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封面
市場調查報告書
商品編碼
1511850

美國藥物利用管理市場規模、佔有率和趨勢分析報告：按計劃類型、最終用途和細分市場預測，2024-2030 年

U.S. Drug Utilization Management Market Size, Share & Trends Analysis Report By Program Type (In-House, Outsourced), By End-use (PBMs, Health Plan Providers/Payors, Pharmacies), And Segment Forecasts, 2024 - 2030
出版日期: | 出版商: Grand View Research | 英文 140 Pages | 商品交期: 2-10個工作天內

價格

美國藥物管理市場的成長與趨勢：

Grand View Research, Inc.最新報告顯示，預計到2030年，美國藥物利用管理市場規模將達到606.8億美元，2024年至2030年複合年成長率為7.30%。

市場成長的主要驅動力是創新但高價藥品的不斷推出、付款人控制支出的努力以及藥品製造商支持患者獲取和銷售的努力。

付款人正在實施限制藥物處方、收緊事先核准和增加患者費用分攤要求等策略，而製造商則鼓勵患者和醫生避免行政法規並增加費用分攤要求。此外，隨著昂貴的藥物變得越來越普遍，並且保險公司利用利用率管理透過影響預計增加的患者治療決策來控制成本，未來幾年對 PA 的需求將會增加。根據國家醫學圖書館 2022 年發布的一項研究，PA 和其他使用管理工具影響處方的很大一部分，醫生平均每週處理 19.7 個 PA。這些工具（包括處方限制和步驟編輯）對於管理患者治療決策和最佳化結果至關重要。

此外，即時資料分析在藥物使用管理中的日益整合為提高醫療保健效率和降低成本提供了重要機會。 Xevant 和 MaxCare RX 等即時分析平台可提供有關處方利用率、成本趨勢和新興模式的見解，為決策者提供可操作的資訊。這些工具使藥房福利專業人員能夠最佳化藥房支出、評估資料分析趨勢並獲得即時見解和警報，最終節省成本並改善健康結果。因此，即時資料分析在藥房利用管理中的整合預計將在未來幾年推動美國藥物利用管理市場的成長。

美國藥物利用管理市場報告亮點

  • 按項目類型分類，由於需要有效的藥物使用管理的慢性病盛行率不斷上升，專有細分市場在 2023 年以最大的收益佔有率佔據市場主導地位。
  • 按最終用途分類，PBM 領域預計將在 2023 年以最大的收益佔有率主導市場，並在預測期內實現最快的成長。該行業的成長主要是由於對專業藥房服務的需求不斷成長。
  • 2024 年 2 月，非營利健康與人類服務組織 Point32Health 簽訂協議，收購 Baystate Health 的子公司 Health New England。
  • 2021 年 10 月，由 Costco 和沃爾瑪等約 40 家私人公司組成的非營利合作夥伴推出了一家新公司 EmsanaRx，為雇主提供 PBM 服務。

目錄

第1章調查方法和範圍

第 2 章執行摘要

第3章 市場變數、趨勢與範圍

  • 市場體系展望
  • 市場趨勢及展望
  • 市場動態
    • 市場促進因素分析
    • 市場限制因素分析
    • 產業機會分析
    • 產業問題分析
  • 定性分析：藥品使用管理的價格分析
  • 商業環境分析工具
    • 產業分析-波特五力分析
    • PESTEL分析

第 4 章美國藥物使用控制市場，依計畫類型，2018-2030 年

  • 美國藥物利用管理市場：按計畫類型細分儀表板
  • 2023 年和 2030 年按計畫類型分類的趨勢和市場佔有率分析
  • 2018-2030 年美國藥物利用管理市場規模與預測（按計畫類型）
  • 公司內部
  • 外包

第5章美國藥物使用控制市場，依最終用途，2018-2030 年

  • 美國藥物使用控制市場：按最終用途細分儀表板
  • 2023 年和 2030 年按最終用途分類的趨勢和市場佔有率分析
  • 美國藥物使用控制市場規模和預測（按最終用途）
  • PBM（個人業務經理）
  • 健康保險提供者/付款人
  • 藥局

第6章 競爭狀況

  • 參與企業
  • 公司市場分析
  • 策略規劃
    • 擴張
    • 併購
    • 夥伴關係/協作/聯盟
    • 其他
  • 公司簡介：第三方提供商
    • Prime Therapeutics LLC
    • MedicusRx
    • EmblemHealth
    • Optum, Inc.
    • Point32Health, Inc.
    • AssureCare LLC
    • MindRx Group
    • Agadia Systems, Inc
    • Elevance Health（CarelonRx）
    • ExlService Holdings, Inc.
    • MRIoA
    • S&C Technologies, Inc.
  • 公司簡介：內部供應商
    • Ultimate Health Plans
    • Security Health Plan of Wisconsin, Inc.
    • Blue Cross and Blue Shield Association
    • Providence
    • Simply Healthcare Plans, Inc
    • Health Plan of San Mateo（HPSM）
    • PerformRx
    • Aetna, Inc.（CVS Health Corp.）
Product Code: GVR-4-68040-296-3

U.S. Drug Utilization Management Market Growth & Trends:

The U.S. drug utilization management market size is anticipated to reach USD 60.68 billion by 2030, exhibiting CAGR of 7.30% from 2024 to 2030, according to a new report by Grand View Research, Inc. The market growth is primarily influenced by the increasing introduction of innovative yet high-priced drugs, leading to efforts by payers to manage spending, and pharmaceutical manufacturers to support patient access and sales.

Payers are implementing strategies like restricting drug formularies, stringent prior authorizations, and raising patient cost-sharing requirements, while manufacturers are investing in programs to assist patients and physicians in navigating administrative controls and meeting cost-sharing obligations. Furthermore, as expensive medications are becoming more common and insurance companies are using utilization management to control costs by influencing patient care decisions, the need for PA is expected to rise in the coming years. According to a study published by the National Library of Medicine in 2022, PA and other utilization management tools impact a significant portion of prescriptions, with physicians handling an average of 19.7 PAs per week. These tools, including formulary restrictions and step edits, are essential for managing patient care decisions and optimizing outcomes.

Moreover, the growing integration of real-time data analytics in drug utilization management poses significant opportunities for improving efficiency and reducing costs in the healthcare sector. Real-time analytics platforms such as Xevant and MaxCare RX offer insights into prescription utilization, cost trends, and emerging patterns, empowering decision-makers with actionable information. These tools enable pharmacy benefit experts to optimize pharmacy spend, assess data analytics trends, and gain access to real-time insights & alerts, ultimately leading to lower costs and improved health outcomes. Thus, this advancement of integrating real-time data analytics in pharmacy utilization management is expected to drive the growth of the U.S. drug utilization management market in the coming years.

U.S. Drug Utilization Management Market Report Highlights:

  • Based on program type, the in-house segment dominated the market with the largest revenue share in 2023, due to the rising prevalence of chronic diseases necessitating effective medication use management.
  • Based on end-use, PBMs segment dominated the market with the largest revenue share in 2023 and also expected to witness the fastest growth over the forecast period. The growth of the segment is primarily driven by the growing demand for specialty pharmacy services.
  • In February 2024, Point32Health, a leading not-for-profit health and well-being organization, signed an agreement to acquire Health New England, a subsidiary of Baystate Health.
  • In October 2021, a non-profit partnership of around 40 private employers including Costco and Walmart, launched EmsanaRx, a new company offering PBM services to employers.

Table of Contents

Chapter 1. Methodology and Scope

  • 1.1. Market Segmentation & Scope
    • 1.1.1. Estimates and Forecast Timeline
  • 1.2. Market Definitions
    • 1.2.1. Segment definitions.
      • 1.2.1.1. Program type
      • 1.2.1.2. End-use
  • 1.3. Research Methodology
  • 1.4. Information Procurement
    • 1.4.1. Purchased Database
    • 1.4.2. GVR's Internal Database
    • 1.4.3. Secondary Sources
    • 1.4.4. Primary Research
      • 1.4.4.1. Details of Primary Research
    • 1.4.5. Research Assumption
  • 1.5. Information or Data Analysis
    • 1.5.1. Data Analysis Models
  • 1.6. Market Formulation & Data Visualization
  • 1.7. Model Details
    • 1.7.1. Volume Price Analysis
    • 1.7.2. Segment-level market estimation: Multivariate analysis
    • 1.7.3. Multivariate analysis
    • 1.7.4. Forecast & CAGR Calculation
  • 1.8. Objectives
  • 1.9. List of Secondary Sources
  • 1.10. List of Abbreviations

Chapter 2. Executive Summary

  • 2.1. Market Snapshot
  • 2.2. Segment Snapshot
  • 2.3. Competitive Landscape Snapshot

Chapter 3. Market Variables, Trends, & Scope

  • 3.1. Market Lineage Outlook
  • 3.2. Market Trends and Outlook
  • 3.3. Market Dynamics
    • 3.3.1. Market Driver Analysis
      • 3.3.1.1. Increasing demand for automated utilization management systems
      • 3.3.1.2. Need for improving prescription patterns for specialty drugs
      • 3.3.1.3. Growing demand for cost containment in the healthcare industry
    • 3.3.2. Market Restraint Analysis
      • 3.3.2.1. Regulatory and privacy issues
      • 3.3.2.2. Lack of transparency
    • 3.3.3. Industry Opportunity Analysis
      • 3.3.3.1. Growing integration of real-time data analytics in the healthcare industry
    • 3.3.4. Industry Challenges Analysis
      • 3.3.4.1. Delayed access to treatment and hindrance in medication adherence
  • 3.4. Qualitative Analysis: Pricing Analysis on Drug Utilization Management
  • 3.5. Business Environment Analysis Tools
    • 3.5.1. Industry Analysis - Porter's Five Forces Analysis
      • 3.5.1.1. Supplier power
      • 3.5.1.2. Buyer power
      • 3.5.1.3. Substitution threat
      • 3.5.1.4. Threat of new entrant
      • 3.5.1.5. Competitive rivalry
    • 3.5.2. PESTEL Analysis

Chapter 4. U.S. Drug Utilization Management Market, By Program Type, 2018 - 2030 (USD Billion)

  • 4.1. U.S. Drug Utilization Management Market: Program Type Segment Dashboard
  • 4.2. Program Type Movement & Market Share Analysis, 2023 & 2030
  • 4.3. U.S. Drug Utilization Management Market Size & Forecast and Forecasts, By Program Type, 2018 - 2030 (USD Billion)
  • 4.4. In-House
    • 4.4.1. In-house market, 2018 - 2030 (USD Billion)
  • 4.5. Outsourced
    • 4.5.1. Outsourced - market, 2018 - 2030 (USD Billion)

Chapter 5. U.S. Drug Utilization Management Market, By End-use, 2018 - 2030 (USD Billion)

  • 5.1. U.S. Drug Utilization Management Market: End-use Segment Dashboard
  • 5.2. End-use Movement & Market Share Analysis, 2023 & 2030
  • 5.3. U.S. Drug Utilization Management Market Size & Forecast and Forecasts, By End-use (USD Billion)
  • 5.4. PBMs
    • 5.4.1. PBMs market, 2018 - 2030 (USD Billion)
  • 5.5. Health Plan Provider/Payors
    • 5.5.1. Health Plan Provider/Payors market, 2018 - 2030 (USD Billion)
  • 5.6. Pharmacies
    • 5.6.1. Pharmacies market, 2018 - 2030 (USD Billion)

Chapter 6. Competitive Landscape

  • 6.1. Participant Categorization
  • 6.2. Company Market Position Analysis
  • 6.3. Strategy Mapping
    • 6.3.1. Expansion
    • 6.3.2. Merger and Acquisition
    • 6.3.3. Partnership/Collaborations/Alliances
    • 6.3.4. Others
  • 6.4. Company Profiles: Third Party Providers
    • 6.4.1. Prime Therapeutics LLC
      • 6.4.1.1. Overview
      • 6.4.1.2. Financial Performance
      • 6.4.1.3. Service Benchmarking
      • 6.4.1.4. Strategic Initiatives
    • 6.4.2. MedicusRx
      • 6.4.2.1. Overview
      • 6.4.2.2. Financial Performance
      • 6.4.2.3. Service Benchmarking
      • 6.4.2.4. Strategic Initiatives
    • 6.4.3. EmblemHealth
      • 6.4.3.1. Overview
      • 6.4.3.2. Financial Performance
      • 6.4.3.3. Service Benchmarking
      • 6.4.3.4. Strategic Initiatives
    • 6.4.4. Optum, Inc.
      • 6.4.4.1. Overview
      • 6.4.4.2. Financial Performance
      • 6.4.4.3. Service Benchmarking
      • 6.4.4.4. Strategic Initiatives
    • 6.4.5. Point32Health, Inc.
      • 6.4.5.1. Overview
      • 6.4.5.2. Financial Performance
      • 6.4.5.3. Service Benchmarking
      • 6.4.5.4. Strategic Initiatives
    • 6.4.6. AssureCare LLC
      • 6.4.6.1. Overview
      • 6.4.6.2. Financial Performance
      • 6.4.6.3. Service Benchmarking
      • 6.4.6.4. Strategic Initiatives
    • 6.4.7. MindRx Group
      • 6.4.7.1. Overview
      • 6.4.7.2. Financial Performance
      • 6.4.7.3. Service Benchmarking
      • 6.4.7.4. Strategic Initiatives
    • 6.4.8. Agadia Systems, Inc
      • 6.4.8.1. Overview
      • 6.4.8.2. Financial Performance
      • 6.4.8.3. Service Benchmarking
      • 6.4.8.4. Strategic Initiatives
    • 6.4.9. Elevance Health (CarelonRx)
      • 6.4.9.1. Overview
      • 6.4.9.2. Financial Performance
      • 6.4.9.3. Service Benchmarking
      • 6.4.9.4. Strategic Initiatives
    • 6.4.10. ExlService Holdings, Inc.
      • 6.4.10.1. Overview
      • 6.4.10.2. Financial Performance
      • 6.4.10.3. Service Benchmarking
      • 6.4.10.4. Strategic Initiatives
    • 6.4.11. MRIoA
      • 6.4.11.1. Overview
      • 6.4.11.2. Financial Performance
      • 6.4.11.3. Service Benchmarking
      • 6.4.11.4. Strategic Initiatives
    • 6.4.12. S&C Technologies, Inc.
      • 6.4.12.1. Overview
      • 6.4.12.2. Financial Performance
      • 6.4.12.3. Service Benchmarking
      • 6.4.12.4. Strategic Initiatives
  • 6.5. Company Profiles: In-House Providers
    • 6.5.1. Ultimate Health Plans
      • 6.5.1.1. Overview
      • 6.5.1.2. Financial Performance
      • 6.5.1.3. Service Benchmarking
      • 6.5.1.4. Strategic Initiatives
    • 6.5.2. Security Health Plan of Wisconsin, Inc.
      • 6.5.2.1. Overview
      • 6.5.2.2. Financial Performance
      • 6.5.2.3. Service Benchmarking
      • 6.5.2.4. Strategic Initiatives
    • 6.5.3. Blue Cross and Blue Shield Association
      • 6.5.3.1. Overview
      • 6.5.3.2. Financial Performance
      • 6.5.3.3. Service Benchmarking
    • 6.5.4. Providence
      • 6.5.4.1. Overview
      • 6.5.4.2. Financial Performance
      • 6.5.4.3. Service Benchmarking
    • 6.5.5. Simply Healthcare Plans, Inc
      • 6.5.5.1. Overview
      • 6.5.5.2. Financial Performance
      • 6.5.5.3. Service Benchmarking
    • 6.5.6. Health Plan of San Mateo (HPSM)
      • 6.5.6.1. Overview
      • 6.5.6.2. Financial Performance
      • 6.5.6.3. Service Benchmarking
    • 6.5.7. PerformRx
      • 6.5.7.1. Overview
      • 6.5.7.2. Financial Performance
      • 6.5.7.3. Service Benchmarking
    • 6.5.8. Aetna, Inc. (CVS Health Corp.)
      • 6.5.8.1. Overview
      • 6.5.8.2. Financial Performance
      • 6.5.8.3. Service Benchmarking
      • 6.5.8.4. Strategic Initiatives

List of Tables

  • Table 1. List of secondary sources
  • Table 2. List of abbreviations
  • Table 3. Specialty drug expenditures, 2016 - 2021
  • Table 4. U.S. drug utilization management market revenue estimates and forecast, by program type, 2018 - 2030 (USD Billion)
  • Table 5. U.S. drug utilization management market revenue estimates and forecast, by end-use, 2018 - 2030 (USD Billion)

List of Figures

  • Fig. 1 U.S. drug utilization management market segmentation
  • Fig. 2 U.S. drug utilization management market segmentation
  • Fig. 3 Market research process
  • Fig. 4 Data triangulation techniques
  • Fig. 5 Primary research pattern
  • Fig. 6 Market research approaches
  • Fig. 7 Value chain-based sizing & forecasting
  • Fig. 8 Market formulation & validation
  • Fig. 9 Market snapshot
  • Fig. 10 Segment snapshot
  • Fig. 11 Competitive landscape
  • Fig. 12 U.S. drug utilization management market: Ancillary/related market outlook
  • Fig. 13 U.S. drug utilization management market dynamics
  • Fig. 14 Market driver relevance analysis (Current & future impact)
  • Fig. 15 Market restraint relevance analysis (Current & future impact)
  • Fig. 16 U.S. drug utilization management market: Porter's five forces analysis
  • Fig. 17 U.S. drug utilization management market: PESTLE analysis
  • Fig. 18 U.S. drug utilization management market: Program type segment dashboard
  • Fig. 19 U.S. drug utilization management market: Program type market share analysis, 2023 & 2030
  • Fig. 20 In-house market, 2018 - 2030 (USD Billion)
  • Fig. 21 Outsourced market, 2018 - 2030 (USD Billion
  • Fig. 22 U.S. drug utilization management market: End-use segment dashboard
  • Fig. 23 U.S. drug utilization management market: End-use market share analysis, 2023 & 2030
  • Fig. 24 Health plan provider/Payors market, 2018 - 2030 (USD Billion)
  • Fig. 25 Pharmacies market, 2018 - 2030 (USD Billion)
  • Fig. 26 PBMs market, 2018 - 2030 (USD Billion)
  • Fig. 27 Company categorization: Third-party providers
  • Fig. 28 Company market position analysis: Third-party providers
  • Fig. 29 Strategic framework: Third-party providers
  • Fig. 30 Company categorization: In-house providers
  • Fig. 31 Company market position analysis: In-house providers