U.S. Drug Utilization Management Market To Reach $60.68 Billion By 2030

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.

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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.

U.S. Drug Utilization Management Market Segmentation

Grand View Research has segmented the U.S. drug utilization management market based on program type and end-use.

U.S. Drug Utilization Management Program Type Outlook (Revenue, USD Billion, 2018 - 2030)

• In-house

• Outsourced

U.S. Drug Utilization Management End-use Outlook (Revenue, USD Billion, 2018 - 2030)

• PBMs

• Health Plan Provider/Payors

• Pharmacies

List of Key Players in the U.S. Drug Utilization Management Market

• Third Party Providers:

  • 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.

• In-House Providers:

  • 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.)