Pharmacy costs are rising faster than any other area of health care. But increases in prescription drug prices aren’t the only thing driving this trend; utilization (how medications are prescribed, used and delivered across a health plan), now matters just as much, if not more. This makes integrating pharmacy and medical benefits an important step in lowering long-term overall health care costs for businesses.

At HealthPartners, integrating pharmacy and medical benefits brings care and coverage together in innovative ways. This more comprehensive perspective means costs for employers tend to stay steadier and more sustainable, while employees gain access to better care with less frustration. It all adds up to an improved, more cost-efficient experience for everyone.

This approach may yield savings in the near term. But over time, focusing on short-term drug price management may end up costing your business and your employees more. That’s because utilization is now the biggest driver of pharmacy benefit costs:

• Drug utilization accounts for roughly 40% of pharmacy trend
• Drug price accounts for roughly 35% of pharmacy trend
• Drug mix accounts for roughly 25% of pharmacy trend

When these drivers are managed together, employers often see more stable pharmacy trend, better workforce health outcomes and stronger control over health plan spending. That makes medical plans with carved-in pharmacy benefits a better, more forward-thinking cost management strategy for your business. Plus, they provide improved transparency, fuller data and more connected insights across your complete health care benefits package, so your business is able make more informed choices and work more efficiently.

Integration connects every part of your plan, allowing for visibility across all care settings and situations. That means when pharmacy and medical benefits live in a single model, the chief driver of pharmacy costs – drug utilization – is managed more effectively. For example:

• Pharmacists and clinicians are better able to work together to determine the most effective therapies, whether pharmaceutical or medical.
• Duplicate medical and pharmaceutical therapies are flagged in real time, reducing unnecessary waste.
• Smarter site-of-care management guides drug administration to the most cost-effective setting, whether a pharmacy or a clinic.
• Formularies are aligned with network management and the latest clinical guidance to help prevent costly redundancy.

When not managed in coordination with your medical plan, drug utilization practices can’t fully curtail increases in an employer’s overall health spending, even when drug pricing is otherwise competitive. But managed alongside medical benefits, proactive utilization practices help keep spending flatter and health care cost trends steadier.

When medical and pharmacy benefits are managed separately, information is often found in different systems. This makes coordination between teams slower, more complicated and more expensive. Integration helps remove these barriers by more closely aligning medical and pharmacy information sharing.

In practice, this means everyone involved in a member’s care works from the same comprehensive information in the same datasets, instead of relying on disconnected or piecemeal details. As a result:

• Providers better understand a member’s complete coverage rules across all their benefits.
• Pharmacists have access to the fuller clinical context behind why a drug was prescribed.
• Health plan teams intervene earlier to coordinate coverage and offer safety support across different therapy modalities.
• Employers can track health care trends and monitor patterns across their entire benefits package.
• Employees get access to proper care faster and with fewer interruptions.

Integration unlocks data-driven decision-making that’s quicker, more appropriately contextualized and more complete. By working smarter (not harder), costs start to come down, stabilize and become more manageable.

HR and finance teams benefit from pharmacy and medical benefit integration as well. Managing benefits together makes better use of staff time, reducing the additional workload and overhead required to align siloed vendors and separate systems. Backed up by a HealthPartners team of Midwest-based experts offering flexible custom reporting, support and dedicated account management, HR and finance teams get one-stop help so they stay focused on people and strategy, not processes and busy work.

For providers, integrated real-time tools and data also streamline work and prevent wasted time. With access to complete and detailed benefits information, coverage requirements and clinical history, providers choose the right care for their patients the first time. The result is fewer phone calls, denials and duplicate prescriptions, and a faster track for employees to receive the care they need to feel better.

That improved employee experience extends beyond the clinic, too. With integrated benefits, an employee can easily navigate their entire health plan whenever they need to. Helpful digital tools, benefit navigators and other resources offer unified coverage details and guidance so employees understand what’s covered, how much it costs, where to go for any kind of care and how to get it. As a result, confusion and delays are reduced, so employees feel supported by how their health benefits work, not frustrated that they can’t figure it out.

HealthPartners plans don’t stop there. Our customizable plan options, value-added benefits and access to digital tools that keep plan administration simple allow employers to focus on their business, not benefits. And affordable and flexible benefits options, extensive provider networks, and access to valuable perks like an Employee Assistance Program help employees perform their best while staying on top of their health.

Ultimately, it’s an approach to employee benefits rooted in long-term, sustainable cost management; happier, healthier employees; and simpler, better care.