Automation concept collageIntegrated benefits can result in even more savings for those withchronic conditions, including $926 in per-member-per-year forpatients with asthma. (Photo: Shutterstock)

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For employers looking to take more control of their health carespend, prescription drugs are often a key area of focus. Whilepharmacy benefits managers have traditionally played gatekeeperbetween drug manufacturers and employers, more self-insuredemployers in recent years have been bypassing the middleman toeither contract directly with manufacturers or work with theirmedical provider to take control of these costs.

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A recent study provides another incentive for employers toconsider an integrated, carve-in pharmacy and medical benefitsmodel: it can lower overall medical spending and lead to fewerhospitalizations and emergency room visits.

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Related: Why more employers and insurers are turning tointegrated health care

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The study, "Medical Costs and Health Care Utilization AmongSelf-Insured Members with Carve-In Versus Carve-Out PharmacyBenefits," appeared in the March edition of the Journal ofManaged Care and Specialty Pharmacy. The research was conducted byemployees of Cambia Health Solutions and Prime Therapeutics, apharmacy benefit manager servicing Cambia Health Solutions.

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"This is the first time that this kind of work has undergonescientific, peer review," study author Patrick Gleason, assistantvice president of health outcomes at Prime Therapeutics, said in an interview.

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Using anonymous data gathered from 1.6 million members enrolledin Cambia Health Solutions self-insured Blue plans without benefitchanges from 2017 through 2018, researchers found that carve-inpharmacy benefits correlated with lower medical costs.Specifically, a 4 percent decrease, or $148, in medical costs permember per year. In addition, odds of being hospitalized decreased15 percent, and ER visits decreased 7 percent for the studyperiod.

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"These findings did not substantially change when high-costmembers were removed from analyses," the authors note, adding thattheir research found potential for additional savings related totreatment for chronic conditions, including:

  • $926 in per-member-per-year savings for patients withasthma
  • $4,351 for those with coronary artery disease
  • $3,177 for chronic obstructive pulmonary disease
  • $1,363 for diabetes
  • $1,707 for depression

To what can we attribute the savings? "When leveragedeffectively, integrated data can inform utilization management;authorization decisions; chronic condition care managementincluding medication adherence, behavioral health conditionsrelated to prescription drug abuse, and those conditions served byspecialty drugs; and population health management," the authorswrite.

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P.J. D'Annunzio is a legal reporterat BenefitsPRO parent company ALMMedia. 

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P.J. D'Annunzio

Reporter at the Legal Intelligencer covering public corruption, federal courts, and breaking news.