Details

Autor(en) / Beteiligte

• Lucas, Emanuel

Titel

Reduced medical spending associated with integrated pharmacy benefits

Ist Teil von

• The American journal of managed care, 2021-07, Vol.27 (7), p.e242-e247

Ort / Verlag

Jamesburg: MultiMedia Healthcare Inc

Erscheinungsjahr

2021

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Am J Manag Care. 2021;27(7):e242-e247. https://doi.org/10.37765/ajmc.2021.88708 _____ Takeaway Points Members with chronic illnesses receiving an integrated pharmacy benefit experienced slower medical cost growth compared with members covered by a pharmacy carve-out. * Integrated pharmacy benefits are associated with reduced medical expenditures over the long term, resulting in annual per-member per-month savings compared with a carve-out. * These savings are observable in the population as a whole but are more pronounced for patients with chronic illnesses. * Any potential savings on drug spending promised by a pharmacy benefits carve-out should be weighed against potential increases in medical spending. _____ An employer considering the structure of its employee health insurance plan must make several consequential decisions about benefit design. Extensive debate about the relative merits of these 2 approaches followed the emergence of pharmacy benefits managers (PBMs) in the 1980s1 and mental health and substance abuse (MH/SA) carve-out plans in the 1990s.2 Carve-outs are generally promoted as a mechanism for cost containment while also attempting to preserve a high standard of quality of care.3,4 In both the PBM and MH/SA contexts, carve-outs rely on specialization as a component of cost reductions.5,6 In the case of PBMs, this can take the form of utilization review and formulary management, which are used to identify cost-effective drugs and promote their utilization through physician and beneficiary education or tiered co-pays.4,7 Carve-out plans can also leverage greater scale to negotiate discounts more effectively. [...]a naive comparison of integrated benefit and carve-out members may result in biased estimates of the effect of carving out pharmacy benefits. To account for the potential impact of other aspects of members' health insurance coverage, we also included the type of insurance plan (health maintenance organization vs preferred provider organization) and insurance market region in the match.