Pharmacy costs, like the rest of health care costs, have risen in recent years. Look no further than headlines about skyrocketing costs of specialty drugs. Drug costs make up roughly 27 percent of total health care costs for employers.  

Employers may carve out pharmacy benefits from their health plans to address the costs. But BlueCross BlueShield of South Carolina can drive greater value through integrated pharmacy benefits. 

Advantages of integrated pharmacy benefits 

Lowering the cost is just one of the benefits. Data suggests combining pharmacy with medical can have a positive impact on care, as well. 

Pharmacy experts say that a holistic view of the member allows them to better manage the member and ease added expense.  

Plans that carve out pharmacy benefits break up the overall picture of care management.  

When employers opt to carve out pharmacy benefits, BlueCross can only see doctor visits on the medical side. We can’t know if the member is taking his or her drugs as prescribed. We don’t know if the member is managing his or her health condition. 

Let’s say a member visits a cardiologist. The doctor prescribes a blood pressure medication. BlueCross wants to know the member is taking the medication. If benefits are integrated, we can validate that prescription.  

If we see a gap in care or nonadherence, we can act on that. Having real-time pharmacy data allows us to be proactive rather than reactive.  

Integration leads to better care, from managing chronic conditions to identifying at-risk employees and safely monitoring drug use. Integration can lower hospitalization rates by as much as 15 percent. The Blue Cross Blue Shield Association says it can lead to 7 percent fewer emergency room visits.

Better care management can lead to cost savings. The Association says integration can save employers $148 per member per year. 

Integration benefits members and groups 

This approach helps both the health plan and the member. An integrated plan means benefits managers deal with only one account team and one billing system.  

It is a streamlined and more efficient way to manage employer groups.

The same is true for members. They have one ID card and one line for customer service. 

Issues get resolved more quickly. Because of how complex the health care system is, people sometimes don’t know if drugs are under the medical benefit or the pharmacy benefit. If the two are linked, navigating this complex system becomes much simpler.   

BlueCross’ dedicated customer service team will help the member find solutions. Often benefit integration means the member can have one deductible versus separate deductibles for pharmacy and medical. It makes it seamless for the member.  

It is a real-time process. If members reach their deductible under medical, when they go to the pharmacy the same day, they will have first-dollar coverage or no cost because we know they have met the deductible.

This isn’t just about what is good for employees. It’s also about what is good for the bottom line. The benefits compound for the management of the plan. Having access to all of the data makes it easy to interpret and forecast finances.