As you know, employers can be overwhelmed with information about the benefits of “carving out,” or purchasing pharmacy benefits separately from core medical benefits. Pharmacy benefit managers (PBMs) do offer a variety of options designed to focus on price, while the true cost of the offer is often obscured. Pricing in the PBM industry can be complex, even confusing, and so it becomes challenging to determine the true cost of pharmacy benefits. In the end, the reality of carving out is not always in line with an employer’s strategic healthcare objectives.

Here are 3 reasons why you should recommend integrating with BCBSRI so that your clients get the most value:

Enhanced care

Our medical and pharmacy programs, activities, and initiatives provide the underpinning of our integration strategy. Together, they provide doctors with the critical information they need to make informed decisions about the care they deliver, give members support so they stay on their treatment plans, and offer employers information and insights to understand current costs—and costs coming down the road.

Our data shows that the first year after carving out, groups saw a 19% higher trend in inpatient hospital stays, a 5% higher trend in ER visits, and a 2% higher trend in specialist visits.*

*Based on a cohort matching study comparing CY2017 medical claims for demographically similar populations with and without pharmacy benefits administered by BCBSRI.

The BCBSRI advantage

In terms of service, the edge also goes to integration. When your employer groups integrate, BCBSRI remains an important pharmacy advocate in terms of timely claims response, critical data exchange and trend reports. PBMs that stand-alone make what could be a simple, integrated and streamlined process much more complicated and burdensome. And this doesn’t even begin to mention the time-consuming administrative lift (as well as added expertise) required to oversee the very complex work of the PBM.

The cost factor

Finally, there’s the important matter of cost. You may be surprised to learn that integrated arrangements often save more money than carve out situations. Our experience has shown us lower claims costs for key conditions, and overall, a $57 PEPM average savings on medical costs for the employer when pharmacy and medical benefits are integrated.* In fact, assuming a pharmacy PEPM of $220 per month, the average group would need to save 26% on pharmacy costs to offset the value that an integrated pharmacy relationship has on medical costs.*

* Based on a cohort matching study comparing CY2017 medical claims for demographically similar populations with and without pharmacy benefits administered by BCBSRI.

To learn more about the benefits of pharmacy integration, contact Sam Slade, VP of our employer segment, at 401-575-2007.