U.S. Drug Utilization Management Market Size & Competitors

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, the analyst 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)

End-use Outlook (Revenue, USD Billion, 2021-2033)

Why You Should Buy This Report

Comprehensive Market Analysis: Gain detailed insights into the market across major regions and segments.
Competitive Landscape: Explore the market presence of key players.
Future Trends: Discover the pivotal trends and drivers shaping the future of the market.
Actionable Recommendations: Utilize insights to uncover new revenue streams and guide strategic business decisions.

Report Deliverables

Market intelligence to enable effective decision-making
Market estimates and forecasts from 2018 to 2030
Growth opportunities and trend analyses
Segment and regional revenue forecasts for market assessment
Competition strategy and market share analysis
Product innovation listings for you to stay ahead of the curve

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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. 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

Figure 1 U.S. drug utilization management market segmentation
Figure 2 U.S. drug utilization management market segmentation
Figure 3 Market research process
Figure 4 Data triangulation techniques
Figure 5 Primary research pattern
Figure 6 Market research approaches
Figure 7 Value chain-based sizing & forecasting
Figure 8 Market formulation & validation
Figure 9 Market snapshot
Figure 10 Segment snapshot
Figure 11 Competitive landscape
Figure 12 U.S. drug utilization management market: Ancillary/related market outlook
Figure 13 U.S. drug utilization management market dynamics
Figure 14 Market driver relevance analysis (Current & future impact)
Figure 15 Market restraint relevance analysis (Current & future impact)
Figure 16 U.S. drug utilization management market: Porter’s five forces analysis
Figure 17 U.S. drug utilization management market: PESTLE analysis
Figure 18 U.S. drug utilization management market: Program type segment dashboard
Figure 19 U.S. drug utilization management market: Program type market share analysis, 2024 & 2033
Figure 20 in-house market, 2021-2033 (USD Billion)
Figure 21 Outsourced market, 2021-2033 (USD Billion
Figure 22 U.S. drug utilization management market: End use segment dashboard
Figure 23 U.S. drug utilization management market: End use market share analysis, 2024 & 2033
Figure 24 Health plan provider/Payors market, 2021-2033 (USD Billion)
Figure 25 Pharmacies market, 2021-2033 (USD Billion)
Figure 26 PBMs market, 2021-2033 (USD Billion)
Figure 27 Company categorization: Third-party providers
Figure 28 Company market position analysis: Third-party providers
Figure 29 Strategic framework: Third-party providers
Figure 30 Company categorization: in-house providers
Figure 31 Company market position analysis: in-house providers

Companies Mentioned

The companies profiled in this U.S. Drug Utilization Management market report include:

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.)

Table Information

Report Attribute	Details
No. of Pages	140
Published	October 2025
Forecast Period	2024 - 2033
Estimated Market Value ( USD ) in 2024	$ 39.77 Billion
Forecasted Market Value ( USD ) by 2033	$ 75.79 Billion
Compound Annual Growth Rate	7.4%
Regions Covered	United States
No. of Companies Mentioned	23

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U.S. Drug Utilization Management Market Forecast to 2033

U.S. Drug Utilization Management Market Report Segmentation

Program Type Outlook (Revenue, USD Billion, 2021-2033)

End-use Outlook (Revenue, USD Billion, 2021-2033)

Why You Should Buy This Report

Report Deliverables

Table of Contents

Companies Mentioned

Table Information

U.S. Drug Utilization Management Market Report Segmentation

Program Type Outlook (Revenue, USD Billion, 2021-2033)

End-use Outlook (Revenue, USD Billion, 2021-2033)

Why You Should Buy This Report

Report Deliverables

Table of Contents

Companies Mentioned

Table Information

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