Integrated Pharmacy Benefits Have Significant Cost Savings

Including pharmacy benefits as part of an employer’s total health insurance benefit package has clear health benefits and cost savings, according to a study from Blue Cross Blue Shield Association (BCBSA) and Prime Therapeutics, LLC.

After examining the yearly medical costs of 1.8 million Blue Cross and Blue Shield members, the investigators found that members with insurance plans that integrated pharmacy benefits—called a “carve-in” model—had fewer hospitalizations and emergency room visits (by 9% and 4%, respectively).

The report, Economic and Event Outcomes of Members with Carve-in versus Carve-out Pharmacy Benefits: A 2 year Cohort Study, will be published in the Journal of Managed Care Pharmacy and presented October 10 at the Academy of Managed Care Pharmacy 2014 Nexus conference.

“Integrating pharmacy benefits into a consumer’s overall medical coverage allows for improved healthcare coordination, resulting in more timely and targeted health interventions by medical practitioners,” Trent Haywood, MD, senior vice president and chief medical officer of BCBSA, said in a statement. “These interventions enhance drug compliance and care and enable more effective disease management programs.”

There were also significant cost savings. The medical costs of consumers with integrated pharmacy benefits were 11% lower compared with those without integrated pharmacy benefits—called a “carve-out” model. On average, carve-in members saved $330 in yearly medical costs.

These savings occurred despite the fact that the carve-in group had a higher rate of 6 chronic diseases: asthma, chronic obstructive pulmonary disease, depression, diabetes, hypertension, and hyperlipidemia.

“The carve-in pharmacy benefit model allows for the integration of pharmacy and medical benefits, a truly holistic, coordinated approach to every aspect of care,” Peter Wickersham, senior vice president of integrated care and specialty at Prime, said in a statement. “As a result, health plan decision makers are better equipped to manage their healthcare expenses and improve the overall health outcomes of their members.”