Why pharmacy integration makes sense
Integrating medical and pharmacy benefits can help to reduce costs, while ensuring a focus on improving patient outcomes, aiming for healthier, more productive employees.
The integration of pharmacy and medical benefits delivers a comprehensive and holistic understanding of your employees’ overall health. Integration combines data gathered from a wide variety of sources across the medical and pharmacy areas to provide real-world insights that result in higher quality care, delivered in a cost-effective manner, with an ease of administration.
Lowering claims costs
The difference we’ve seen between groups that integrate and groups that carve out is clear. Our experience shows that when carving out, the average employer group would need to achieve a 26% savings on pharmacy costs to offset the value that integrated pharmacy has on medical costs.*
*Assuming a typical pharmacy PEPM of $220 per month. Based on a cohort matching study comparing CY2017 medical claims for demographically similar populations with and without pharmacy benefits administered by BCBSRI.
Improving patient outcomes
Our approach to ensuring quality healthcare for BCBSRI members reaches into every area of our company, and that includes our emphasis and progress in the area of pharmacy integration.
Because it involves a more holistic approach to health and well-being, integration can be an effective way to enhance the quality of care. It can:
- Provide a greater opportunity for effective interventions by identifying over- and underutilization of medications based on medical data
- Help identify and close gaps in care more completely compared to carve-out PBMs
Making administration easier
Companies that carve out often discover there is significant administrative burden added on their staff. Who will handle oversight of the pharmacy benefit management function? Is there time and expertise available in your HR group to allocate responsibility for this? Administering pharmacy benefits in a carve-out situation is a complex, even overwhelming challenge— in terms of policies, service, pricing, formularies, etc.—that seem opaque to those without experience. With pharmacy integration, BCBSRI handles all of that. We’ve got the experience and knowledge to manage pharmacy benefits on your behalf. We speak the language and handle pharmacy challenges as part and parcel of the business relationship we have with our clients.
The information provided above is based on an analysis of BCBSRI’s experience with its employer groups, and is believed to be accurate as of the production date; however, it is subject to updates. It is not intended to represent or guarantee that any individual employer group will achieve the same or similar results.