Utilization Management » Drug Inclusions and Exclusions Thursday, July 29, 2010
 

 

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Drug Inclusions and Exclusions

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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 51. Although the trend table reveals few material changes, there is a small decrease in the number of employers excluding weight loss/gain drugs. Most employers are covering diabetes supplies and sleep disorder drugs. The percentage of employers that cover OTC drugs with no limitations increased to 58.5% from 30.6% in 2008. Employers use a range of approaches to manage drug classes including prior authorization and days supply limits as shown in Table 52.

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