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Why Integrating Pharmacy Benefits Is a Winning Strategy

By Heather Kerrigan | Sep 19, 2018

Pharmacy is one of the most frequently used health plan benefits. In fact, more than four billion prescriptions are filled at retail pharmacies every year. However, pharmacy is also one of the most expensive benefits for both members and trustees. "Prescription drug costs have increased dramatically over the last several years," Veronica Hawkins, Medical Mutual vice president for government accounts, explains. But, she continues, integrated pharmacy benefits can help control costs: "As a result, more organizations are integrating their medical and pharmacy benefits to have a more coordinated approach."

Integrating these benefits with other health offerings can have a significant impact on the health and well-being of your members — and their wallets.

The Importance of an Integrated Pharmacy Strategy

Providing pharmacy with other medical offerings in your health plan can contribute to better health outcomes and cost savings.

A three-year Highmark study found that integrated medical and pharmacy benefits saved an average of $172 per member per year. These members also had 5 percent fewer hospitalizations and 16 percent lower hospitalization costs. And individuals with chronic conditions were 1 to 2 percent more likely to adhere to their medication regimens.

Workers already tend to rate health insurance as the most important benefit, and adding integrated pharmacy benefits is an enhancement that can help keep members not only healthier on the job but also more satisfied with the union.

Merging Benefits With Existing Health Plans

If you choose to integrate pharmacy and medical benefits for members, it's first necessary to speak with your health insurance provider to determine what benefits are available. Most health insurance companies contract with a pharmacy benefit manager (PBM) to administer their prescription drug plans. While a board can partner directly with a PBM, doing so may lead to higher costs and greater administrative burdens. It may also not provide the alignment required for better management of member care.

Once integrated benefits are established, members will receive a new health insurance card that can be used for both medical and pharmacy benefits. Depending on the health insurance provider, the revised plan may also come with new online tools or other information that can help them take better control of their health.

In addition, many integrated plan providers have mechanisms in place to ensure that prescribing is done responsibly and that members only receive drugs they truly need.

Making the Most of an Integrated Plan

It's important to employ a solid communication strategy that frequently engages members with their benefits. Often, communication about health benefits takes place only when a member is new or during open enrollment. In reality, to get the most from an integrated plan, communication should be ongoing and invite member engagement and feedback. Member touch points need not always be in person: They can come through email, newsletters or even a regularly updated website.

Provide members with tools like worksheets or online calculators to help them anticipate the cost of filling a prescription. Along with these tools, speak with members about cost-saving measures, from home delivery to receiving a 90-day supply of a prescription, if these options are available through your plan. Urge members to use in-network pharmacies by providing a list or directing them to your insurer's website, and encourage everyone, especially those managing chronic conditions, to speak with their health care providers about whether generic forms of their prescription medications are an option.

Integrating medical and pharmacy offerings can benefit both members and trustees. Not only are significant savings possible, but boosting members' health also keeps them engaged and more productive on the job. If you choose to move in this direction, it's vital to clearly explain the benefit to members and ensure that they understand how to take advantage of what's offered so that everyone gets the most out of the plan.

Heather Kerrigan started her career in journalism at Governing magazine, reporting on state and local politics and policy, with a specific focus on public workforce, environment, health care, education and technology issues. Prior to co-founding River Horse Communications, Heather offered freelance editorial services to a variety of outlets, including serving as volume editor and lead author for SAGE Publications' Historic Documents series and editor-in-chief of The Kanter Journal. Heather also blogs for two government-focused publications, GovLoop and NEOGOV, covering issues of importance to federal employees. Heather is the author of the book Retire Rich With Your 401(k) Plan. She holds a bachelor's degree in journalism from The George Washington University.