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封面
市場調查報告書
商品編碼
1869952

美國藥物利用管理市場規模、佔有率和趨勢分析報告：按項目類型、最終用途和細分市場預測（2025-2033 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, 2025 - 2033
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

市場規模與趨勢：

據估計，2024 年美國藥物利用管理市場價值為 397.7 億美元，預計到 2033 年將達到 757.9 億美元。

預計從 2025 年到 2033 年，該市場將以 7.49% 的複合年成長率成長。市場成長預計將受到自動化利用管理服務日益普及以及改善專科藥物處方模式以降低總體成本和改善患者療效的需求不斷成長的推動。

藥物利用管理措施，例如事先核准（PA）、階梯治療和用藥數量限制，旨在最佳化患者療效，減少浪費、濫用、不必要的用藥和成本。這些措施對於控制醫療成本、影響患者照護決策和提高醫療品質至關重要。處方醫生、付款者和藥劑師之間的協作日益重要，以確保患者能夠及時獲得藥物，同時保持成本效益和價值。未來包括：在事先核准過程中更依賴藥劑師；實施電子事先核准（ePA）以簡化核准流程；以及製定電子健康資訊交流的最佳實踐和國家標準。

美國醫療保健支出佔GDP的很大一部分，其中處方藥支出佔比很高，這進一步凸顯了控制醫療成本的必要性。根據美國醫療保險和醫療補助服務中心（CMS）預測，到2025年，美國醫療保健總支出將達到4.9兆美元，其中處方藥支出預計在2023年將達到約4,497億美元，比上年成長11.4%。為了有效控制這些成本，醫療服務提供者和支付者正在實施各種策略。其中一個策略是合理用藥（UM），它利用臨床指南和用藥清單等工具，確保患者獲得最合適、最具成本效益的治療。這種方法不僅有助於降低醫療成本，還能確保患者獲得最佳護理，進而改善患者的治療效果。

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
  • 市場趨勢與展望
  • 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：藥物利用管理定價分析
  • 商業環境分析工具
    • 產業分析—波特五力分析
    • PESTEL 分析

第4章美國藥物利用管理市場（依專案類型分類），2021-2033年

  • 美國藥物利用管理市場：專案類型細分儀表板
  • 項目類型趨勢與市場佔有率分析，2024 年和 2033 年
  • 美國藥物利用管理市場規模及按項目類型分類的預測，2021-2033年
  • 內部
  • 外包

第5章美國藥物利用管理市場（依最終用途分類），2021-2033年

  • 美國藥物利用管理市場：終端用戶細分儀表板
  • 2024 年和 2033 年終端用戶趨勢和市場佔有率分析
  • 美國藥物利用管理市場規模及最終用途預測
  • PBM
  • 健康計劃提供者/付款方
  • 藥局

第6章 競爭情勢

  • 參與企業
  • 企業市場分析
  • 策略規劃
    • 擴張
    • 併購
    • 夥伴關係/合作/聯盟
    • 其他
  • 公司簡介：第三方供應商
    • 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

Market Size & Trends:

The U.S. drug utilization management market size was estimated at USD 39.77 billion in 2024 and is projected to reach USD 75.79 billion by 2033, growing at a CAGR of 7.49% from 2025 to 2033. Increasing use of automated utilization management services and rising need for improved prescription patterns for specialty drugs to lower the overall cost & improve patient outcomes is expected to drive market growth.

Drug utilization management criteria, such as Prior Authorizations (PAs), step therapy, and quantity limits, are designed to optimize patient outcomes and reduce waste, errors, unnecessary drug use, & costs. These programs are essential for controlling healthcare costs, influencing patient care decisions, and improving the quality of treatment. Collaboration between prescribers, payers, and pharmacists has become more emphasized to ensure patients receive timely access to drugs while maintaining cost-effectiveness and value. The future of utilization management involves a growing reliance on pharmacists in the PA process, the adoption of Electronic PA (ePA) to streamline approvals, and the development of best practices & national standards for electronic health information exchange.

The need for cost containment in healthcare is further emphasized by the fact that the U.S. spends a substantial portion of its GDP on healthcare, with prescription drugs being a major source of this expenditure. According to the U.S. Centers for Medicare & Medicaid Services (CMS), in 2025, the U.S. spent USD 4.9 trillion on healthcare services, and around USD 449.7 billion was spent on prescription drugs in 2023, which is a 11.4% increase from 2022. To manage these costs effectively, healthcare providers and payers are implementing various strategies, including UM, which involves the use of clinical guidelines, formularies, and other tools to ensure that patients receive the most appropriate & cost-effective treatments. This approach not only helps reduce healthcare costs but also improves patient outcomes by ensuring that patients receive the best possible care.

U.S. Drug Utilization Management Market Report Segmentation

This report forecasts revenue growth at the country level and provides an analysis of the latest industry trends and opportunities in each of the sub-segments from 2021 to 2033. For this study, Grand View Research has segmented the U.S. drug utilization management market report based on program type and end-use:

  • Program Type Outlook (Revenue, USD Billion, 2021 - 2033)
    • In-house
    • Outsourced
  • End-use Outlook (Revenue, USD Billion, 2021 - 2033)
    • PBMs
    • Health Plan Provider/Payors
    • Pharmacies

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, 2021 - 2033 (USD Billion)

  • 4.1. U.S. Drug Utilization Management Market: Program Type Segment Dashboard
  • 4.2. Program Type Movement & Market Share Analysis, 2024 & 2033
  • 4.3. U.S. Drug Utilization Management Market Size & Forecast and Forecasts, By Program Type, 2021 - 2033 (USD Billion)
  • 4.4. In-House
    • 4.4.1. In-house market, 2021 - 2033 (USD Billion)
  • 4.5. Outsourced
    • 4.5.1. Outsourced - market, 2021 - 2033 (USD Billion)

Chapter 5. U.S. Drug Utilization Management Market, By End Use, 2021 - 2033 (USD Billion)

  • 5.1. U.S. Drug Utilization Management Market: End Use Segment Dashboard
  • 5.2. End Use Movement & Market Share Analysis, 2024 & 2033
  • 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, 2021 - 2033 (USD Billion)
  • 5.5. Health Plan Provider/Payors
    • 5.5.1. Health Plan Provider/Payors market, 2021 - 2033 (USD Billion)
  • 5.6. Pharmacies
    • 5.6.1. Pharmacies market, 2021 - 2033 (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, 2021 - 2033 (USD Billion)
  • Table 5 U.S. drug utilization management market revenue estimates and forecast, by end use, 2021 - 2033 (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, 2024 & 2033
  • Fig. 20 In-house market, 2021 - 2033 (USD Billion)
  • Fig. 21 Outsourced market, 2021 - 2033 (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, 2024 & 2033
  • Fig. 24 Health plan provider/Payors market, 2021 - 2033 (USD Billion)
  • Fig. 25 Pharmacies market, 2021 - 2033 (USD Billion)
  • Fig. 26 PBMs market, 2021 - 2033 (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