Tuesday 27 January 2015

US Pharmacy Benefit Management (PBM) Industry Report And Strategy

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.

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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.

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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

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