When purchasing health insurance, decision makers are faced with the question of whether to include pharmacy benefits as part of the total health package, or a carve-out model as a separate benefit administered by an external pharmacy benefit manager (PBM).

A recent two-year analysis conducted by Blue Cross® and Blue Shield® of Minnesota and Prime Therapeutics brings new evidence to light for employers considering these options.

The analysis compared the per-member, per-year (PMPY) allowed medical costs, hospitalizations and emergency room visits of commercially insured members with chronic conditions to those with carve-out benefits.



 

 

 

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 ### Results

Integrating pharmacy and medical with Blue Cross and Blue Shield of Minnesota demonstrated significant savings over the carve-out model:

- $422 average savings on medical costs PMPY\* compared to $148 from a leading competitor
- 17% lower hospitalization rates\*
- 13% fewer emergency room visits\*

  
Blue Cross and Blue Shield of Minnesota members using specialty drugs and integrated benefits, compared to those with a carve-out PBM, were found to have:

- 22% overall lower hospitalization rates\*
- 21% overall lower medical costs\*

Contact your Blue Cross representative to discuss how integration could benefit your business.



 

 

 

 

 

### More resources

- [Understanding prescription drug benefits](/understanding-health-insurance/prescription-drugs/understanding-prescription-drug-benefits "Understanding prescription drug benefits")
- [Get help taking your medications](/understanding-health-insurance/prescription-drugs/get-help-taking-your-medications "Get help taking your medications")
- [See prescription drug programs](/understanding-health-insurance/prescription-drugs/prescription-drug-programs "Prescription drug programs")



 

 

 



 

 



 

 

 

 

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### Let's work together

Give us a call: **1-877-293-7035** (TTY **711**)

Not already working with Blue Cross? Check out our plans and resources for large and small groups.



 

[View small group health plans](/employers/small-group-health-plans)

[View large group health plans](/employers/plans-resources-large-groups)

 

 

 



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1. Prime and Blue Cross and Blue Shield of Minnesota internal analysis, 2022. Complete report available upon request.
2. Competitor X analysis, 2023.
3. Rheumatoid arthritis and multiple sclerosis.

\*Source: Blue Cross and Blue Shield of Minnesota and Prime Therapeutics internal analysis, 2022.

Prime Therapeutics LLC is an independent company providing pharmacy benefit management services.