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市場調查報告書
商品編碼
1402004
到 2030 年的藥品福利管理市場預測:按服務、商業模式、最終用戶和地區進行的全球分析Pharmacy Benefit Management Market Forecasts to 2030 - Global Analysis By Service, By Business Model, By End User and By Geography |
根據 Stratistics MRC 的數據,2023 年全球藥品福利管理市場規模為 5,021 億美元,預測期內複合年成長率為 7.7%,到 2030 年將達到 8,439 億美元。
藥房福利管理 (PBM) 是一項管理健康保險計劃處方藥福利的服務。 PBM 尋求透過與藥房談判、管理處方箋和處理申請來最佳化藥物利用率並控制成本。 PBM 的作用是簡化藥物取得、提高負擔能力並促進高效的醫療保健服務。
根據醫療保險和醫療補助服務中心 (CMS) 醫療保險優勢登記文件,2023 年,美國有 3,080 萬人參加了醫療保險優勢計劃,佔醫療保險合格人口的 51.0%。
慢性病流行推動
全球慢性病負擔持續增加,增加了對藥物取得和用藥醫囑遵從性的有效管理的需求。 PBM 透過協商藥品價格、最佳化處方以及實施與慢性病治療相關的成本控制策略,在這方面發揮著至關重要的作用。 PBM 的重點是透過個人化的藥物治療方案改善患者的治療結果,與不斷變化的醫療保健格局保持一致,解決慢性病的複雜性和不斷成長的具有長期健康需求的人口。確保以具有成本效益的方式獲得藥物已變得至關重要人們健康所需的藥物。
藥價缺乏透明度
這種不透明的定價機制給消費者和 PBM 帶來了了解藥品真實成本的挑戰。由於複雜的回扣結構以及 PBM 和藥品製造商之間的私人價格談判,相關人員常常難以理解處方藥的實際價值。這種缺乏透明度不僅阻礙了資訊的決策,而且還降低了對醫療保健系統的信任。患者可能被迫支付高額自付費用,PBM 可能難以有效協商和管理藥品成本。
支持政策及政策
各國政府越來越認知到 PBM 在提高醫療保健效率和控制藥品成本方面發揮的關鍵作用,有利的法律規範可以促進市場成長。促進 PBM 領域透明度、公平競爭和標準化的政策創造了一個促進創新和協作的環境。透過使法規與醫療保健系統不斷變化的需求保持一致,政策制定者可以授權 PBM 最佳化處方藥福利,最終使患者和提供者受益。此類監管支持不僅將培育更具彈性和競爭力的 PBM 市場,而且有助於整體改善醫療保健的可負擔性和可近性。
缺乏標準化
由於藥品處方集、福利結構和報銷模式多樣化,缺乏統一性導致 PBM業務變得複雜。標準化的缺乏會抑制互通性,並阻礙醫療保健生態系統中各個相關人員之間的無縫資訊交流。它還在比較和基準化 PBM實績方面帶來了挑戰,限制了透明度並阻礙了最佳實踐的建立。此外,缺乏標準化流程可能會導致效率低下和錯誤,從而影響護理品質和患者治療結果。
COVID-19 的爆發對藥品福利管理 (PBM) 市場產生了多方面的影響。醫療保健需求的增加、藥物供應鏈的中斷以及病患行為的變化重塑了處方藥物管理的動態。遠端醫療的擴展、數位化的加速以及對公共衛生的重新關注凸顯了 PBM 在適應大流行帶來的挑戰方面不斷變化的作用。雖然這場危機刺激了創新,但也凸顯了需要有彈性和靈活的 PBM 策略來駕馭當前的醫療保健形勢。
專業藥房服務業預計將在預測期內成為最大的行業。
透過滿足需要複雜且高成本的慢性病和罕見疾病藥物治療的患者的獨特需求,專業藥房服務產業有望實現良好的成長。這些服務最佳化了專業藥物的獲取,並確保及時給藥、病患教育和全面支持。提供專業藥局服務的 PBM 有助於提高用藥醫囑遵從性、控制成本並改善病患治療效果,在快速發展的藥品福利領域展現了對個體化照護的重要承諾。
預計零售藥局領域在預測期內複合年成長率最高
預計零售藥局領域在預測期內將以最快的複合年成長率成長。 PBM 與零售藥局合作,最佳化處方藥福利、協商價格並簡化申請處理。這種夥伴關係將確保患者方便地獲得藥物,同時提高醫療保健系統的成本效益和效率。零售藥局是 PBM 生態系統中的關鍵參與者,有助於實現向廣大人群提供負擔得起且易於獲得的藥物服務的總體目標。
由於強大的醫療基礎設施、高昂的醫療成本和沈重的慢性病負擔,北美在預測期內佔據了最大的市場佔有率。該地區完善的法規環境和健康保險普及正在增加 PBM 的存在。此外,隨著對成本控制的持續重視以及醫療保健領域先進技術的整合進一步促進了 PBM 的成長,北美已成為塑造藥品福利管理服務發展的關鍵參與者。
由於醫療保健意識提高、慢性病數量增加和保險覆蓋範圍擴大等多種因素,亞太地區在預測期內將呈現最高的複合年成長率。政府控制醫療成本和改善藥品取得的努力進一步推動了 PBM 的採用。該地區多元化且不斷成長的藥品市場為 PBM 提供了最佳化藥物效益的機會。然而,挑戰包括克服不同的監管環境和不同的醫療保健系統。隨著 PBM 獲得認可,亞太地區為尋求控制藥品成本和加強患者照護的公司呈現出充滿活力的前景。
According to Stratistics MRC, the Global Pharmacy Benefit Management Market is accounted for $502.1 billion in 2023 and is expected to reach $843.9 billion by 2030 growing at a CAGR of 7.7% during the forecast period. Pharmacy Benefit Management (PBM) is a service that administers prescription drug benefits for health insurance plans. PBMs negotiate with pharmacies, manage formularies, and process claims, aiming to optimize drug utilization and control costs. Their role streamlines drug access, enhances affordability, and promotes efficient healthcare delivery.
According to the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage Enrollment Files, 30.8 million people in the U.S. were enrolled in a Medicare Advantage plan, which accounted for 51.0% of the eligible Medicare population in 2023.
Growing prevalence of chronic conditions boosts
The global burden of chronic diseases continues to rise, there is an increased demand for efficient management of medication access and adherence. PBMs play a pivotal role in this landscape by negotiating drug prices, optimizing formularies, and implementing strategies to control costs associated with chronic disease treatments. Their focus on improving patient outcomes through personalized medication plans aligns with the evolving healthcare landscape, making PBMs essential in addressing the complexities of chronic conditions and ensuring cost-effective access to necessary medications for a growing population with long-term health needs.
Lack of transparency in drug pricing
This opacity in pricing mechanisms creates challenges for both consumers and PBMs in understanding the true cost of medications. With intricate rebate structures and undisclosed pricing negotiations between PBMs and pharmaceutical manufacturers, stakeholders often face difficulties in comprehending the actual value of prescribed drugs. This lack of transparency not only hampers informed decision-making but also diminishes trust in the healthcare system. Patients may bear the brunt of high out-of-pocket costs, while PBMs may struggle to effectively negotiate and manage drug expenses.
Supportive policies and regulations
Governments increasingly recognize the pivotal role of PBMs in enhancing healthcare efficiency and controlling drug costs, favorable regulatory frameworks can stimulate market growth. Policies that promote transparency, fair competition, and standardization within the PBM sector create a conducive environment for innovation and collaboration. By aligning regulations with the evolving needs of healthcare systems, policymakers can empower PBMs to optimize prescription drug benefits, ultimately benefiting patients and healthcare providers. This regulatory support not only fosters a more resilient and competitive PBM market but also contributes to the overall improvement of healthcare affordability and accessibility.
Lack of Standardization
With diverse drug formularies, benefit structures, and reimbursement models, the absence of uniformity introduces complexities in PBM practices. This lack of standardization can impede interoperability, hindering seamless information exchange among various stakeholders in the healthcare ecosystem. It also creates challenges in comparing and benchmarking PBM performance, limiting transparency and inhibiting the establishment of best practices. Moreover, the absence of standardized processes may lead to inefficiencies and errors, impacting the quality of care and patient outcomes.
The COVID-19 pandemic has exerted a multifaceted impact on the Pharmacy Benefit Management (PBM) market. Increased healthcare demands, disruptions in the drug supply chain, and altered patient behavior have reshaped the dynamics of prescription drug management. Telehealth expansion, accelerated digitalization, and a renewed focus on public health underscore the evolving role of PBMs in adapting to the challenges posed by the pandemic. While the crisis has prompted innovation, it has also highlighted the need for resilient and flexible PBM strategies to navigate the ongoing healthcare landscape.
The specialty pharmacy services segment is expected to be the largest during the forecast period
The specialty pharmacy services segment is expected to have a lucrative growth by addressing the unique needs of patients requiring complex, high-cost medications for chronic and rare conditions. These services optimize access to specialty drugs, ensuring timely delivery, patient education, and comprehensive support. PBMs offering specialty pharmacy services enhance medication adherence, manage costs, and contribute to improved patient outcomes, demonstrating a vital commitment to personalized care in the rapidly evolving landscape of pharmaceutical benefits.
The retail pharmacies segment is expected to have the highest CAGR during the forecast period
The retail pharmacies segment is anticipated to witness the fastest CAGR growth during the forecast period. PBMs collaborate with retail pharmacies to optimize prescription drug benefits, negotiate pricing, and streamline claims processing. This partnership ensures convenient access to medications for patients while enhancing cost-effectiveness and efficiency in the healthcare system. Retail pharmacies, as key players in the PBM ecosystem, contribute to the overall goal of providing affordable and accessible pharmaceutical care to a broad population.
North America secures the largest share in the market over the forecast period driven by a robust healthcare infrastructure, high healthcare spending, and a significant burden of chronic diseases. The region's well-established regulatory environment and widespread adoption of health insurance contribute to the strong presence of PBMs. Moreover, the constant emphasis on cost containment and the integration of advanced technologies in healthcare further propel the growth of PBMs, making North America a key player in shaping the evolution of pharmacy benefit management services.
The Asia Pacific region exhibits the highest CAGR in the market over the forecast period due to multiple factors driven by increasing healthcare awareness, rising chronic diseases and expanding insurance coverage. Governments' efforts to control healthcare costs and improve access to medications further propel PBM adoption. The region's diverse and growing pharmaceutical market offers opportunities for PBMs to optimize drug benefits. However, challenges include navigating varied regulatory landscapes and diverse healthcare systems. As PBM awareness rises, the Asia Pacific presents a dynamic landscape for companies aiming to enhance pharmaceutical cost management and patient care.
Some of the key players in Pharmacy Benefit Management market include Abarca Health LLC., SS&C Technologies, Inc., Anthem, Inc., Benecard Services, LLC, CaptureRx, Centene Corporation, ProCare Rx, Change Healthcare, OptumRx, Inc., Cigna, Medimpact, CVS Health, Elixir Rx Solutions, LLC and Express Scripts Holding Company.
In July 2023, CVS Caremark announced a partnership with the discount drug service provider GoodRx to reduce out-of-pocket prescription costs for millions of people.
In October 2022, Omnicell, Inc., a provider of medication management and adherence tools for health systems and pharmacies, launched Specialty Pharmacy Services, a comprehensive offering designed to help health systems launch and/or optimize a fully managed, hospital-owned specialty pharmacy.
In March 2022, ProdigyRx, a pharmacy benefits manager, launched its business operations that offer PBM services and clinical solutions for workers' compensation insurers, third-party administrators, and self-insured/administered employers.