As specialty drug spending continues to rise and present challenges to the health care industry, integrating medical and pharmacy benefits can lead to a range of benefits for stakeholders across the health care spectrum. 

At least according to Prime Therapeutics (Prime) experts YuQian Liu, PharmD, senior director of specialty clinical solutions, and Camille Rabe, PharmD, clinical account director, who presented their insights at the Academy of Managed Care Pharmacy (AMCP) annual meeting in Nashville, Tennessee, through their session, “Mission possible: How integrated medical and pharmacy benefits can improve specialty drug management.”  

The goal of integrated specialty drug management, Liu explained, is to deliver a seamless experience for members and providers, but also total cost of care management for payers.  

Liu highlighted findings from several reports published over the last decade, illustrating the range of benefits that integration presents, including:  

• $8.73 reduction in per member per month (PMPM) spend  
• 15% decrease in hospitalization  
• 7% decrease in emergency room visits 

But there are challenges to establishing integrated benefits. In a poll of session attendees, they cited key barriers include technology systems, costs and time. 

Specific challenges range from a lack of data alignment, complex processes, operating platform limitations, isolated knowledge and experiences, as well as uncertainty in the health care landscape. However, mindset can be critical for making a shift, Liu shared.  

“Learning pharmacy benefits is like learning a new language, and you need an infrastructure for teams to learn,” she said.  

Rabe also noted how identifying issues can be easier to see in plain sight. “When we have gaps in systems, it always shows up with gaps in care,” she said.  

She suggested that having tools that can analyze data can not only help manage spend, but also lead to better management of complex therapies, including cancer and autoimmune conditions. This requires a cohesive approach.  

“From a PBM perspective, when health plans, payers and patients can be partners, it can deliver value,” Rabe said. 

Liu wrapped up the session with guidance heard at several sessions that also resonated with the audience: “We have to arrive at the center of this, which is better patient care.”  

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