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市场调查报告书
商品编码
1402004
到 2030 年的药品福利管理市场预测:按服务、商业模式、最终用户和地区进行的全球分析Pharmacy Benefit Management Market Forecasts to 2030 - Global Analysis By Service, By Business Model, By End User and By Geography |
根据 Stratistics MRC 的数据,2023 年全球药品福利管理市场规模为 5,021 亿美元,预测期内复合年增长率为 7.7%,到 2030 年将达到 8,439 亿美元。
药房福利管理 (PBM) 是一项管理健康保险计划处方药福利的服务。 PBM 寻求透过与药房谈判、管理处方笺和处理申请来优化药物利用率并控製成本。 PBM 的作用是简化药物取得、提高负担能力并促进高效的医疗保健服务。
根据医疗保险和医疗补助服务中心 (CMS) 医疗保险优势登记文件,2023 年,美国有 3,080 万人参加了医疗保险优势计划,占医疗保险合格人口的 51.0%。
慢性病流行推动
全球慢性病负担持续增加,增加了对药物取得和用药医嘱遵从性的有效管理的需求。 PBM 透过协商药品价格、优化处方以及实施与慢性病治疗相关的成本控制策略,在这方面发挥着至关重要的作用。 PBM 的重点是透过个人化的药物治疗方案改善患者的治疗结果,与不断变化的医疗保健格局保持一致,解决慢性病的复杂性和不断增长的具有长期健康需求的人口。确保以具有成本效益的方式获得药物已变得至关重要人们健康所需的药物。
药价缺乏透明度
这种不透明的定价机制给消费者和 PBM 带来了了解药品真实成本的挑战。由于复杂的回扣结构以及 PBM 和药品製造商之间的私人价格谈判,相关人员常常难以理解处方药的实际价值。这种缺乏透明度不仅阻碍了资讯的决策,而且还降低了对医疗保健系统的信任。患者可能被迫支付高额自付费用,PBM 可能难以有效协商和管理药品成本。
支持政策及政策
各国政府越来越认识到 PBM 在提高医疗保健效率和控製药品成本方面发挥的关键作用,有利的法律规范可以促进市场成长。促进 PBM 领域透明度、公平竞争和标准化的政策创造了一个促进创新和协作的环境。透过使法规与医疗保健系统不断变化的需求保持一致,政策制定者可以授权 PBM 优化处方药福利,最终使患者和提供者受益。此类监管支持不仅将培育更具弹性和竞争力的 PBM 市场,而且有助于整体改善医疗保健的可负担性和可近性。
缺乏标准化
由于药品处方集、福利结构和报销模式多样化,缺乏统一性导致 PBM业务变得复杂。标准化的缺乏会抑制互通性,并阻碍医疗保健生态系统中各个相关人员之间的无缝资讯交流。它还在比较和基准化 PBM实绩方面带来了挑战,限制了透明度并阻碍了最佳实践的建立。此外,缺乏标准化流程可能会导致效率低下和错误,从而影响护理品质和患者治疗结果。
COVID-19 的爆发对药品福利管理 (PBM) 市场产生了多方面的影响。医疗保健需求的增加、药物供应链的中断以及病患行为的变化重塑了处方药物管理的动态。远端医疗的扩展、数位化的加速以及对公共卫生的重新关注凸显了 PBM 在适应大流行带来的挑战方面不断变化的作用。虽然这场危机刺激了创新,但也凸显了需要有弹性和灵活的 PBM 策略来驾驭当前的医疗保健形势。
专业药房服务业预计将在预测期内成为最大的行业。
透过满足需要复杂且高成本的慢性病和罕见疾病药物治疗的患者的独特需求,专业药房服务产业有望实现良好的成长。这些服务优化了专业药物的获取,并确保及时给药、病患教育和全面支持。提供专业药局服务的 PBM 有助于提高用药医嘱遵从性、控製成本并改善病患治疗效果,在快速发展的药品福利领域展现了对个体化照护的重要承诺。
预计零售药局领域在预测期内复合年增长率最高
预计零售药局领域在预测期内将以最快的复合年增长率成长。 PBM 与零售药局合作,优化处方药福利、协商价格并简化申请处理。这种伙伴关係将确保患者方便地获得药物,同时提高医疗保健系统的成本效益和效率。零售药局是 PBM 生态系统中的关键参与者,有助于实现向广大人群提供负担得起且易于获得的药物服务的总体目标。
由于强大的医疗基础设施、高昂的医疗成本和沈重的慢性病负担,北美在预测期内占据了最大的市场占有率。该地区完善的法规环境和健康保险普及正在增加 PBM 的存在。此外,随着对成本控制的持续重视以及医疗保健领域先进技术的整合进一步促进了 PBM 的成长,北美已成为塑造药品福利管理服务发展的关键参与者。
由于医疗保健意识提高、慢性病数量增加和保险覆盖范围扩大等多种因素,亚太地区在预测期内将呈现最高的复合年增长率。政府控制医疗成本和改善药品取得的努力进一步推动了 PBM 的采用。该地区多元化且不断成长的药品市场为 PBM 提供了优化药物效益的机会。然而,挑战包括克服不同的监管环境和不同的医疗保健系统。随着 PBM 获得认可,亚太地区为寻求控制药品成本和加强患者照护的公司呈现出充满活力的前景。
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.