Employers are using a broad range of utilization management tools in their plan designs for all diseases and conditions. These tools, listed in Table 53, 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. The most popular tools are refill too soon (89.5%), quantity limits (88.8%) and prior authorization (80.6%). This mirrors the usage of tools by employers in 2008. Figures 8-13 illustrate the mix of tools used varies amongfor all the diseases and the chronic conditions addressed in the survey. There is movement to use more tools overall and in each disease state than last year. Review the differences in:
The drug benefit industry is slowly adopting medication possession ratio (MPR) as one way to measure patient adherence to drug therapies. Implementing a broad range of economic incentives and utilization management tools will help to improve MPRs.
(Click to view a enlarged view of Table 53)
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