Pharmacy Benefit Management Market Size & Share Analysis - Growth Trends & Forecasts (2025 - 2030)

The Report Covers Global Pharmacy Benefit Management Market Growth and Companies. The Market is Segmented by Service (Specialty Pharmacy, Drug Formulatory Management, Benefit Plan Design and Consultation, and Other Services), Business Model (Government Health Programs, Employer-Sponsored Programs, and Health Insurance Management), End User (Pharmacy Benefit Management Organization, Mail Order Pharmacies, Retail Pharmacies, and Other End Users), and Geography (North America, Europe, Asia-Pacific, Middle East and Africa and South America). The Report Offers the Value (in USD) for the Above Segments.

Pharmacy Benefit Management Market Size & Share Analysis - Growth Trends & Forecasts (2025 - 2030)

Pharmacy Benefit Management Market Size

Pharmacy Benefit Management Market Summary
Study Period 2019 - 2030
Market Size (2025) USD 622.64 Billion
Market Size (2030) USD 819.18 Billion
CAGR (2025 - 2030) 5.64 %
Fastest Growing Market Asia-Pacific
Largest Market North America
Market Concentration Low

Major Players

Pharmacy Benefit Management Market Major Players

*Disclaimer: Major Players sorted in no particular order

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Pharmacy Benefit Management Market Analysis

The Pharmacy Benefit Management Market size is estimated at USD 622.64 billion in 2025, and is expected to reach USD 819.18 billion by 2030, at a CAGR of 5.64% during the forecast period (2025-2030).

  • The pharmacy benefit management market is experiencing significant growth due to a rising inclination toward pharmacy benefit management systems (PBMS), increasing health expenditure, and growing demand for prescription products. The rising health spending across the globe is expected to increase the adoption of technologically advanced software and solutions to monitor the inventory and supply of drugs and provide affordable medications to patients. This is anticipated to augment the market growth during the forecast period.
  • For instance, according to the Canadian Institute for Health Information published in November 2023, the healthcare expenditure in Canada reached USD 344 billion in 2023 from USD 334 billion in 2022. Thus, the significant increase in healthcare spending is expected to foster the adoption of advanced pharmacy benefit management systems to make medicines more accessible to patients.
  • The rising inclination toward pharmacy benefits management increases accuracy, improves the safety and efficiency of the pharmacy store, and improves patient health outcomes. This is anticipated to fuel the market's growth during the forecast period. For instance, in March 2022, Rite Aid's pharmacy benefit manager (PBM) division, Elixir, announced its Pharmaceutical Care Management Association (PCMA) membership. Elixir's inclusion in PCMA enhances patient access to cost-effective prescription medications. Thus, the growing demand for pharmacy benefit management services among drug manufacturers, retail pharmacies, and health insurance providers is expected to fuel the market growth during the forecast period.
  • Moreover, the company's rising activities in developing advanced software and solutions contribute to market growth. For instance, in July 2023, Prime Therapeutics LLC (Prime), a pharmacy benefit manager (PBM), unveiled its 2023 formulary recommendations for Humira. These recommendations aim to provide clients with cost-effective options, fostering heightened competition among manufacturers. Consequently, clients stand to benefit from potential savings on both Humira and its biosimilar alternatives.
  • Therefore, the market is expected to grow during the forecast period due to increasing healthcare expenditure and company activities. However, the reluctance to adopt pharmacy automation systems and stringent regulatory processes on confidentiality will likely hinder the growth of the pharmacy benefit management market during the forecast period.

Pharmacy Benefit Management Industry Overview

The pharmacy benefit management market is competitive, with several global and international players. The key players are adopting different growth strategies to enhance their market presence, such as partnerships, agreements, collaborations, new product launches, geographical expansions, mergers, and acquisitions. Some of the key companies in the market are CVS Health, Optum, SS&C Tecnologies Inc., Elixir Rx Solutions LLC, and Centene Corporation (Envolve Health).

Pharmacy Benefit Management Market Leaders

  1. CVS Health

  2. SS&C Technologies, Inc.

  3. Elixir Rx Solutions, LLC

  4. Anthem, Inc.

  5. Optum, Inc.

  6. *Disclaimer: Major Players sorted in no particular order
Pharmacy Benefit Management Market Concentration
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Pharmacy Benefit Management Market News

  • February 2024: The New York State Department of Financial Services (DFS) superintendent proposed new market conduct regulations for Pharmacy Benefit Managers (PBMs) in the state. These regulations are designed to bolster consumer protections and combat anti-competitive practices in the state.
  • February 2024: Better Therapeutics Inc. inked a rebate deal with a prominent Pharmacy Benefit Manager (PBM) in the United States. This agreement explicitly targets the PBM's commercial clientele, enabling plan participants to include AspyreRx in their formularies while qualifying for rebates.

Pharmacy Benefit Management Market Report - Table of Contents

1. INTRODUCTION

  • 1.1 Study Assumptions and Market Definition
  • 1.2 Scope of the Study

2. RESEARCH METHODOLOGY

3. EXECUTIVE SUMMARY

4. MARKET DYNAMICS

  • 4.1 Market Overview
  • 4.2 Market Drivers
    • 4.2.1 Rising Inclination Towards Pharmacy Benefit Management System (PBMS)
    • 4.2.2 Increasing Health Expenditure
    • 4.2.3 Growing Demand for Prescription Products
  • 4.3 Market Restraints
    • 4.3.1 Reluctance To Adopt Pharmacy Automation Systems and Stringent Regulatory Procedures on Confidentiality
  • 4.4 Porter's Five Forces Analysis
    • 4.4.1 Threat of New Entrants
    • 4.4.2 Bargaining Power of Buyers/Consumers
    • 4.4.3 Bargaining Power of Suppliers
    • 4.4.4 Threat of Substitute Products
    • 4.4.5 Intensity of Competitive Rivalry

5. MARKET SEGMENTATION (Market Size by Value - USD)

  • 5.1 By Service
    • 5.1.1 Specialty Pharmacy
    • 5.1.2 Drug Formulatory Management
    • 5.1.3 Benefit Plan Design and Consultation
    • 5.1.4 Other Services
  • 5.2 By Business Model
    • 5.2.1 Government Health Programs
    • 5.2.2 Employer-Sponsored Programs
    • 5.2.3 Health Insurance Management
  • 5.3 By End User
    • 5.3.1 Pharmacy Benefit Management Organization
    • 5.3.2 Mail Order Pharmacies
    • 5.3.3 Retail Pharmacies
    • 5.3.4 Other End Users
  • 5.4 Geography
    • 5.4.1 North America
    • 5.4.1.1 United States
    • 5.4.1.2 Canada
    • 5.4.1.3 Mexico
    • 5.4.2 Europe
    • 5.4.2.1 Germany
    • 5.4.2.2 United Kingdom
    • 5.4.2.3 France
    • 5.4.2.4 Italy
    • 5.4.2.5 Spain
    • 5.4.2.6 Rest of Europe
    • 5.4.3 Asia-Pacific
    • 5.4.3.1 China
    • 5.4.3.2 Japan
    • 5.4.3.3 India
    • 5.4.3.4 Australia
    • 5.4.3.5 South Korea
    • 5.4.3.6 Rest of Asia-Pacific
    • 5.4.4 Middle East and Africa
    • 5.4.4.1 GCC
    • 5.4.4.2 South Africa
    • 5.4.4.3 Rest of Middle East and Africa
    • 5.4.5 South America
    • 5.4.5.1 Brazil
    • 5.4.5.2 Argentina
    • 5.4.5.3 Rest of South America

6. COMPETITIVE LANDSCAPE

  • 6.1 Company Profiles
    • 6.1.1 Optum Inc.
    • 6.1.2 Centene Corporation (Envolve Health)
    • 6.1.3 CVS Health
    • 6.1.4 SS&C Technologies Inc.
    • 6.1.5 Anthem Inc.
    • 6.1.6 Elixir Rx Solutions LLC
    • 6.1.7 Express Scripts Holding Company
    • 6.1.8 Benecard Services LLC
    • 6.1.9 CaptureRx
    • 6.1.10 Change Healthcare
    • 6.1.11 Abarca Health
    • 6.1.12 ProCare Rx
    • 6.1.13 Cigna
  • *List Not Exhaustive

7. MARKET OPPORTUNITIES AND FUTURE TRENDS

**Subject to Availability
Competitive Landscape Covers - Business Overview, Financials, Products and Strategies, and Recent Developments
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Pharmacy Benefit Management Market Analysis

As per the scope of the report, the pharmacy benefit management market plays a significant role in the healthcare industry. It uniquely administers the pharmacy product and focuses on real-time interaction. Pharmacy benefit managers (PBMs) manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers.

The pharmacy benefit management market is segmented by service, business model, end user, and geography. By service, the market is segmented into specialty pharmacy, drug formulary management, benefit plan design and consultation, and other services. By business model, the market is segmented into government health programs, employer-sponsored programs, and health insurance management. By end user, the market is segmented into pharmacy benefit management organizations, mail-order pharmacies, retail pharmacies, and other end users. By geography, the market is segmented into North America, Europe, Asia-Pacific, the Middle East and Africa, and South America. The report also covers the estimated market sizes and trends for 17 countries across major regions globally. The report offers the value (in USD) for the above segments.

By Service Specialty Pharmacy
Drug Formulatory Management
Benefit Plan Design and Consultation
Other Services
By Business Model Government Health Programs
Employer-Sponsored Programs
Health Insurance Management
By End User Pharmacy Benefit Management Organization
Mail Order Pharmacies
Retail Pharmacies
Other End Users
Geography North America United States
Canada
Mexico
Europe Germany
United Kingdom
France
Italy
Spain
Rest of Europe
Asia-Pacific China
Japan
India
Australia
South Korea
Rest of Asia-Pacific
Middle East and Africa GCC
South Africa
Rest of Middle East and Africa
South America Brazil
Argentina
Rest of South America
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Pharmacy Benefit Management Market Research FAQs

How big is the Pharmacy Benefit Management Market?

The Pharmacy Benefit Management Market size is expected to reach USD 622.64 billion in 2025 and grow at a CAGR of 5.64% to reach USD 819.18 billion by 2030.

What is the current Pharmacy Benefit Management Market size?

In 2025, the Pharmacy Benefit Management Market size is expected to reach USD 622.64 billion.

Who are the key players in Pharmacy Benefit Management Market?

CVS Health, SS&C Technologies, Inc., Elixir Rx Solutions, LLC, Anthem, Inc. and Optum, Inc. are the major companies operating in the Pharmacy Benefit Management Market.

Which is the fastest growing region in Pharmacy Benefit Management Market?

Asia-Pacific is estimated to grow at the highest CAGR over the forecast period (2025-2030).

Which region has the biggest share in Pharmacy Benefit Management Market?

In 2025, the North America accounts for the largest market share in Pharmacy Benefit Management Market.

What years does this Pharmacy Benefit Management Market cover, and what was the market size in 2024?

In 2024, the Pharmacy Benefit Management Market size was estimated at USD 587.52 billion. The report covers the Pharmacy Benefit Management Market historical market size for years: 2019, 2020, 2021, 2022, 2023 and 2024. The report also forecasts the Pharmacy Benefit Management Market size for years: 2025, 2026, 2027, 2028, 2029 and 2030.

Pharmacy Benefit Management Industry Report

The global pharmacy benefit management (PBM) market is on a significant upswing, fueled by the growing need for cost-effective management of prescription drugs amidst rising chronic diseases and healthcare costs worldwide. The PBM industry is crucial in mediating drug prices among insurers, pharmacies, and manufacturers to enhance medication affordability. With a keen focus on adopting technologies like AI to improve efficiency in negotiations and claims processing, the specialty pharmacy services lead in PBM market share due to the high costs of specialty drugs. Moreover, insurer and service provider consolidations are amplifying insurance companies' market dominance, especially in North America, which boasts a large share due to widespread health insurance coverage. The Asia Pacific region is also seeing rapid growth, thanks to increased healthcare insurance uptake. Mordor Intelligence™ Industry Reports highlight the PBM market's dynamic expansion, size, and revenue growth, offering a comprehensive analysis and forecast. This sector is pivotal in ensuring drug affordability and accessibility, marking a promising future for global healthcare. Get a free report PDF download for detailed PBM industry insights and market share analysis.