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Procurement Market Intelligence Report

Pharmacy Benefit Management Services
Sourcing Guide & Market Trends

Comprehensive intelligence for making smart purchasing decisions

Learn about actual and potential costs

How much should I pay for Pharmacy Benefit Management Services?

What is the average price of Pharmacy Benefit Management Services?

This procurement report includes pricing information to help you purchase Pharmacy Benefit Management Services. Our analysts provide a benchmark price and a price range based on key pricing factors to help you understand what you should be paying for this specific product or service. To see the average price for this and hundreds of other products and services, subscribe to ProcurementIQ.

Has the price of Pharmacy Benefit Management Services been rising or falling?

Analysts look at market data from the previous three years to determine an overall price trend. You can use the recent price trends to help you understand price volatility and plan your budget.

I’m not ready to purchase Pharmacy Benefit Management Services yet. Will I pay more if I wait too long?

We forecast the next three years of price movements by looking at factors likely to affect the market's supply chain, such as inputs, demand and competition. You can then use the price forecast to figure out the best time to purchase.

What other costs are associated with purchasing Pharmacy Benefit Management Services?

Our analysts calculate the total cost of ownership and assign a level of low, moderate or high, depending on things like customization, integration and installation. Use this information to budget for Pharmacy Benefit Management Services with a reduced risk of unexpected costs.

See how we display average pricing information, trends and market data.

Find the vendor to meet your needs

Where can I purchase ?

There are about 75 companies operating in the PBM service market, which is highly concentrated and competitive. The top three suppliers, Cigna, CVS Health Corporation and UnitedHealth Group, control between 60.0% and 80.0% of total market revenue. High barriers to entry contribute to high market concentration by reducing the number... Subscribe to learn more.

Questions to ask potential suppliers

How can I gain leverage during negotiations?


How do you win and retain business?

What is your reputation among your peers in the PBM services market?

How long have you had your longest client?

What do you consider to be best market practices in terms of switching suppliers?

What makes you stand out from your competition?


Do your policies comply with the requirements of the ACA? Have you ever faced litigation due to lack of regulatory compliance?

How do you stay up to date on new prescription and healthcare policies?

Please describe your level of rebate and discount disclosure and any reasons behind concealing any revenue sources.

How are you handling the Trump administration's regulation on rebates?

What DIR fees do you charge? How often are these fees disputed by pharmacies and employers?


What prescription drugs are covered on the MAC list?

Does the plan provide coverage for preventive drugs and pharmaceuticals such as flu vaccines?

Is there a maximum for annual out-of-pocket costs for which plan participants will be responsible?

Do you partner with other PBM service providers, pharmacies and mailing services? How do these partnerships affect your pricing?

What is the reach of your provider network? How often is your provider directory updated?

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Key elements for every RFP

What should my RFP include?

Project Budget

If one exists, buyers should specify their budget for the desired PBM services and related products and services.

Buyers should include information about any budgetary constraints.

Buyers can reference the benchmark price and total cost of ownership sections of this report for assistance in creating a budget.

Selection Criteria

Buyers will evaluate potential vendors based on their ability to fulfill buyers’ project requirements and expectations.

Buyers will evaluate potential vendors based on their performance references for similar projects as well as qualification and expertise of staff assigned to this project.

Buyers should specify their evaluation process for the submitted proposals, including technical and financial evaluation.

For other selection criteria requirements, buyers should reference the Buying-Decision Scorecard section of this report.

Project Schedule

Buyers should outline the tentative schedule and process for the RFP and project.

Buyers need to include the date when proposals are due and when the award will be announced.

Buyers should outline the length and terms of the contract, including the desire for the option to renew, if applicable.

Evaluate major factors to mitigate risk

How risky is the supply chain?

The supply chain for PBM services carries an overall moderate level of risk, which hampers buyer power. Buyers of PBM services should remain conscious of the moderate supply chain risk because disruptions in the drug supply can disrupt the dispensing and payment of claims and other services. Pharmaceutical manufacturers... Subscribe to learn more.