Study Shows Integrated Medical and Pharmacy Benefits Lower Costs, Promote Better Health
At a time when employers are seeking innovative ways to control medical benefits expenses, a study from Highmark Inc. has revealed that the integration of medical and pharmacy benefits lowers overall medical costs while promoting better health.
In an effort to save on health benefits costs, some employers choose a "carve-out" model by contracting with a pharmacy benefits manager to provide its prescription drug benefit. Highmark's study, which was published in Benefits & Compensation Digest, shows that an integrated medical and prescription drug benefit, however, has the potential to provide greater savings to group customers.
Highmark analyzed clients that carve out pharmacy benefits for their employees and compared them to Highmark's customers who have an integrated medical and prescription drug benefit.
"The findings showed that during the four-year period of the analysis, annual medical expenses for our group customers averaged 6.2% lower for customers who carve in the pharmacy prescription drug benefit versus those who do not," said Dr. Eric Culley, manager of clinical pharmacy services at Highmark. "Therefore, for a group of 1,000 employees, that equates to an approximate $549,260 in medical cost avoidance during a four-year period. For the same timeframe, customers with an integrated medical and prescription drug benefit experienced an annual average of 15.8% less in outpatient expenses and 7.7% less in emergency room expenses for their employees."
"The study provides evidence that validates that the integration of Highmark's medical and pharmacy benefits promotes better health and lowers overall medical costs," said Dr. Donald Fischer, Highmark's chief medical officer. "By using pharmacy claims data, we are able to identify members who have chronic conditions and provide physicians and members access to information that can help them more effectively manage their diseases."
In fact, 43% of Highmark members with asthma, 41% with diabetes and about 30% of members with chronic obstructive pulmonary disease (COPD) have been identified as having chronic conditions based on pharmacy claims.
"If those members with chronic conditions had their pharmacy benefit carved out, it would have been difficult for us to identify their disease and get them the help they need in managing it," said Fischer.
Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit www.highmark.com.