other lower-cost medications. In the US, there are some independent PBM’s while some are owned by managed care organizations and retail pharmacies. Today, the PBM industry has become more determined through a series of mergers and acquisitions.


Some of the factors driving the growth of the PBM industry are: accelerating US aging population, increasing life expectancy rate and incidences of chronic and infectious diseases which further increase the healthcare expenditure and pharmaceutical sales in the US. The ongoing trends and development in the PBM industry include rising medicare enrollments and increased acceptance of specialty drugs.


This report assesses the US PBM industry in terms of both market volume and market value. The increasing competition in the PBM industry has been analyzed on number of factors: revenue, dispensing specialty pharmaceuticals, claims and PDP lives. The top three companies having a vicious competition with each other and dominating the PBM industry are- Express Script, CVS Health and Catamaran. These players are being profiled in the report along with their key financials and strategies for growth. 

 

1. Overview


1.1 Introduction
1.2 History of PBM
1.3 Retail Dispensing Process & Flow of Funds
1.4 Mail Dispensing Process and Flow of Funds


2. The US PBM Market


2.1 Rx Market
-Market Volume
-Growth Rate
-Market Segments
-Branded Vs Generic Growth
-Dispensing Channels


2.2 Pharmaceutical Sales
-Sales Growth
-Branded Vs Generic Market
-Dispensing Channels


2.3 Specialty Drugs


3. Market Dynamics


3.1 Growth Drivers


3.1.1 Increasing Life Expectancy Rate in the US
3.1.2 Rising Healthcare Expenditure in the US
3.1.3 Rising Pharmaceutical Sales
3.1.4 Accelerating US Aging Population
3.1.5 Ameliorating Economic Conditions
3.1.6 Rising Incidences of Chronic and Infectious Diseases
3.1.7 Rising Medicare Enrollments


3.2 Trends and Developments


3.2.1 PBM Mergers and Acquisitions
3.2.2 Trends in Drug Prices
3.2.3 Increased Acceptance of Specialty Drugs
3.2.4 Average Wholesale Price Trend


3.3 Challenges


3.3.1 Lack of Insurer Capabilities
3.3.2 Regulator Risk


4. Competitive Landscape
-Share by Revenue
-Share by Prescription Volume
-Share by Claims
-Share by PDP Lives


5. Company Profiles


5.1 Express Script


5.1.1 Business Overview
5.1.2 Financial Overview
5.1.3 Business Strategies
-Introduction of Programs
-Development through Acquisitions


5.2 CVS Health


5.2.1 Business Overview
5.2.2 Financial Overview
5.2.3 Business Strategies
-Strategic Acquisitions
-HealthCare Programs


5.3 Catamaran


5.3.1 Business Overview
5.3.2 Financial Overview
5.3.3 Business Strategies
-Mergers and Acquisitions
-Expansion of HealthCare Reforms 

List of Charts


Types of PBM Services
PBM Managers Formulary Structure
History of PBMs
Retail Dispensing Process and Flow of Funds
Mail Dispensing Process and Flow of Funds
US Annual Prescription Growth- by Volume (2008-2018E)
US Monthly Prescription Volume Growth (Jan 2013- Oct 2014)
Rx Market Share by Segment (2014E)
US Monthly Branded Prescription Volume Growth (January 2013-October 2014)
US Monthly Generic Prescription Volume Growth (January 2013-October 2014)
US Annual Pharmaceutical Sales Growth (2007-2013)
US Monthly Pharmaceutical Sales Growth (January 2013-September 2014)
US Monthly Branded Pharmaceutical Sales Growth (January 2013-September 2014)
US Monthly Generic Pharmaceutical Sales Growth (2013-2014)
Pharmacy and Medical Benefit Spend (2012-2018E)
Utilization Rate by Dispensing Channel (2009-2013)
US Drug Spending Growth (2008-2013)
The US Life Expectancy Rate (2009-2014E)
The US Healthcare Expenditure Per Capita (2006-2013)
The US Pharmaceutical Sales (2010-2013)
The US Aging Population (2009-2013)
GNI of the US (2006-2013)
Medicare Enrollments (2006-2013)
Drugs Price Index (2008-2014)
Specialty Drug Spend (2012-2018)
Average Wholesale Price Trend (2013)
Market Share of Leading PBMs by Revenue (2013)
Market Share of PBMs by Adjusted Prescription Volume (2013)
Market Share of PBMs by Claims (2014E)
Market Share of PBMs by PDP Lives (2013)
Revenue of Express Script by Business Segment (2013)
Express Script Revenue and Net Income (2009-2013)
CVS Health Business Revenue – by Segment (2013)
CVS Health Revenue and Net Income (2009-2013)
Catamaran’s Revenue by Business Segment (2013)
Catamaran Revenue and Net Income (2009-2013)


List of Tables


Rx Market by Segment (2008-2013)
Rx Market Share by Segment (2008-2013)
US Monthly Branded Prescription Volume Growth by Dispensing Channel (December 2013-October 2014)
US Monthly Generic Prescription Volume Growth by Dispensing Channel (December 2013-October 2014)
US Monthly Branded Pharmaceutical Sales Growth by Dispensing Channel (December 2013-September 2014)
US Monthly Generic Pharmaceutical Sales Growth by Dispensing Channel (December 2013-September 2014)
Mergers and Acquisitions 

1. Overview
Pages : 7
USD 150

1.1 Introduction
1.2 History of PBM
1.3 Retail Dispensing Process & Flow of Funds
1.4 Mail Dispensing Process and Flow of Funds


Figure 1.1: Types of PBM Services
Figure 1.2: PBM Managers Formulary Structure
Figure 1.3: History of PBMs
Figure 1.4: Retail Dispensing Process and Flow of Funds
Figure1.5: Mail Dispensing Process and Flow of Funds 

 
2. The US PBM Market
Pages : 13
USD 350

2.1 Rx Market
-Market Volume
-Growth Rate
-Market Segments
-Branded Vs Generic Growth
-Dispensing Channels


2.2 Pharmaceutical Sales
-Sales Growth
-Branded Vs Generic Market
-Dispensing Channels


2.3 Specialty Drugs


Figure 2.1: US Rx Market (2008-2018E)
Figure 2.2: US Annual Prescription Growth- by Volume (2008-2018E)
Figure 2.3: US Monthly Prescription Volume Growth (Jan 2013- Oct 2014)
Figure 2.4: Rx Market Share by Segment (2014E)
Figure 2.5: US Monthly Branded Prescription Volume Growth (January 2013-October 2014)
Figure 2.6: US Monthly Generic Prescription Volume Growth (January 2013-October 2014)
Figure 2.7: US Annual Pharmaceutical Sales Growth (2007-2013)
Figure 2.8: US Monthly Pharmaceutical Sales Growth (January 2013-September 2014)
Figure 2.9: US Monthly Branded Pharmaceutical Sales Growth (January 2013-September 2014)
Figure 2.10: US Monthly Generic Pharmaceutical Sales Growth (2013-2014)
Figure 2.11: Pharmacy and Medical Benefit Spend (2012-2018E)
Figure 2.12: Utilization Rate by Dispensing Channel (2009-2013)
Figure 2.13: US Drug Spending Growth (2008-2013)


Table 2.1: Rx Market by Segment (2008-2013)
Table 2.2: Rx Market Share by Segment (2008-2013)
Table 2.3: US Monthly Branded Prescription Volume Growth by Dispensing Channel (December 2013-October 2014)
Table 2.4: US Monthly Generic Prescription Volume Growth by Dispensing Channel (December 2013-October 2014)
Table 2.5: US Monthly Branded Pharmaceutical Sales Growth by Dispensing Channel (December 2013-September 2014)
Table 2.6: US Monthly Generic Pharmaceutical Sales Growth by Dispensing Channel (December 2013-September 2014) 

 
3. Market Dynamics
Pages : 10
USD 250

3.1 Growth Drivers


3.1.1 Increasing Life Expectancy Rate in the US
3.1.2 Rising Healthcare Expenditure in the US
3.1.3 Rising Pharmaceutical Sales
3.1.4 Accelerating US Aging Population
3.1.5 Ameliorating Economic Conditions
3.1.6 Rising Incidences of Chronic and Infectious Diseases
3.1.7 Rising Medicare Enrollments


3.2 Trends and Developments


3.2.1 PBM Mergers and Acquisitions
3.2.2 Trends in Drug Prices
3.2.3 Increased Acceptance of Specialty Drugs
3.2.4 Average Wholesale Price Trend


3.3 Challenges


3.3.1 Lack of Insurer Capabilities
3.3.2 Regulator Risk


Figure 3.1: The US Life Expectancy Rate (2009-2014E)
Figure 3.2: The US Healthcare Expenditure Per Capita (2006-2013)
Figure 3.3: The US Pharmaceutical Sales (2010-2013)
Figure 3.4: The US Aging Population (2009-2013)
Figure 3.5: GNI of the US (2006-2013)
Figure 3.6: Medicare Enrollments (2006-2013)
Figure 3.7: Drugs Price Index (2008-2014)
Figure 3.8: Specialty Drug Spend (2012-2018)
Figure 3.9: Average Wholesale Price Trend (2013)


Table 3.1: Mergers and Acquisitions 

 
4. Competitive Landscape
Pages : 3
USD 150

-Share by Revenue
-Share by Prescription Volume
-Share by Claims
-Share by PDP Lives


Figure 4.1: Market Share of Leading PBMs by Revenue (2013)
Figure 4.2: Market Share of PBMs by Adjusted Prescription Volume (2013)
Figure 4.3: Market Share of PBMs by Claims (2014E)
Figure 4.4: Market Share of PBMs by PDP Lives (2013) 

 
5. Company Profiles
Pages : 10
USD 200

5.1 Express Script


5.1.1 Business Overview
5.1.2 Financial Overview
5.1.3 Business Strategies
-Introduction of Programs
-Development through Acquisitions


5.2 CVS Health


5.2.1 Business Overview
5.2.2 Financial Overview
5.2.3 Business Strategies
-Strategic Acquisitions
-HealthCare Programs


5.3 Catamaran


5.3.1 Business Overview
5.3.2 Financial Overview
5.3.3 Business Strategies
-Mergers and Acquisitions
-Expansion of HealthCare Reforms


Figure 5.1: Revenue of Express Script by Business Segment (2013)
Figure 5.2: Express Script Revenue and Net Income (2009-2013)
Figure 5.3: CVS Health Business Revenue – by Segment (2013)
Figure 5.4: CVS Health Revenue and Net Income (2009-2013)
Figure 5.5: Catamaran’s Revenue by Business Segment (2013)
Figure 5.6: Catamaran Revenue and Net Income (2009-2013) 

 
 
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