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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.

Crohn's Disease
 

icon of intestines

Depression
 

Icon of clouds in a head

High Cholesterol
 

Icon of checkmark in heart

Chronic Kidney Disease
 

Icon of kidneys

Diabetes
 
 

Icon of blood sugar meter

High Blood Pressure
 

Icon of blood pressure meter

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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Download PDF Adobe Acrobat

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