Why Separating Prescription Drug Benefits Does Not Reduce Costs
Highmark, Inc. recently verified its integrated pharmacy, medical benefits program is reducing costs, Sarah Marche of Highmark shared in a recent episode of Healthcare Strategies.
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By - Integrating pharmacy and medical benefits drives down costs for employer groups, Highmark Inc. verified through three separate studies. And Sarah Marche, senior vice president of pharmacy services at Highmark broke down the findings in the latest episode of Healthcare Strategies.
Traditionally, many employer groups carve out prescription drug benefits, removing them from medical benefits packages. These services are then managed by pharmacy benefit managers (PBMs) because of the misnomer that PBMs have the ability to customize benefits more than a health plan.
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What many employer groups do not know is many health plans can have dedicated pharmacy teams. At Highmark, this team includes pharmacists and clinicians, totaling over 300 people.
To generate evidence that integration is more effective than carving out pharmacy benefits, Highmark conducted several studies—two internally and one by an independent vendor.
Results showed employer groups that separated out prescription benefits had higher medical costs than those employer members who integrated benefits. Measured length of hospitalizations and emergency department visits were also reduced in integration groups.
“One of the fundamental beliefs you have to believe in is that if you take your drug as prescribed, it’s going to lead to better clinical outcomes and lower costs,” Marche explained on the podcast. “That is a belief that Highmark has, and we stand behind ensuring that our members are getting access to appropriate prescription drug therapy and actually taking the drugs as prescribed.”
Marche also noted that spend might increase initially. But this is a product of adherence.
“The more adherent you are and the more you take your drug as prescribed, your claims costs are going to be higher because you’re actually taking the drug versus a member who doesn’t take their prescription as prescribed,” she said. “Their costs are going to be lower but they’re not taking the drug.”
Over time, though, those costs will decline as adherence improves patient outcomes.
“If you believe in drug therapy and you believe this is the best way to treat some disease states, you’ll see your drug spend go up. But if you’re better managing that disease, you should see medical costs go down,” Marche furthered.
Integrating pharmacy and prescription benefits streamlines benefits for employees.
“We fundamentally believed that integrating the medical and drug benefits lead to better clinical outcomes and lower costs,” Marche concluded.
