Prime shows how carve-in wins for clients—it’s better than carve-out.
Prime’s carve-in analytics prevail in a rigorous scientific peer review.August 21, 2020
For the first time, Prime’s puts its carve-in analytics through a rigorous scientific peer review. It’s clear. This published, peer reviewed study showed Regence and Prime carve-in pharmacy was associated with lowered overall health care costs.
Carve-out is out. This study used medical data and followed members for two years. The final cohorts consisted of 205,835 carve-in and 125,555 carve-out members.
Compared to the carve out members, members with carve-in benefits had an average:
- $148 lower total medical cost PMPY
- 15% lower odds of hospitalization
- 7% lower odds of ED visit
In 5 of 7 chronic conditions, members with carve-in benefits had significant lower costs and medical event odds as shown here:
- 12%-17% lower medical costs
- 22%-36% lower odds of hospitalization
- 16%-20% lower odds of ED visit
The study findings indicate that integrated, carve-in pharmacy and medical benefits are associated with lower medical costs, fewer hospitalizations, and fewer ED visits.
This study, co-authored by researchers at Prime and Regence Health Plans, is to our knowledge, the only scientifically peer-reviewed study published on the subject. The authors received a platinum award for this research, which is published in the peer-reviewed Journal of Managed Care & Specialty Pharmacy (JMCP).
November 18, 2022
This quarterly pipeline wrap-up provides a review of newly approved traditional drugs, recent…
November 15, 2022
Mitchell Scott is Senior Director of Prime’s Special Investigations Unit (SIU) and Pharmacy…
November 11, 2022
At Prime Therapeutics (Prime), we’ve positioned ourselves to best prepare our clients to…