Medical benefits management diversification for PBM

A leading pharmacy benefit management (PBM) company had achieved a robust growth trajectory via organic growth and acquisitions. Health Business Group was asked to evaluate the attractiveness of other medical benefits markets including oncology, radiology, orthopedics, and medical devices and to develop an entry strategy for the more promising ones.We developed a baseline market size estimate for each opportunity, using secondary sources to segment the market by key characteristics. We also researched pricing levels and market growth along the same dimensions.We assessed the impact of ongoing and anticipated industry changes on the attractiveness of the market. Benefits management is a dynamic field, with significant changes underway in payment methodologies and reimbursement levels, evolution in evidence-based guidelines, concerns about patient safety, new technologies, and changes in patient mix.We investigated the competitive landscape to understand current capabilities of the main players, and to assess the value of our client’s technology, knowhow and relationships in these fieldsWe worked to create a rigorous fact base built upon primary and secondary research. We provided a refined assessment of the attractiveness of the opportunity as well as market entry options with advantages and disadvantages of each. For the most promising segment we conducted acquisition screening and performed commercial due diligence on two companies.