Prime shows how carve-in wins for clients—it’s better than carve-out.

June 1, 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).

Medical Costs and Health Care Utilization Among Self-Insured Members with Carve-In Versus Carve-Out Pharmacy Benefits (Spring 2020)

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