Pharmacy Benefit Management (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer groups, unions, government employee groups, and managed care organizations. PBMs are responsible for developing and maintaining the formulary, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims. They also provide drug utilization review, mail order pharmacy services, and specialty pharmacy services.
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Key Trends
Pharmacy benefit management (PBM) technology is a rapidly evolving field that is constantly innovating to meet the needs of patients, providers, and payers. The following are some of the key trends in PBM technology:
1. Personalized medicine: PBMs are increasingly using data to tailor medication regimens to individual patients. This personalized approach to medicine can improve patient outcomes and reduce costs.
2. Predictive analytics: PBMs are using data to predict which patients are likely to experience adverse events or non-adherence. This allows them to intervene early and prevent problems before they occur.
3. Digital health: PBMs are incorporating digital health tools into their platforms to improve patient engagement and medication adherence. These tools include mobile apps, text messaging, and wearable devices.
4. Drug pricing transparency: PBMs are under pressure to provide more transparency around drug pricing. This includes providing patients with information on the cost of their medications and the discounts that are available.
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Key Drivers
The key drivers of the pharmacy benefit management (PBM) market are the rising costs of healthcare and the increasing demand for cost-effective and efficient drug benefit programs. PBMs are third-party administrators of drug benefit programs that use their negotiating clout with drug manufacturers to obtain discounts and rebates on behalf of their clients, which include employers, health plans, government agencies, and unions. In return for these discounts, PBMs may require their clients to use a particular pharmacy or group of pharmacies, which can result in higher costs for consumers.
The rising costs of healthcare are a major driver of the PBM market. Healthcare costs have been rising steadily for years, and this trend is expected to continue. In order to control costs, employers and health plans are increasingly turning to PBMs to manage their drug benefit programs. PBMs are able to negotiate discounts with drug manufacturers that can save their clients millions of dollars.
The increasing demand for cost-effective and efficient drug benefit programs is another key driver of the PBM market. With the rising costs of healthcare, employers and health plans are looking for ways to cut costs. PBMs are able to offer their clients significant savings on their drug benefit programs. In addition, PBMs can help their clients design drug benefit programs that are more efficient and cost-effective.
Key Market Segments
The pharmacy benefit management market bifurcated on the basis of type, end-user, and region. On the basis of type, it is segmented into specialty pharmacy services, drug formulary management, mail order service, and others. By end-user, it is analyzed across pharmacy benefit management organization, mail order pharmacies, retail pharmacies, and others. Region-wise, it is studied across North America, Europe, Asia-Pacific, and rest of the World.
Key Market Players
The pharmacy benefit management market report includes players such as Express Scripts Holding Company, CVS Health Corporation, DST Systems, Inc., Rite Aid Corp., ProCare Rx., UnitedHealth Group, Benecard Services, LLC, BioScrip, Inc., CaptureRx, and Change Healthcare.
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