First few Article Sentences
Over the past decade, pharmacy costs have exhibited a trend exceeding that of either medical benefits or general inflation. Pharmacy is generally only 20 percent of the total claim cost, yet it garners a lot of attention. In an effort to control costs, many employers have been lured into “carving out” their pharmacy from their medical coverage. By carving out, they obtain benefits for drug coverage through a stand-alone Pharmacy Benefit Manager (PBM) instead of receiving integrated medical and pharmacy benefits through the same carrier.
To examine this further, Premera Blue Cross recently conducted an actuarial analysis to study the difference in cost between integrated plans and plans that carve out pharmacy from medical benefits. Our study shows that although carving out to a separate PBM may save money on the pharmacy benefit alone, the impact of higher medical costs without an integrated benefit dwarf those pharmacy savings.