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封面
市场调查报告书
商品编码
1869952

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

价格

市场规模与趋势：

据估计，2024 年美国药物利用管理市场价值为 397.7 亿美元，预计到 2033 年将达到 757.9 亿美元。

预计从 2025 年到 2033 年，该市场将以 7.49% 的复合年增长率成长。市场成长预计将受到自动化利用管理服务日益普及以及改善专科药物处方模式以降低总体成本和改善患者疗效的需求不断增长的推动。

药物利用管理措施，例如事先核准（PA）、阶梯治疗和用药数量限制，旨在优化患者疗效，减少浪费、滥用、不必要的用药和成本。这些措施对于控制医疗成本、影响患者照护决策和提高医疗品质至关重要。处方医生、付款者和药剂师之间的协作日益重要，以确保患者能够及时获得药物，同时保持成本效益和价值。未来包括：在事先核准过程中更依赖药剂师；实施电子事先核准（ePA）以简化核准流程；以及製定电子健康资讯交流的最佳实践和国家标准。

美国医疗保健支出占GDP的很大一部分，其中处方药支出占比很高，这进一步凸显了控制医疗成本的必要性。根据美国医疗保险和医疗补助服务中心（CMS）预测，到2025年，美国医疗保健总支出将达到4.9兆美元，其中处方药支出预计在2023年将达到约4,497亿美元，比上年增长11.4%。为了有效控制这些成本，医疗服务提供者和支付者正在实施各种策略。其中一个策略是合理用药（UM），它利用临床指南和用药清单等工具，确保患者获得最合适、最具成本效益的治疗。这种方法不仅有助于降低医疗成本，还能确保患者获得最佳护理，进而改善患者的治疗效果。

目录

第一章调查方法和范围

第二章执行摘要

第三章 市场变数、趋势与范围

  • 市场体系展望
  • 市场趋势与展望
  • 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：药物利用管理定价分析
  • 商业环境分析工具
    • 产业分析—波特五力分析
    • PESTEL 分析

第四章美国药物利用管理市场（依专案类型划分），2021-2033年

  • 美国药物利用管理市场：专案类型细分仪表板
  • 项目类型趋势与市场占有率分析，2024 年和 2033 年
  • 美国药物利用管理市场规模及按项目类型分類的预测，2021-2033年
  • 内部
  • 外包

第五章美国药物利用管理市场（依最终用途划分），2021-2033年

  • 美国药物利用管理市场：终端用户细分仪表板
  • 2024 年和 2033 年终端用户趋势和市场份额分析
  • 美国药物利用管理市场规模及最终用途预测
  • PBM
  • 健康计划提供者/付款方
  • 药局

第六章 竞争情势

  • 参与企业
  • 企业市场分析
  • 策略规划
    • 扩张
    • 併购
    • 伙伴关係/合作/联盟
    • 其他的
  • 公司简介：第三方供应商
    • 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

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