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US Pharmacy Benefit Management (PBM) Industry Report: 2015 Edition
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Date: 16, December 2015 | Pages: 55
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PBMs initially enacted the role of a third-party administrator, administering the drug claims of health plans/employers. However, they widened the horizon by expanding into a wide variety of business functions, eventually resulting in better management of drug benefits for members and reducing the overall drug spending costs for plan sponsors. Some of the key functions performed by PBMs that have an impact on reducing drug expenditures are formulary and benefit plan designing, retail network management and operating mail order pharmacies. 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.


The PBM suppliers control medication spending and usage by the righteousness of their propelled apparatuses and strategies, empowering utilization of generics and other lower-cost pharmaceuticals. In the US, there are some autonomous PBM's while some are claimed by overseeing care associations and retail drug stores. Today, the PBM business has turned out to be more decided through a progression of mergers and acquisitions.


Some of the factors driving the growth of the US 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 developments in the PBM industry include rising medicare enrollments, rising number of exclusions on the formulary list 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 a variety of factors: revenue, dispensing specialty pharmaceuticals and claims. 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 PBM Timeline
1.3 Retail Dispensing Process & Flow of Funds
1.4 Mail Dispensing Process and Flow of Funds


2. Market Analysis


2.1 Global Pharmaceutical Market
-Market Value
-Regional Breakdown


2.2 The US


2.2.1 Pharmaceutical Market
-Market Value
-Growth Rate
-Specialty Drugs


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


3. Market Dynamics


3.1 Growth Drivers


3.1.1 Increasing Life Expectancy in the US
3.1.2 Rising Healthcare Expenditure in the US
3.1.3 Accelerating US Aging Population
3.1.4 Ameliorating Economic Conditions
3.1.5 Rising Incidences of Chronic and Infectious Diseases


3.2 Trends and Developments


3.2.1 Rising Medicare Enrollments
3.2.2 Increasing Exclusions on PBM Formulary List
3.2.3 Changes in Prescription Drug Use
3.2.4 PBM Mergers and Acquisitions
3.2.5 Trends in Drug Prices
3.2.6 Increased Acceptance of the Specialty Drugs


3.3 Challenges


3.3.1 Lack of Insurer Capabilities
3.3.2 Regulatory Risk


4. Competitive Landscape


4.1 Competition by Industry Trend
-By Drug Type
-By Membership
-By Total Equivalent Prescription
-By Claims


4.2 Competition by Financials
-By Revenue
-By Revenue Growth Rate
-By Revenue per Claim
-By EBITDA per Claim


5. Company Profiles


5.1 Express Script


5.1.1 Business Overview
5.1.2 Financial Overview
5.1.3 Business Strategies


5.2 CVS Health


5.2.1 Business Overview
5.2.2 Financial Overview
5.2.3 Business Strategies


5.3 Catamaran


5.3.1 Business Overview
5.3.2 Financial Overview
5.3.3 Business Strategies  

List of Charts


Types of PBM Services
PBM Managers Formulary Structure
PBM Development Timeline
Retail Dispensing Process and Flow of Funds
Mail Dispensing Process and Flow of Funds
Global Pharmaceutical Market Revenue (2009-2014)
Pharmaceutical Market Share by Region (2014)
Pharmaceutical Market Revenue YoY Change by Region (2010-2014)
The US Pharmaceutical Market Value (2009-2014)
The US Annual Pharmaceutical Sales Growth (2009-2014)
The US Monthly Pharmaceutical Sales Growth (Jan 2014-Aug 2015)
The US Monthly Pharmaceutical Sales Growth by Pharmaceutical Group (January 2014- August 2015)
Share of Traditional and Specialty Pharmaceutical in the US (2014)
The US Distributor Specialty Sales by Customer Type
The US Rx Market (2009-2014E)
The US Rx Market Volume by Category (2009-2014E)
Rx Utilization Rates by Category (2009-2014E)
The US Generic Market- Quarterly Prescription & YoY Growth
The US Annual Prescription Growth- by Volume (2009-2014)
The US Monthly Prescription Volume Growth (Oct 2014-Aug 2015)
The US Monthly Prescription Volume by Type (October 2014- September 2015)
The US Monthly Prescription Volume Growth by Branded/Generic (October 2014-September 2015)
The US Life Expectancy Rate (2009-2014E)
The US Medication Spending (2009-2014)
The US Aging Population Trend (1960-2060)
The US GDP Per Capita (2009-2014)
Enrollments in Medicare Program by Beneficiary Type (2011-2014)
Number of Products in PBM Formulary Exclusion List (2012-2016)
Prescription Drug Use by Age Group, US (2014)
Prescription Drug Use by Age Group & Gender, US (2014)
Drugs Price Index (2008-2014)
The US Specialty Drug Spend (2009-2014E)
PBM Market Growth by Drug Type (2013-2014)
PBM Market by Scrips (2014)
PBM Market Share by Scrips (2014)
PBM Market Share by Membership (2014)
PBM Market Share by Total Equivalent Prescription (2014)
PBM Market Share by Claims (2014)
Competition by Profitability Metrics (2014)
Revenue Growth Rates (2010-2014)
Revenue per Claim (2010-2014E)
EBITDA per Adjusted Claim (2010-2014)
Revenue of Express Script by Business Segment (2014)
Revenue of Express Script by Revenue Type (2014)
Express Script Revenue and Net Income (2009-2014)
CVS Health Business Revenue – by Segment (2012-2014)
CVS Health Revenue and Net Income (2010-2014)
Catamaran’s Revenue by Business Segment (2014)
Catamaran Revenue and Net Income (2010-2014)


List of Tables


The US Monthly Pharmaceutical Sales Growth by Dispensing Channel (September 2014- August 2015)
The US Monthly Branded Pharmaceutical Sales Growth by Dispensing Channel (September 2014 –August 2015)
The US Monthly Generic Pharmaceutical Sales Growth by Dispensing Channel (September 2014 –August 2015)
The US Monthly Prescription Volume Growth by Dispensing Channel (October 2014- September 2015)
The US Monthly Branded Prescription Volume Growth by Dispensing Channel (October 2014- September 2015)
The US Monthly Generic Prescription Volume Growth by Dispensing Channel (October 2014- September 2015)
Mergers and Acquisitions
Leading PBMs by PBM Revenue (2014)
Leading PBMs Financial Comparison by PBM Revenue 

1. Overview
Pages : 6
USD 150

1.1 Introduction
1.2 PBM Timeline
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: PBM Development Timeline
Figure 1.4: Retail Dispensing Process and Flow of Funds
Figure 1.5: Mail Dispensing Process and Flow of Funds
 

 
2. Market Analysis
Pages : 16
USD 400

2.1 Global Pharmaceutical Market
-Market Value
-Regional Breakdown


2.2 The US


2.2.1 Pharmaceutical Market
-Market Value
-Growth Rate
-Specialty Drugs


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


Figure 2.1: Global Pharmaceutical Market Revenue (2009-2014)
Figure 2.2: Pharmaceutical Market Share by Region (2014)
Figure 2.3: Pharmaceutical Market Revenue YoY Change by Region (2010-2014)
Figure 2.4: The US Pharmaceutical Market Value (2009-2014)
Figure 2.5: The US Annual Pharmaceutical Sales Growth (2009-2014)
Figure 2.6: The US Monthly Pharmaceutical Sales Growth (Jan 2014-Aug 2015)
Figure 2.7: The US Monthly Pharmaceutical Sales Growth by Pharmaceutical Group (January 2014- August 2015)
Figure 2.8: The US Pharmaceutical Market by Type (2008-2014E)
Figure 2.9: Share of Traditional and Specialty Pharmaceutical in the US (2014)
Figure 2.10: The US Distributor Speciality Sales by Customer Type
Figure 2.11: The US Rx Market (2009-2014E)
Figure 2.12: The US Rx Market Volume by Category (2009-2014E)
Figure 2.13: Rx Utilization Rates by Category (2009-2014E)
Figure 2.14: The US Generic Market- Quarterly Prescription & YoY Growth
Figure 2.15: The US Annual Prescription Growth- by Volume (2009-2014)
Figure 2.16: The US Monthly Prescription Volume Growth (Oct 2014-Aug 2015)
Figure 2.17: The US Monthly Prescription Volume by Type (October 2014- September 2015)
Figure 2.18: The US Monthly Prescription Volume Growth by Branded/Generic (October 2014-September 2015)


Table 2.1: The US Monthly Pharmaceutical Sales Growth by Dispensing Channel (September 2014- August 2015)
Table 2.2: The US Monthly Branded Pharmaceutical Sales Growth by Dispensing Channel (September 2014 –August 2015)
Table 2.3: The US Monthly Generic Pharmaceutical Sales Growth by Dispensing Channel (September 2014 –August 2015)
Table 2.4: The US Monthly Prescription Volume Growth by Dispensing Channel (October 2014- September 2015)
Table 2.5: The US Monthly Branded Prescription Volume Growth by Dispensing Channel (October 2014- September 2015)
Table 2.6: The US Monthly Generic Prescription Volume Growth by Dispensing Channel (October 2014- September 2015) 

 
3. Market Dynamics
Pages : 10
USD 250

3.1 Growth Drivers


3.1.1 Increasing Life Expectancy in the US
3.1.2 Rising Healthcare Expenditure in the US
3.1.3 Accelerating US Aging Population
3.1.4 Ameliorating Economic Conditions
3.1.5 Rising Incidences of Chronic and Infectious Diseases


3.2 Trends and Developments


3.2.1 Rising Medicare Enrollments
3.2.2 Increasing Exclusions on PBM Formulary List
3.2.3 Changes in Prescription Drug Use
3.2.4 PBM Mergers and Acquisitions
3.2.5 Trends in Drug Prices
3.2.6 Increased Acceptance of the Specialty Drugs


3.3 Challenges


3.3.1 Lack of Insurer Capabilities
3.3.2 Regulatory Risk


Figure 3.1: The US Life Expectancy Rate (2009-2014E)
Figure 3.2: The US Medication Spending (2009-2014)
Figure 3.3: The US Aging Population Trend (1960-2060)
Figure 3.4: The US GDP Per Capita (2009-2014)
Figure 3.5: Enrollments in Medicare Program by Beneficiary Type (2011-2014)
Figure 3.6: Number of Products in PBM Formulary Exclusion List (2012-2016)
Figure 3.7: Prescription Drug Use by Age Group, US (2014)
Figure 3.8: Prescription Drug Use by Age Group & Gender, US (2014)
Figure 3.9: Drugs Price Index (2008-2014)
Figure 3.10: The US Specialty Drug Spend (2009-2014E)


Table 3.1: Mergers and Acquisitions 

 
4. Competitive Landscape
Pages : 7
USD 200

4.1 Competition by Industry Trend
-By Drug Type
-By Membership
-By Total Equivalent Prescription
-By Claims


4.2 Competition by Financials
-By Revenue
-By Revenue Growth Rate
-By Revenue per Claim
-By EBITDA per Claim


Figure 4.1: PBM Market Growth by Drug Type (2013-2014)
Figure 4.2: PBM Market by Scrips (2014)
Figure 4.3: PBM Market Share by Scrips (2014)
Figure 4.4: PBM Market Share by Membership (2014)
Figure 4.5: PBM Market Share by Total Equivalent Prescription (2014)
Figure 4.6: PBM Market Share by Claims (2014)
Figure 4.7: Competition by Profitability Metrics (2014)
Figure 4.8: Revenue Growth Rates (2010-2014)
Figure 4.9: Revenue Per Claim (2010-2014E)
Figure 4.10: EBITDA Per Adjusted Claim (2010-2014)


Table 4.1: Leading PBMs by PBM Revenue (2014)
Table 4.2: Leading PBMs Fianancials Comparison by PBM Revenue 

 
5. Company Profiles
Pages : 9
USD 200

5.1 Express Script


5.1.1 Business Overview
5.1.2 Financial Overview
5.1.3 Business Strategies


5.2 CVS Health


5.2.1 Business Overview
5.2.2 Financial Overview
5.2.3 Business Strategies


5.3 Catamaran


5.3.1 Business Overview
5.3.2 Financial Overview
5.3.3 Business Strategies


Figure 5.1: Revenue of Express Script by Business Segment (2014)
Figure 5.2: Revenue of Express Script by Revenue Type (2014)
Figure 5.3: Express Script Revenue and Net Income (2009-2014)
Figure 5.4: CVS Health Business Revenue* – by Segment (2012-2014)
Figure 5.5: CVS Health Revenue and Net Income (2010-2014)
Figure 5.6: Catamaran’s Revenue by Business Segment (2014)
Figure 5.7: Catamaran Revenue and Net Income (2010-2014) 

 
 
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