Well-managed drug benefit plans include a variety of drug inclusions, exclusions, and utilization management tools to manage drug mix. A significant majority of employers exclude coverage of experimental and investigational drugs, hair growth treatment, over-the-counter (OTC) drugs, and weight loss/gain products as shown in Table 47. Most employers are covering diabetes supplies and sleep disorder drugs. Employers use a range of approaches to manage drug classes, including prior authorization and days supply limits as shown in Table 48.

Employers are using a broad range of utilization management tools in their plan designs for all diseases and conditions. The most popular tools are refill too soon (82.4%), quantity limits (81.4%), and prior authorization (79.4%). This mirrors the usage of tools by 2007 employers.

The use of each tool varies for five highly prevalent diseases that are commonly treated with drug therapies. More employers are using disease management in 2008 than last year to manage diabetes than asthma, high blood pressure, and high cholesterol. The refill too soon supply limit and retrospective drug utilization review are used most frequently to manage drugs used to treat depression.

Utilization Management Tools
Employers and their pharmacy benefit managers employ a variety of tools to manage drug use. These tools, listed in Table 49, and arrayed in Figure 6, 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, such as refill too soon or quantity limit edits, while often transparent to employers and members, are highly effective in directing the proper use of prescription drugs. Figures 6 through 11 illustrate the mix of tools used for all diseases and the chronic conditions addressed in the survey.