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When you carve out pharmacy, many challenges come in like higher costs and lower utilization. What can you do? How can you spend less and engage more?

Rx Bottle

50%

Drug spend represents 26% of total health care cost, yet 50% of people in the U.S. aren’t taking their drugs as prescribed.1

Member

42%
MORE

HealthScape studies showed 29% better engagement, which subsequently grew to 42% for some members2 when medical and pharmacy benefits were connected.

Rx Clipboard

15%
LOWER

Across all our markets, carved in members needed 11% less inpatient care in the first year of study and 15% less in the second, when compared to members with medical-only.3

Here’s a look at the complexity of chronic conditions
and the upside of bringing your benefits together.

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Chron's Disease

 

icon of intestines

icon of intestines Chron's Disease

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$100 BILLION

The cost of treating autoimmune diseases is estimated at more than $100 billion annually in the U.S.4 Gastrointestinal diseases have many causes, including autoimmune issues. One example is Crohn’s Disease, a costly, chronic illness with drug costs overtaking inpatient hospital expenses as the top cost driver.

26% LESS

One way to push back against these costs is to have integrated medical and pharmacy benefits. Improved management of GI diseases like Crohn's Disease has resulted in a 26% reduction in costs, a savings of $121 PMPM/$1,452 PMPY.5

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Depression

 

icon of depression

icon of depression Depression

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$3 BILLION

More than 29% of U.S. adults have reported a depression diagnosis in their lifetime.6 Direct and indirect costs tied to depressive disorders represent a $3 billion cost to U.S. businesses.7

13% LESS

Members diagnosed with a depression disorder cost 13% less, or saved $73 PMPM/$876 PMPY when medical and pharmacy benefits were connected.8

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High Cholesterol

 

icon of heart

icon of heart High Cholesterol

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17.9 MILLION

Cardiovascular disease is the leading cause of death globally, leading to an estimated 17.9 million lives lost each year.9 With so many factors connected to CVD, it demands a more holistic approach. Studies have shown, for example, that pharmacist-led interventions in cardiac rehabilitation significantly improved patient outcomes.10

15% SAVINGS

The HealthScape studies found that members with conditions related to cardiovascular disease, including high cholesterol, showed 15% savings ($55 PMPM/$660 PMPY).11

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Chronic Kidney Disease
 

icon of kidneys

icon of kidneys Chronic Kidney Disease

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1 in 7 ADULTS

Chronic Kidney Disease affects more than 1 in 7 U.S. adults — an estimated 35.5 million Americans.12 And, as many as 9 in 10 adults who have CKD are not aware they have the disease. Early-stage kidney disease usually has no symptoms, and many people don’t know they have CKD until it is very advanced.13

23% SAVINGS

This is why it’s so critical to connect benefits and engage with employees as often as possible. Members diagnosed with CKD experienced 23% ($92 PMPM/$1,104 PMPY) savings when using carved in pharmacy benefits.14

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Diabetes

 

icon of insulin

icon of insulin Diabetes

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$412.9 BILLION

Cases of diabetes globally are projected to surpass one billion by 2050.15 Diabetes-related complications can escalate quickly to high-risk situations or life-threatening emergencies which can also result in higher medical costs. According to a report by the American Diabetes Association, the annual cost of diabetes is $412.9 billion.16

19% LESS

In aggregate, members with diabetes diagnoses who had connected pharmacy benefits cost their employers 19% less, or an average of $70 PMPM/$840 PMPY savings.17

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High Blood Pressure
 

icon of blood pressure meter

icon of blood pressure meter High Blood Pressure

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34 MILLION

About 34 million U.S. adults who should be medicated according to high blood pressure guidelines may need a prescription or to fill their prescription and start taking it.18 One key to better care and medication adherence is being able to more holistically and individually understand patients’ concerns and barriers.

17% SAVINGS

Connected medical and pharmacy benefits helped improve outcomes for members with cardiovascular disease, and lowered the costs of cardiac-related care.
Treatment of high blood pressure showed a savings of 17% or $68 PMPM/$816 PMPY.119

Integrating your medical and pharmacy benefits helps get your employees and business all on the same page.

We’re here for you, so you can be there for them.

When employees are facing complex conditions, their pharmacy needs can also be complex. So, it’s important to look at the whole picture. We can help. Read our white paper Adobe Acrobat on how integrating pharmacy and medical benefits together can be better for your employees and your business.

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1 2020 National Health Expenditure Study

2, 3, 5, 8, 11, 14, 17, 19 Integrated pharmacy study, “Unlocking the Secret: Connecting Medical and Pharmacy,” HealthScape Advisors, 2022. Results of the integrated pharmacy study are the product of a robust analytical exercise. The study was conducted across the five markets: Illinois, Montana, New Mexico, Oklahoma, and Texas. Over 2,500 hypotheses were tested across five markets. In aggregate, 545 findings were identified as statistically significant and favorable for carve-in groups. The study population consisted of 1,530 carve-in groups and 514 carve-out groups, with 2.6M and 4.5M members within each population, respectively, in 2021.

“Condition-Specific Integration Results,” HealthScape Advisors, 2023. The study reviewed integration value metrics and analyzed condition-specific 2022 claims data.

The methodologies and results of the 2022 integrated pharmacy study and the 2023 study on condition-specific integration results by HealthScape Advisors have been reviewed and validated by Scott Allen, a credentialed health care actuary who is a Fellow of the Society of Actuaries and a member of the American Academy of Actuaries.

Results may vary and performance may be driven by client-specific benefit design and program engagement. PMPY reflects total allowed amounts studied.

4 Gastroenterology. 2022 Feb;162(2):621-644

6 Gallop, U.S. Depression Rates Reach New Highs, 2023

7 Greenberg P, Chitnis A, Louie D, Suthoff E, Chen SY, Maitland J, Gagnon-Sanschagrin P, Fournier AA, Kessler RC. The Economic Burden of Adults with Major Depressive Disorder in the United States (2019). Adv Ther. 2023 Oct;40(10):4460-4479. doi: 10.1007/s12325-023-02622-x. Epub 2023 Jul 31. PMID: 37518849; PMCID: PMC10499687.

9 World Health Organization, “Cardiovascular Diseases,” 2024

10 Aamna Ahmed, Ping Guo, and Zahraa Jalal, “A Systematic Review Investigating the Roles and Impact of Pharmacist Interventions in Cardiac Rehabilitation,” International Journal of Clinical Pharmacology and Therapeutics

12, 13 Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2023

15 Elaine Chen, “Diabetes Will Be ‘a Defining Disease of This Century’ as Global Cases Are Set to Surpass One Billion by 2050,” STAT, June 22, 2023

16 Matthew P. Petersen, “Economic Costs of Diabetes in the U.S. in 2017,” Diabetes Care, May 2018, 917-918

18 Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline — NHANES 2017–2020. Centers for Disease Control and Prevention (CDC). May 12, 2023