Key research takeaway: A recent study by Prime Therapeutics (Prime) and Horizon Blue Cross and Blue Shield of New Jersey (Horizon), presented at the Academy of Managed Care Pharmacy (AMCP) annual meeting, sought to compare medical costs and health care resource use between people whose pharmacy benefits were integrated into their health plan with those whose pharmacy benefits were managed separately. 

What Prime has to say: “Integrating medical and pharmacy benefits can enable better coordination of comprehensive care through programs such as chronic disease and specialty pharmacy management, which can improve adherence and overall health outcomes,” said Jacinda Tran, Ph.D., PharmD, M.B.A., lead author and senior health outcomes researcher at Prime. “From a data standpoint, combining medical and pharmacy claims gives us a more complete picture and could support more targeted interventions.” 

What Horizon has to say: “Healthcare is complex enough at baseline,” said Timothy O’Shea, PharmD, director of specialty pharmacy at Horizon. “Adding in another layer from having pharmacy and medical carved out only adds to that complexity. There are lots of use cases that highlight the benefits of integration from utilization management approaches, care management, gap closure, data analytics and more. We believe this analysis showed the direct link between an effective integrated approach and health outcomes” 

Further analysis: The study found that public sector members with integrated benefits saw nearly $900 (or 10%) lower medical costs each year and fewer emergency room visits. 

Implications: Findings indicate that coordination across the pharmacy and medical benefit may lead to reduced costs and use of health care resources. 

Prime’s approach: Prime integrates medical and pharmacy claims data through linked benefit management and analytics platforms, allowing visibility across clinician administered and self administered drugs to track utilization, outcomes and total cost of care. 

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