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Highmark Study Shows Integrated Medical and Pharmacy Benefits Lower Costs, Promote Better Health

PITTSBURGH, June 2 /PRNewswire/ -- At a time when employers are seeking innovative ways to control medical benefits expenses, a study from Highmark Inc. has revealed that the integration of medical and pharmacy benefits lowers overall medical costs, while promoting better health.

In an effort to save on health benefits costs, some employers choose a "carve-out" model by contracting with a pharmacy benefits manager to provide its prescription drug benefit. Highmark's study, which was published in Benefits & Compensation Digest, shows that an integrated medical and prescription drug benefit, however, has the potential to provide greater savings to group customers.

Highmark analyzed clients that carve out pharmacy benefits for their employees and compared them to Highmark's customers who have an integrated medical and prescription drug benefit.

"The findings showed that during the four-year period of the analysis, annual medical expenses for our group customers averaged 6.2 percent lower for customers who carve in the pharmacy prescription drug benefit versus those who do not," said Dr. Eric Culley, manager of clinical pharmacy services at Highmark. "Therefore, for a group of 1,000 employees, that equates to an approximate $549,260 in medical cost avoidance during a four-year period. For the same timeframe, customers with an integrated medical and prescription drug benefit experienced an annual average of 15.8 percent less in outpatient expenses and 7.7 percent less in emergency room expenses for their employees."

"The study provides evidence that validates that the integration of Highmark's medical and pharmacy benefits promotes better health and lowers overall medical costs," said Dr. Donald Fischer, Highmark's chief medical officer. "By using pharmacy claims data, we are able to identify members who have chronic conditions and provide physicians and members access to information that can help them more effectively manage their diseases."

In fact, 43 percent of Highmark members with asthma, 41 percent with diabetes and about 30 percent of members with chronic obstructive pulmonary disease (COPD) have been identified as having chronic conditions based on pharmacy claims.

"If those members with chronic conditions had their pharmacy benefit carved out, it would have been difficult for us to identify their disease and get them the help they need in managing it," said Fischer.

About Highmark Inc.

As one of the leading health insurers in Pennsylvania, Highmark Inc.'s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.7 million people through the company's health care benefits business. Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people's health. Highmark exerts an enormous economic impact throughout Pennsylvania. A recent study states that Highmark's positive impact exceeded $2.5 billion. The company provides the resources to give its members a greater hand in their health.

Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit

SOURCE Highmark Inc.
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