ResearchMoz

The US Pharmacy Benefit Management (PBM) Industry Report: 2013 Edition

Koncept Analytics
Published Date » 2014-02-18
No. Of Pages » 59
 In the US, a third party administrator of prescription drug program is known as a Pharmacy Benefit Manager (PBM). The primary responsibilities of a PBM include processing and paying prescriptions drug claim, developing and maintaining formulary, negotiating discounts and rebates with drug manufacturers and pharmacies. The US prescription volume has witnessed an unprecedented 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 ceaselessly focus on enabling the plan sponsors and individuals to obtain prescribed drugs at lower prices. 
   
 In order to improve the value of drug benefit and manage the cost...
Table of Content

1. Overview
1.1 History of PBM
1.2 PBM Managers
1.3 Retail Dispensing Process & Flow of Funds
1.4 Mail Dispensing Process and Flow of Funds

2. The US PBM Market Size
2.1 PBM Market by Value
  • Market Value Growth
  • Breakdown by Dispensing Channels
2.1.1 Retail Channels
2.1.2 Institutional Channels
2.2 PBM Market by Volume
  • Market Volume Growth
  • Breakdown by Dispensing Channels
2.2.1 Retail Channels
2.2.2 Institutional Channels
2.3 Generic Drugs
  • Market Overview
  • Penetration Rate
2.4 Specialty Drugs

3. Market Dynamics
3.1 Growth Drivers
3.1.1 Accelerating US Aging Population
3.1.2 Rising Incidences of Chronic and Infectious Diseases
3.1.3 Increasing Life Expectancy Rate in the US
3.1.4 Escalating Healthcare Expenditure in the US
3.1.5 Healthcare Reforms
3.1.6 Rising Pharmaceutical Sales
3.1.7 Ameliorating Economic Conditions
3.2 Trends and Developments
3.2.1 Rising Medicare Enrollments
3.2.2 Trends in Drug Prices
3.2.3 Generic Drug Utilization
3.2.4 Increased Acceptance of Specialty Drug
3.2.5 Medicaid Pharmacy Program Savings
3.2.6 Penetration of Unbranded Generic Drug Prescription
3.2.7 PBM Mergers and Acquisitions

4. Competitive Landscape
4.1 Competition by Prescription Volume
4.2 Competition by Claims
4.3 Competition by Lives Managed
4.4 Competition by Specialty Pharmacy Drug Spending
4.5 Competition by Health Plans
4.6 Analysis of PBMs Operating Statistics
4.7 Competition by Customer Segment Mix

5. Company Profiles
5.1 Express Script
5.1.1 Business Overview
5.1.2 Financial Overview
5.1.3 Business Strategies
  • Expansion through Acquisitions
  • Unremitting Focus on Innovation
5.2 CVS Caremark
5.2.1 Business Overview
5.2.2 Financial Overview
5.2.3 Business Strategies
  • Acquisitions and Collaborations
  • Focus on Geographic Expansion
5.3 Catamaran
5.3.1 Business Overview
5.3.2 Financial Overview
5.3.3 Business Strategies
  • Expansion of Customer Base
  • Broadening Services Portfolio

List of Tables


The US Dollar Spend by Retail Channels - In US$ Billions (2008-2012) 
The US Dollar Spend by Institutional Channels - In US$ Billions (2008-2012) 
Number of Prescription Dispensed via Retail Channels in the US - In Million (2008-2012) 
Potential Medicaid Pharmacy Program Savings for Top 10 States (2012-2021) 
Selected PBM M&A Transactions - in US$ million (1993–2012) 
EBITDA Multiples for Selected PBM transactions (2000-2012) 
Dollar Share of Leading PBMs by PBM Revenue (2013E) 
PBM Market Share Based on Adjusted Prescription Volume (2012) 
Adjusted Mail-Order Penetration (Q112-Q213) 
Generic Dispensing Rate (Q112-Q213) 
Revenue per Adjusted Rx (Q112-Q213) 
EBITDA per Adjusted Rx (Q112-Q213) 
PBM Profitability Metrics (2012) 

List of Figures


History of PBMs
Types of PBM Services
PBM Managers Formulary Structure
Retail Dispensing Process and Flow of Funds
Mail Dispensing Process and Flow of Funds
The US Prescription Drug Market – by Value (2008-2012) 
The US Prescription Drug Market by Dispensing Channels – by Value (2012) 
Percentage Share of the Dispensing Channels in the US Prescription Drug Market - by Value (2012) 
Percentage Share of Retail Dispensing Channels in the US Prescription Drug Market – by Value (2012) 
Percentage Share of Institutional Dispensing Channels in the US Prescription Drug Market – by Value (2012) 
The US Prescription Drug Market – by Volume (2012) 
The US Prescription Drug Market by Dispensing Channels – by Volume (2012) 
Percentage Share of the Dispensing Channels in the US Prescription Drug Market - by Volume (2012) 
Percentage Share of Retail Dispensing Channels in the US Prescription Drug Market – by Volume (2012) 
Number of Prescription Dispensed via Institutional Channels in the US (2008-2012) 
Penetration of Generic Drugs (2003-2013E) 
Estimated PBM Profitability of Generic versus Branded Scripts by Channel (2012) 
Estimated Brand Revenue Lost to Generic Launches (2012-2016E) 
Specialty Market Share by Dispensing Channels (2012) 
The US Aging Population (2008-2012) 
The US Life Expectancy Rate (2006-2013E) 
The US Healthcare Expenditure per Capita (2006-2012E) 
The US Pharmaceutical Sales (2010-2012) 
GNI of the US (2006-2012) 
Medicare Enrollments (2005-2014E) 
Drugs Price Index (2008-2013E) 
Specialty Drug Spending Trend (2012 & 2015E) 
Generic Drug Penetration Rate (2005-2013E) 
Percentage Share of Leading PBMs by PBM Revenue (2013E) 
Fortune 100 PBM Market Share (2012) 
Percentage Share of PBM on Adjusted Prescription Dispensed - Volume (2012) 
PBM Market Share by Claims (2014E) 
PBM Market Share by Lives Managed (2013E) 
Percentage Share of Specialty Pharmacy Drug Spending (2012) 
Top 35 Health Plan (Based on Lives) PBM Market Share (2012) 
PBMs Pro-forma Customer Segment Mix (2012) 
Revenue of Express Script by Business Segment (2012) 
Express Script Revenue and Net Income (2008-2012) 
CVS Caremark Business Revenue – by Segment (2012) 
CVS Caremark Revenue and Net Income (2008-2012) 
Catamaran’s Revenue by Business Segment (2012) 
Catamaran Revenue and Net Income (2008-2012) 

Upcoming Reports:

Greece: market of electric ceiling or wall lightning fittings
By - Williams and Marshal Strategy
This report presents a comprehensive overview of the electric ceiling or wall lightning fittings market in Greece and its state as of January 2014. It provides detailed analysis of the industry, its dynamics and structure. The purpose of the report is to describe the state of the electric ceiling or wall lightning fittings market in Greece, to present actual and retrospective information about the volumes and dynamics of production, imports, exports and consumption, the characteristics of the market for the period 2008-2012 and to build a forecast for the market development until 2018. In...
In Flight Entertainment & Communication Market - Global Scenario, Trends, Industry Analysis, Size, Share And Forecast, 2011 – 2018
By - Transparency Market Research
In flight entertainment, also referred to as IFE, is the entertainment provided to passengers traveling in an air craft during the flight. The entertainment services comprise of food and drink, along with availability of different entertainment media including individual television sets for every passenger, reading material such as magazines, and music among others.  Growing competition in the airlines industry and increasing demand are the two major forces driving the market growth. Fast paced life and growth in per capita disposable incomes have enabled people to...
Mold Inhibitors Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2014 - 2020
By - Transparency Market Research
Mold inhibitors serve as additives which are used for preventing mold growth and reducing the mold contamination, for the purpose of minimizing the risk of having mycotoxin producing mold which proliferate on feed or grain. These inhibitors have the function to suppress generation of molds. Mold inhibitors generally include propionic acid and other organic acids. However, as mold inhibitors have no effect on mycotoxins which are already present in the contaminated feed, they may still be present even if the growth has been avoided. Various mold inhibitors are used in the industry such...

Research Assistance

We will be happy to help you find what you need.
Please call us or write us:

866-997-4948 (Us-Canada Toll Free)
Tel: +1-518-618-1030
Email: sales@researchmoz.us
Select License type:

Share this report

Related News

ARM-based Microcontrollers Launched by Toshiba
Jan 29, 2015  
Recently, Toshiba has added to its line two ARC Cortex M4F based microcontrollers of the series TX04. These two microcontrollers called TMPM475FDFG and TMPM470FDFG are able to operate at two non-brush DC motors simultaneously. These two microcontrollers are aimed to satisfy the demands of consumers for more efficient motors and add the vectoring technology to make sure a high-level...
Telefonica Deal Allows Sky to Venture into U.K. Mobile Market
Jan 29, 2015  
Sky Telecom Inc. on Thursday announced that beginning from 2016, the telecommunications company will be offering mobile services in the United Kingdom. This will be possible after the mobile virtual network operator (MVNO) deal with Spanish multinational telecommunications company Telefonica is finalized. Sky’s strategy so far has been to deliver premium content to its mobile...
Increasing LTE Subscribers Help SK Telecom Jump Q4 Net
Jan 29, 2015  
South Korea’s leading mobile operator SK Telecom Co. said on Thursday that its fourth quarterly earnings jumped owing to a surge in number of subscribers who switched to its speedier mobile internet connection. Another reason for this jump in earnings was due to an increase in sales from the business solution services division of SK Telecom. The net profit came to a total of...
Kuwait’s Zain Plans Potential Sale of Transmitter Towers
Jan 29, 2015  
Zain, a telecom operator in Kuwait has appointed a team of advisors to help analyze the prospective sale of the operator’s transmitter towers in a few of the eight markets where it has operations. The company issued a statement on Wednesday where the announcement was made. Zain has controlling stakes in numerous mobile companies in Iraq, Kuwait, South Sudan, Sudan, Jordan, and...
JCTC to Partner with Manufactures to train Students
Jan 29, 2015  
Chip Blankenship, CEO of GE Appliances announced his plan to form a partnership with Technical College and Jefferson Community to bridge the gap between skilled manufacturing labor and unmet demand in the industry. According to a report published by Kentucky Federation for Advanced Manufacturing Education, there are about 600,000 jobs that have to be filled in with skilled...