Integrated Pharmacy Benefits Improve Health Outcomes at Less Cost

Pharmacy benefit services integrated within health insurance plans result in improved medical outcomes and cost savings compared with services administered separately from the insurer, according to a study released by Blue Cross Blue Shield Association and its pharmacy benefit manager (PBM), Prime Therapeutics LLC.

The 2-year cohort study compared the medical costs and hospitalizations of 818,054 Blue Cross and Blue Shield members covered under insurance plans with integrated pharmacy benefits, frequently referred to as a carve-in model, to those of 1,042,029 members enrolled in plans with separate pharmacy benefits administered by an external PBM, often termed a carve-out model.

The results indicated that members with carve-in pharmacy benefits had 11% lower annual medical costs than those covered under the carve-out model, with an average savings of $330 per year spanning 2010 and 2011. Furthermore, carve-in members experienced 9% fewer hospitalizations and 4% fewer emergency department visits across those 2 years compared with carve-out members.

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

The report, titled “Economic and Event Outcomes of Members with Carve-In Versus Carve-Out Pharmacy Benefits: A Two-Year Cohort Study,” will be presented at the Academy of Managed Care Pharmacy 2014 Nexus conference in Boston on October 10, 2014, as well as published as an abstract in the Journal of Managed Care Pharmacy.

“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,” said Peter Wickersham, senior vice president of integrated care and specialty at Prime, in the press release. “As a result, health plan decision makers are better equipped to managed [sic] their health care expenses and improve the overall health outcomes of their members.”