Step Therapy.
Employees and their doctors are required to start with more inexpensive treatments for certain conditions. "If something that's simple and cheap can take care of you, then they won't pay for something that's less simple and more expensive," explains Gary Claxton, director of the Healthcare Marketplace Project at the Kaiser Family Foundation.

Fixed Benefit.
Starting in July 2003, Humana, a Louisville-based health insurer, offered its employees the option of a pharmacy benefit that divides drugs into four classes based on how likely the drug is to offset other medical expenses, explains vice president of pharmacy and clinical integration William Fleming. Then, instead of fixing the employee's contribution through a co-payment, Humana contributes a fixed amount for each prescription that varies with the class of the drug. For all but the drugs in the lowest tier of reimbursement, which includes those that treat hair loss and sexual dysfunction, the company caps an employee's out-of-pocket costs per prescription.

Consumer-Driven Plans.
The trend toward consumer-driven health-care plans, in the form of health savings accounts and health reimbursement arrangements, may also curb drug costs. Prescription drugs are one of the areas where such plans can have the greatest impact on consumer behavior.—M.M.

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