True benefit integration results in effective care management and cost savings
Chronic conditions account for 75% of health care costs, and because these conditions are treated with prescription drugs, having one health plan that offers integrated care management is essential to caring for the “whole” member. When your health plan and prescription plan work together, they work better.
Excellus BCBS pharmacy management offers a unique model. While other Pharmacy Benefit Managers (PBMs) claim integration, it’s just a claims file upload, which is not real-time and does not allow for safety checks and appropriate medication use. But with us, you get in-house nurses and pharmacists reviewing patient pharmacy and medical claims in real-time. This is critical to patient safety, medication appropriateness, and condition management.
Having Excellus BCBS medical and prescription drug coverage leads to increased quality of care, a reduction in employer and member health care costs, while also helping to minimize productivity loss due to absenteeism.
Benefit integration saves money in three ways: effective management of specialty drugs, proactive disease management, and aggressive promotion of generic drugs. Based on our assessment, we observe up to a 6% lower medical cost (pmpm)* for those groups for which we manage both medical and pharmacy benefits, compared to those groups who carve their prescription drug plan out to a third party.
* These savings are consistent with what others have noted nationally, including an evaluation by the Blue Cross Blue Shield Association, which showed a 4-8% reduction in medical costs when both medical and pharmacy benefits are managed together within a health plan.