CarelonRx recently conducted a specialty value of integration study1 to better understand how our integrated approach to specialty drug management can enhance existing medical and pharmacy benefits.
Download the full white paper here .
Key findings and cost savings
The study data1 shows that by integrating benefits, our clients can save more than $100 in all-cause medical spending, per member per month, and more than $66 in inpatient spending, per member per month.
Data also revealed significant improvement for members with integrated benefits taking specialty drugs under the pharmacy benefit, including lower (-6.3) inpatient utilization and shorter (-13.1%) hospitalization stays.
Specialty value of integration study1
Our study included more than 40,000 commercial members2 with at least one specialty medical condition.3 The goal was to compare cost per member in total as well as by site of care, utilization across sites of care, and other key quality performance indicators.
Though members taking specialty medications make up a small percentage of our overall member population, they account for the highest spend because of the cost of the treatments and management they need. In fact, 3.2% of members are on a specialty medication,4 and 60.2% of total drug spend is for specialty medication4 (medical + pharmacy).
The long-term effects of not integrating benefits
We learned that not integrating specialty pharmacy benefits can be more costly in the long run, due to factors such as comorbidity management, fragmented patient care, increased hospitalizations, and ER visits. Inpatient services make up the highest cost for healthcare expenditures, totaling $434 billion spent on inpatient expenditures and $47.3 billion spent on ER expenditures, industry-wide.5
Integrated benefits are more than a convenience
Specialty care is complicated. That's why we provide integrated, whole-health solutions that can make members' lives a little bit easier, like our clinical-first approach to managing drug lists, our Specialty Condition Management Enhanced solution (comprehensive, personalized care for 22 rare conditions), and our Cost Relief program to enable $0 out of pocket costs for those enrolled.
At CarelonRx, we're passionate about benefits that improve the whole health of members, which is why our integrated approach is unmatched in the industry. To read all about how integration is a first step to controlling pharmacy costs, reducing hospitalizations, and more, download the white paper: How medical and pharmacy benefit integration drives savings .
1. CarelonRx Specialty Conditions Value of Integration (VOI) Study 2022 (formerly known as IngenioRx).
2. The study included 40,000 commercial integrated Anthem and Empire medical and CarelonRx (formerly known as IngenioRx) pharmacy members.
3. Specialty conditions are defined by those indications listed in CarelonRx’s Specialty Drug List.
4. CarelonRx Internal Data, 2023.
5. The Centers for Disease Control and Prevention (CDC): National Center for Health Statistics – Health Care and Insurance (accessed December 2022) https://www.cdc.gov/nchs/fastats/health-care-and-insurance.htm