Why Integrated Medical And Pharmacy Benefits Outperform Carve-out Strategies

Many employers have tried to manage costs by separating pharmacy benefits from medical coverage. However, this fragmented approach often falls short of delivering meaningful savings or improved outcomes. When medical and pharmacy benefits operate in silos, opportunities for early intervention are missed, risks may go undetected, and care becomes reactive due to the lack of necessary insight for improved outcomes. 

When care isn’t coordinated, chronic conditions become harder to manage and may lead to increased emergency visits and hospitalizations, ultimately offsetting any perceived savings. 

The Impact Of Integration Is Measurable

Anthem completed a multi-year analysis, which compared members with integrated and separate medical coverage and pharmacy benefits.

Companies that integrated pharmacy and medical benefits experienced significant advantages, including:*

• $38 per member per month lower total medical costs
• 31% fewer inpatient admissions
• 16% fewer emergency room visits
• $75M in monthly medical cost savings across the integrated population

For chronic conditions such as diabetes and hypertension, integrated medical and pharmacy benefits not only reduced overall cost of care but also improved medication adherence and delivered better long-term health outcomes.

From Isolated Savings To Total Value

Approaches that once focused on individual cost drivers are now falling short. Employers are no longer focused on optimizing individual components of their healthcare benefits. The priority has shifted to managing total cost of care, improving employee health, and driving long-term sustainability.

Integration shifts the focus:

• From isolated savings to total value 
• From reactive care to proactive management 
• From complexity to more coordinated, simpler experiences 

By connecting medical and pharmacy benefits, employers gain a more unified, data-driven view that enables earlier intervention, better outcomes, and measurable value to both employers and employees. 

See What’s Possible With Connected Healthcare

Download The case for connected care: How carving out pharmacy holds employers back, our white paper on the value of integration. It demonstrates why a connected approach delivers stronger results — along with real-world data and insights to help you get more from your medical and pharmacy benefits strategy.

* CarelonRx Value of Integration Study, commercial book of business (Fl+ASO), 2024.