US Pharmacy Benefit Management Market Report

Transcription

1 US Pharmacy Benefit Management Market Report

2 Executive Summary 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-, and Catamaran. These players are being profiled in the report along with their key financials and strategies for growth.

3 Million Billion The growing availability and rapid use of generic drugs continue to have a substantial moderating influence on prescription drug expenditures US Rx Market ( E) The total Rx market increased with a CAGR of during the period spanning During , the US annual prescription volume has exhibited positive growth. The Rx market comprises of three segments- generic Rx, branded Rx and other. In 2013, the branded Rx market declined by and became million in On the other hand, generic Rx units were.million, marking an increase of US Annual Prescription Volume Growth ( E) US Rx Market by Segment ( ) Branded Rx Generic Rx

4 The changing lifestyle and rising consumer income level has resulted in overall increase in PBM industry. Rx Market Share- by Segment (2014E) It is estimated that generic Rx will lead the Rx market in 2014 with Rx market share. In 2013, the US annual pharmaceutical sales have grown by... as compared to In 2013, an increasing trend was noticed in the utilization of mail delivery channel for dispensing specialty drugs with the decreasing utilization of retail channel over the past five years. Branded Rx Generic Rx Other US Annual Pharmaceutical Sales Growth ( ) Utilization Rate of Dispensing Channel for Specialty Drugs ( ) Retail Channel Mail delivery Channel

5 emerged as the largest market share holder in context of adjusted prescription volume Market Share of PBM by Revenue Optum(UNH) Catamaran Humana Pharmacy Solution Prime Therapeutics Medimpact Healthcare Systems All Others Market Share of PBM by PDP Lives was the largest PBM with a share of of the total revenue followed by with share. In terms of lives managed, the United Health Group Inc. represents a market share of thereby becoming the leader in the PBM Market Share by PDP Lives. emerged as the largest market share holder in context of adjusted prescription volume with market share. Market Share of PBM by Adjusted Prescription Volume United Health Group Inc. Humana Inc. Aetna Inc. Cigna Others WellCare Health Plans,Inc. Well Point,Inc. OptumRx Catamaran Human Pharmacy Solution Prime Therapeutics Medimpact Envision Pharamaceutical Services Others