Integrated Medical and Pharmacy Benefits Linked to Lower Health Care Costs
Key Takeaways:
- Members with integrated medical and pharmacy benefits experienced lower growths in per-member-per-month (PMPM) costs compared to those without integrated benefits, with cost savings being mainly driven by lower emergency care spending.
- Integrated benefits were associated with reduced emergency care utilization, with members having fewer inpatient and emergency department (ED) visits than members without integrated benefits.
- Combining population health management programs (PHMPs) with integrated pharmacy benefits was associated with improvements in outreach by health coaches, suggesting an enhanced effectiveness in care management.
With rising health care costs in the US, self-funded insurance plans have emerged as a way for employers to manage costs. In these plans, employers can either bundle or carve out benefits to reduce spending.
Prior research suggests that bundling medical and pharmacy benefits may reduce medical costs, but the mechanism to achieve these savings remains unclear.
Study Methods and Outcomes
Investigators used 2022 and 2023 medical claims data from Independence Blue Cross to compare medical costs and health care utilization between plans with integrated medical and pharmacy benefits and those without. They also explored the role of PHMPs in reducing costs.
The study included 194 self-funded health plans. Of these plans, 101 had integrated benefits and 93 did not.
Integrated Benefits Associated With Cost Savings
The integrated cohort had a 7.5% ($32.48 PMPM) reduction in total cost growth from 2022 to 2023 compared to the non-integrated cohort. Lower PMPM spending for inpatient and ED care were the main drivers of these savings.
Inpatient and ED visits were lower in the integrated cohort as well, with 6.72 and 7.62 fewer visits per 1000 members per year than the non-integrated cohort.
The cost savings within the integrated cohort were significant for patients with chronic conditions, with a 5.8% ($38.58 PMPM) reduction in total cost growth. Again, these savings were largely driven by decreased inpatient and ED spending.
Impact of PHMPs
Members in the integrated group who were enrolled in a PHMP saved an estimated 7.8% ($39.28 PMPM) in total care costs compared to those in the non-integrated group.
PHMPs were associated with improved member outreach, as those with integrated benefits had 12.8% more nurse outreaches than those without integrated benefits. In addition, members in the integrated cohort had a 10.8% higher chance of outreach by PHMP nurses than those in the non-integrated cohort.
Overall, integrated pharmacy benefits were associated with enhanced member identification and outreach by PHMPs.
Implications for Managed Care
These findings illustrate the potential cost savings that could be achieved by bundling medical and pharmacy benefits. In addition, combining integrated benefits with PHMPs could help reduce costs and improve the effectiveness of these programs. Furthermore, the data gathered might better inform health coaches and improve their outreach strategies and care management.
The authors concluded, “These results support the consideration of benefit integration strategies for employers seeking to optimize health care spending and improve care management.”
Reference
Wilkinson ES, David G, Kumar R, Saynisch PA, Smith-McLallen A. Bundling medical and pharmacy benefits: impact on medical costs. J Managed Care Specialty Pharm. 2026;32(8). doi:10.18553/jmcp.2026.32.8.945
