Why it pays to integrate pharmacy benefits

Benefits integration enables a more complete picture of patient health—which in turn supports better care coordination, condition management, and cost control. Pharmacy and medical benefits integration can:

• Improve prescriber-pharmacy coordination
• Enable more data-driven decision-making (in real time)
• Improve medication adherence and avoid duplicative therapies
• Support chronic condition management
• Identify and address gaps in care
• Reduce avoidable costs

Simplifying benefits administration

For employers, integration through BCBSRI helps streamline benefits management.

• One vendor contract and point of contact
• Industry-leading provider and pharmacy networks
• Aligned medical and pharmacy policies
• Comprehensive reporting and analytics
• Consultative account management

Helping employers manage specialty drug spend

• Biosimilar strategy: Helps increase access to more affordable treatments
• Synergie Medication Collective℠: Leverages the strength of group purchasing
• HighTouchRx®: Uses integrated medical and pharmacy data to identify drug-savings opportunities, such as duplicate therapies or avoidable costs
• IntegratedRx®: Streamlines treatment for patients by allowing them to receive medications through their care provider’s in-house pharmacy (available for cancer and cystic fibrosis)

Delivering savings at the pharmacy

• FlexAccess®: Helps eligible employees access manufacturer copay assistance
• MedsYourWay®: Helps members find the lowest available price of applicable discount cards for eligible medications

Integration can help cut costs, eliminate duplicative treatments

Example: Optimizing dosage cuts annual Rx expense by $312,000 
To treat a rare condition, a member was prescribed four 5-mg tablets per day of a specialty drug. Total cost for 30-day supply: $64,000.

A BCBSRI pharmacist worked with the prescribing provider to optimize dosage of the same drug for equivalent treatment at an annual health plan savings of $312,000.¹

Example: Eliminating duplicative therapy saves over $87,000 
Member was prescribed an infusion medication (medical benefit) and pen (Rx benefit) to address same diagnosis. Different providers prescribed the two different drugs to treat the same condition. 

BCBSRI pharmacy review and discontinuation of duplicative treatment saved the health plan $87,052 on an annualized basis.²