CHICAGO — Pharmacy benefits included as part of an employer’s total health insurance package, known as a "carve-in" model, provide cost savings and more effective care, according to a study by the Blue Cross Blue Shield Association and Prime Therapeutics.
BCBS and Prime said Monday that the study examined annual medical costs of 1.8 million members of Blue Cross and Blue Shield independent companies whose pharmacy benefits were divided between carve-in and "carve-out" models. Under a carve-out plan, an employer enlists a pharmacy benefit manager to manage prescription benefits separately from the insurance company administering medical benefits.
BlCBS members with carve-in pharmacy benefit plans had 9% fewer hospitalizations and 4% fewer emergency room visits than members with carve-out drug benefit plans. Those with integrated pharmacy benefits also incurred 11% lower medical costs, with an average savings of $330 in annual medical costs.
The study, conducted with data spanning 2010 and 2011, showed that patients with carve-in pharmacy benefits had total medical costs of $3,176, compared with $3,506 for members with carve-out Rx benefits.
"Blue Cross and Blue Shield companies work with employers across the country who utilize both integrated and separate pharmacy benefit models," Trent Haywood, senior vice president and chief medical officer of the Blue Cross Blue Shield Association, said in a statement. "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. 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 vs. Carve-out Pharmacy Benefits: A 2-Year Cohort Study," will be published as an abstract in the Journal of Managed Care Pharmacy and presented at the Academy of Managed Care Pharmacy 2014 Nexus conference in Boston on Friday.
Believed to be the largest of its kind, the study used data from patients covered by 25 BCBS companies and the Federal Employee Program (FEP) spanning the 48 contiguous states. There were 814,000 Blue members who had insurance plans with carve-in pharmacy benefits and 1 million with carve-out drug benefits.
Pharmacy spending reached $325.8 billion last year in the United States, according to the IMS Institute for Healthcare Informatics. BCBS and Prime noted that as these costs rise, health plan decision makers must be more proactive in managing pharmacy benefits.
"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," stated Peter Wickersham, senior vice president of integrated care and specialty at Prime Therapeutics. "As a result, health plan decision makers are better-equipped to managed their health care expenses and improve the overall health outcomes of their members."
