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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

Publisher Grand View Research
Published Oct 06, 2025
Length 140 Pages
SKU # GV20574978

Description

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
Please note The report will be delivered in 2-3 business days upon order notification.

Table of Contents

140 Pages
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

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