Utilization Management » Drug Inclusions and Exclusions Sunday, May 19, 2013
 

 

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Drug Inclusions and Exclusions

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A significant majority of employers exclude coverage of investigational drugs, hair growth treatment, over-the-counter (OTC) drugs and weight loss/gain products as shown in Table 28. More than half (54%) of employers now exclude non-sedating antihistamines with 40% excluding PPIs, both figures representing significant increases from 2010. Thirty percent of self-insured employers excluded Proton Pump Inhibitors (PPIs), compared to 52% of fully insured. Carve-in employers were more likely to exclude PPIs, as were small employers (p<.05). Fully insured, carve-in and smaller employers were also more likely to exclude nonsedating antihistamines (p<.05) and most other drug classes. In conjunction with the wellness movement, fewer employers are excluding coverage of smoking cessation and weight loss products.

Table 28

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