Employers Use of Utilization Management Tools

Based on study by the Pharmacy Benefit Management Institute (PBMI) of 417 employers, here is a ranked list of Utilization Management (UM) tools used in 2009 for overall plan design.  The survey breaks it down further by class.

  • Refill Too Soon Supply Limit – 90%
  • Quantity Limits – 89%
  • Prior Authorization – 81%
  • Disease Management – 69%
  • Step Therapy – 59%
  • Therapeutic Substitution – 55%
  • Retrospective Drug Utilization Review (RDUR) – 47%
  • Outbound Telephone Calls – 44%
  • Dose Optimization – 44%
  • Face-to-Face Pharmacist Consults – 36%
  • Pill Splitting – 29%
  • Prescriber Profiling – 23%
  • Copayment Relief or Waivers – 20%
  • Generic Sampling – 16%
  • Academic Detailing of Prescribers – 11%

What I think would be interesting to know is which of these is provided by their PBM or managed care company versus which ones are they directly sourcing?

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