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Pharmacy Benefit Management (PBM) for Medicaid and Medicare: Introduction
Pharmacy Benefit Management (PBM), also known as the third-party administrator of commercial drug services, Medicare Part-D plans, self-assured plans, federal employee health insurance program, Medicare Part-D plans, and government employees' plans, PBMs have the following key tasks: production and maintenance, contracting, discounts agreements with drug suppliers, and collection and reimbursement for prescription drug claims.
PBMs are part of both retail pharmacies as well as insurance agencies. They work in integrated healthcare systems. Many times, health insurance companies contract with outside firms to negotiate prices, insurance claims and delivery of prescription medications. These prescription benefit managers are available to help with self-insured employer plans and corporate insurance programs. They also provide services for Medicare Part-D plans, federal health benefits programs, and government workers' plans.
PBMs allow plan sponsors and individuals to get lower prescription drug prices by aggregating the collective buying power of their clients through their client health plans. PBMs negotiate price discounts with mail service pharmacies that home-delivery prescriptions without consulting with a pharmacist.
There are many ways that pharmacy benefit management companies can generate revenue. They collect the administrative and Service fees for the original insurance plan. They also receive rebates from manufacturers. Traditional PBMs don't disclose the net price of prescription drugs. This allows them to resell drugs at prices that are higher than what they negotiate with the manufacturer.
The Global Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market Forecast:
The Pharmacy Benefit Management (PBM) Market has been growing at a moderate rate with substantial growth rates in the past few years. It is expected that the market will expand significantly during the forecasted period, i.e., 2020-2027
The U.S. Pharmacy Benefit Management Market (PBM) was worth USD 370.2 billion in 2019, rising at 8.7% CAGR over the forecast period, 2020-2026.
The Global Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market Overview:
Market growth is expected to be boosted by an aging population, rising life expectancy rates and increased use of drugs. Technology innovations that enable the creation of low-cost products will also have a positive effect on growth. The market for pharmacy benefit management (PBM), due to its benefits, will see an increase in the product application scope.
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Pharmacy benefit management (PBM), driven by the need to develop specialty drugs and an increase in medical enrollments, will be a major driver of the market. Product demand will be driven by an increase in R&D spending to develop new treatments and medical equipment.
Industry growth is also driven by the increasing use of narrow networks and growth in mail-order and online penetration. Market consolidation, increasing consumerism and technological advances are some of the trends in the global pharmacy benefit management market (PBM).
The market may be affected by the high price of drugs, the low reimbursement rate, and the legal regulations.
Market Segmentation Analysis of Global Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market:
Based on Service, the market is divided into Retail Pharmacy Services, Specialty Pharmacy Services, Benefit Plan Design and Consultation, Drug Formulary Management, Mail Order Service, and Others.
The Specialty Pharmacy Services Segment dominated the market and is anticipated to register substantial growth in the pharmacy benefit management (PBM) market with considerable CAGR during the forecast period. A specialty pharmacy service for patients with complex chronic conditions and require expensive and complicated prescriptions. Specialty Pharmacy Services provides a 100% local pharmacy that can prescribe compounds for both human and animal use.
Geographically, the market can be divided into North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa.
North America will hold the largest market share. North America's dominance can be attributed to factors like high prescription drug spending, high prevalence of chronic disease amongst the general populace, and technological advances in pharmacy benefit management (PBM) programs.
According to the Centers for Disease Control and Prevention (CDC), 8.2% of Americans had been diagnosed with diabetes in 2018.
Europe is expected to hold the second-largest global market share. The market's expansion in Europe is primarily due to the strong potential patient population, adoption and use of technology-advanced healthcare IT, as well as high healthcare spending.
The market for the Asia Pacific will grow at the highest rate of CAGR due to increased prescription drug spending and the adoption of advanced healthcare infrastructure.
The market growth rates and market share of Latin America and the Middle East, and Africa are expected to be comparatively lower. The market will likely grow due to strong improvements in healthcare infrastructure and increased demand for prescription medicines in these regions in the coming years.
The Key Market Segmentation of the Global Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market:
Global Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market can be divided into Types, Applications, End-Users, and Geographical landscapes, etc.
Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market Segmentation By Type:
Retail Pharmacy Services
Specialty Pharmacy Services
Benefit Plan Design and Consultation
Drug Formulary Management
Mail Order Service
Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market Segmentation By Application:
Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market Segmentation By End-User:
Pharmacy Benefit Management Organization
Mail Order Pharmacies
Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market Segmentation By Geographical Landscape:
Middle East and Africa
Major Key Players in the Global Pharmacy Benefit Management (PBM) for Medicaid and Medicare Market Are:
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