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封面
市场调查报告书
商品编码
1511850

美国药物利用管理市场规模、份额和趋势分析报告：按计划类型、最终用途和细分市场预测，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个工作天内

价格

美国药物管理市场的成长与趋势：

Grand View Research, Inc.最新报告显示，预计到2030年，美国药物利用管理市场规模将达到606.8亿美元，2024年至2030年复合年增长率为7.30%。

市场成长的主要驱动力是创新但高价药品的不断推出、付款人控制支出的努力以及药品製造商支持患者获取和销售的努力。

付款人正在实施限制药物处方、收紧事先核准和增加患者费用分摊要求等策略，而製造商则鼓励患者和医生避免行政法规并增加费用分摊要求。此外，随着昂贵的药物变得越来越普遍，并且保险公司利用利用率管理透过影响预计增加的患者治疗决策来控製成本，未来几年对 PA 的需求将会增加。根据国家医学图书馆 2022 年发布的一项研究，PA 和其他使用管理工具影响处方的很大一部分，医生平均每週处理 19.7 个 PA。这些工具（包括处方限制和步骤编辑）对于管理患者治疗决策和优化结果至关重要。

此外，即时资料分析在药物使用管理中的日益集成为提高医疗保健效率和降低成本提供了重要机会。 Xevant 和 MaxCare RX 等即时分析平台可提供有关处方利用率、成本趋势和新兴模式的见解，为决策者提供可操作的资讯。这些工具使药房福利专业人员能够优化药房支出、评估资料分析趋势并获得即时见解和警报，最终节省成本并改善健康结果。因此，即时资料分析在药房利用管理中的整合预计将在未来几年推动美国药物利用管理市场的成长。

美国药物利用管理市场报告亮点

  • 按项目类型划分，由于需要有效的药物使用管理的慢性病盛行率不断上升，专有细分市场在 2023 年以最大的收益占有率占据市场主导地位。
  • 按最终用途划分，PBM 领域预计将在 2023 年以最大的收益占有率主导市场，并在预测期内实现最快的成长。该行业的成长主要是由于对专业药房服务的需求不断增长。
  • 2024 年 2 月，非营利健康与人类服务组织 Point32Health 签订协议，收购 Baystate Health 的子公司 Health New England。
  • 2021 年 10 月，由 Costco 和沃尔玛等约 40 家私人公司组成的非营利合作伙伴推出了一家新公司 EmsanaRx，为雇主提供 PBM 服务。

目录

第一章调查方法和范围

第 2 章执行摘要

第三章 市场变数、趋势与范围

  • 市场体系展望
  • 市场趋势及展望
  • 市场动态
    • 市场驱动因素分析
    • 市场限制因素分析
    • 产业机会分析
    • 产业问题分析
  • 定性分析：药品使用管理的价格分析
  • 商业环境分析工具
    • 产业分析-波特五力分析
    • PESTEL分析

第 4 章美国药物使用控制市场，依计画类型，2018-2030 年

  • 美国药物利用管理市场：按计画类型细分仪表板
  • 2023 年和 2030 年按计画类型分類的趋势和市场占有率分析
  • 2018-2030 年美国药物利用管理市场规模与预测（按计画类型）
  • 公司内部
  • 外包

第五章美国药物使用控制市场，依最终用途，2018-2030 年

  • 美国药物使用控制市场：按最终用途细分仪表板
  • 2023 年和 2030 年按最终用途分類的趋势和市场占有率分析
  • 美国药物使用控制市场规模和预测（按最终用途）
  • PBM（个人业务经理）
  • 健康保险提供者/付款人
  • 药局

第六章 竞争状况

  • 参与企业
  • 公司市场分析
  • 策略规划
    • 扩张
    • 併购
    • 伙伴关係/协作/联盟
    • 其他的
  • 公司简介：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.
  • 公司简介：内部供应商
    • 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