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The Value of Pharmacy and Medical Benefit Integration

February 2020 | Written by Mark Cziraky, PharmD, CLS, FAHA, FNLA

As health care costs continue to rise, employers and payers are under increasing cost pressure to optimally manage their members’ care. Formerly, it was believed that employers could save money for their employees by carving-out pharmacy benefits and purchasing options a la carte. In recent years, more and more large health care providers have been vertically integrating with pharmacy benefits managers (PBMs) to offer more carve-in solutions. With today’s technology, having complete data on members from carve-in clients enables health plans to generate a more holistic view of the member. This in turn provides information to ensure members are receiving the right care, which leads to appropriate utilization of health care resources and lower total medical costs. This White Paper explores the impact of integrated Elevance Health medical and pharmacy benefits on medical costs.

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