A new study from Highmark shows that integrating medical and pharmacy benefits – rather than carving out pharmacy benefits – lowers overall medical costs while promoting better health.
According to Eric Culley, manager of clinical pharmacy services at Highmark, some employers "carve out" pharmacy benefits and contract with a pharmacy benefits manager in hopes of getting a better deal on prescription drugs.
Highmark's study showed that combining pharmacy and medical benefits lowered annual medical expenses by 6.2 percent over a carved-out plan, Culley said. For a group of 1,000 employees, that equates to an approximate savings of $549,260 in medical costs 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 percent less in outpatient expenses and 7.7 percent less in emergency room expenses for their employees," Culley said.
Highmark, a Pittsburgh-based healthcare provider, analyzed clients that carve out pharmacy benefits for their employees and compared them to customers who have an integrated medical and prescription drug benefit.
Donald Fischer, Highmark's chief medical officer, said the study also used pharmacy records to identify patients with chronic conditions. Highmark provided those patients and their physicians with information to help them more effectively manage their diseases.
According to Fischer, through the study, researchers identified 43 percent of those Highmark members with asthma, 41 percent with diabetes and about 30 percent of members with chronic obstructive pulmonary disease (COPD).
"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," he said.
Highmark serves 4.7 million people through the company's healthcare benefits business, according to Highmark executives.