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Utilization
Management Tools
Employers and their pharmacy benefit managers employ a variety of
tools to manage drug use.
These tools (listed in Table 42) range from interpersonal interventions
(like academic detailing of prescribers or face-to-face pharmacist
consults) to claim system edits (like quantity limits and dose optimization).
Claim system edits are often transparent to employers and members.
Because there are so many claim system management tools, employers
typically underreport the number of tools they use in their drug benefit
programs.
This explains why the use of most tools for all diseases is less than
the number used for specific disease states. We also hypothesize that
employers intervening in specific diseases may be more aware of claim
system edits and interventions for managing utilization and drug mix,
and report their use accordingly.
Figures 7 to 12 illustrate the mix of tools employers are using for
all diseases and for the five specific conditions addressed in the
survey.
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